17卷6期

• Link 公衛論壇 Public Health Forum
• 當前發展生物統計應有的看法當前發展生物統計應有的看法
• 戴政
  J. J. Tai
• 無
  none
• 無
  none
• 439 - 441
• 10.6288/CJPH1998-17-06-01

• Link 綜論 Review Article
• 台灣地區生活品質研究概況An Overview of quality-of-life Research in Taiwan
• 陸玓玲
  Dih-Ling Luh
• 生活品質 ； 文獻回顧
  quality of life research ; review
• 本文目的在於瞭解台灣地區歷年來之生活品質研究概況。以政大社資中心為資料搜尋來源，查詢至1996年之台灣地區生活品質研究報告，分別就研究之年代、作者學術背景、研究對象、研究方法及對生活品質之定義作一簡單的整理及描述。結果發現：1．台灣地區之生活品質研究有逐年增加的趨勢。2．國內對於生活品質之研究可大略歸為「健康生活品質」、「都市生活品質」、「生活環境品質」及「工作生活品質」箏四類，其內容及研究方式不盡相同。3．生活品質是許多學科共同的關注主題，通常被定義為多層面的概念，並以不同的方法進行研究。4．針對健康生活品質研究而言，大多是在近五年內以結構式問卷之橫斷式調查所進行，全部以個人為分析單位，作者學術背景全部屬於醫學（大部分為護理研究所）及公共衛生學院之研究所，研究對象則以病患為主，其次為家屬或照顧者，所研究的疾病均屬於慢性或需要長期照護的健康問題。5．歸納健康生活品質研究之特徵包括：疾病（醫療）取向、個人取向、缺乏對環境因素的考慮、缺乏本土性的研究工具及缺乏多樣性的研究方法。本報告所分析之台灣地區生活品質研究雖無法涵蓋所有的研究，但基於政大社會科學資料中心在收集國內學術論文的完整性，本文之描述分析對於台灣地區生活品質研究概況的瞭解應有所貢獻。
  The purpose of this paper was to give an overview of quality of life (QOL) studies in Taiwan. All QOL studies in the Social Science Information Center, National Cheng-chi University reported before 1996 were reviewed. In order to provide an overview of the content of QOL reports, data from each report on the study year, author's specialty, study population, study design, and definition of QOL was collected. Analysis of the data showed that: (1) the quantity of QOL research increased yearly from 1978 to 1996. (2) studies could be broadly devided into three categories: ”health-related QOL”, ”environment/urban QOL”. and ”work QOL”; (3) most QOL studies used a multi-discipline approach; (4) the studies which focused on health-related QOL from 1992 to 1996 had authors' who worked in a medical or public health college, a study population consisting of patients or caregivers, a study design which was usually cross-sectional, data collection which used a questionnaire, and analysis based on the individual as the fundamental unit; (5) health-related QOL research could he characterized as disease oriented and individual-oriented. These studies showed a general lack of concern about the environment, native study instruments, and the diversity of study methods.
• 442 - 457
• 10.6288/CJPH1998-17-06-02

• Link 原著 Original Article
• 蓋斑鬥魚防治登革熱病媒埃及斑蚊幼蟲潛力之研究Laboratory Comparative Evaluation of Larvivorous Fishes as Dengue Fever Vector Control Agents
• 王正雄
  Cheng-Hsung Wang
• 食蚊魚 ； 蓋斑鬥魚 ； 大肚魚 ； 孔雀魚 ； 埃及斑蚊
  larvivorous fish ; Macropodus opercularis ; Gambusia affinis ; Poecilia reticulata ; Aedes aegypti
• 利用大肚魚(Gambusia affinis)、孔雀魚(Poecilia reticulata)防治病媒蚊幼蟲已有相當的歷史，但常受環境的影響而限制其應用。本研究比較此二種傳統食蚊魚及另一種本土蓋斑鬥魚(Macropodus opercularis)對埃及斑蚊(Aedes aegypti)幼蟲之捕食量及水域環境之適應性。蓋斑鬥魚(♀)對斑蚊四齡幼蟲平均捕食量為374.6隻／日，相較於大肚魚(♀)44.0隻／日。孔雀魚(♀)41.8隻／日高出甚多。至於對水域環境之適應性，蓋斑鬥魚之耐飢半數存活期為80天；且水深只要淹沒鰓蓋，即可存活，具耐旱性；臨界致死高低溫分別為36℃及9℃；對自來水殘鈴氯之半數致死濃度(LC50)為1.5ppm；對殺幼蟲劑之容忍性，以1ppm之濃度試驗五天，結果以色列品系蘇力菌(Bacillus thuringiensis israelensis, BTI)、昆蟲生長調節劑(insect growth regulator, IGR)、亞培松（temephos商品名Abate）能完全存活，百滅寧(permethrin)存活率為40.0%，賽滅寧(cypermethrin)存活率6.7%，陶斯松(chlorpyrifos)則悉數死亡。與大肚魚、孔雀魚相較，蓋斑鬥魚具有極高的水域適應性，如釋放於飲水或澆菜水容器，以防治孳生其內之登革熱病媒埃及斑蚊具有極高之防治潛力。
  As mosquito larvae control agents, the predatory capacity of Gambusia affinis and Poecilia reticulata is limited. This study was designed to compare a Taiwan native larvivorous fish, Macropodus opercularis, with G. affinis and P. reticulata that have been used extensively in mosquito control in water bodies. Results revealed an outstanding predatory capacity of M. opercularis to the fourth instar larvae of Aedes aegypti and the greatest survival rate for this fish under harsh laboratory conditions. M. opercularis consumed the mosquito larvae as many as 375/day, while G. affinis and P. reticulata consumed 44/day and 42/day, respectively. In the circumstance of no food supply, approximately 50% of M. opercularis would be able to remain alive for 80 days. This fish could survive for at least five days in a water body with the depth only enough to cover the fish gill; it could endure the water temperature at as low as 9? and as high as 36?; it demonstrated and LC50 of chlorine in water at the level of 1.5 ppm; there were no fishes killed in five-day tolerance tests when the test concentrations of chemicals-temephos, Bacillus thuringiensis israelensis, or the insect growth regulator-were set at 1.0 ppm. However, the mortality rates for the fishes were 60% when treated with 1.0 ppm of permethrin, 93% with cypermethrin and 100% with chlorpyrifos. In conclusion that M. opercularis can consume larvae eight time more than other kinds of fish can. It has the best potential to be used in breeding sites to control dengue fever vectors.
• 458 - 467
• 10.6288/CJPH1998-17-06-03

• Link 原著 Original Article
• 比較透氣膠膜與安全膠布固定靜脈留置針之成效探討Comparison between Transparent and Tape Dressing with Their Complications Associated with intra-venous Therapy
• 王憲華、李維玲、 陳小蓮、吳家麗、陳品玲
  Shian-Hua Wang, Wei-Ling Lee, Siu-Lin Chan, Ka-Lai Wu, Ping-Ling Chen
• 靜脈留置針 ； 透氣膠膜 ； 安全膠布
  intra-venous catheter ; transparent dressing ; tape dressing
• 本研究比較國內常使用的兩種固定靜脈留置針敷料〔透氣膠膜，安全膠布〕，探討使用後之靜脈注射相關合併症發生率是否有差異，研究對象為內外科病房中由靜脈注射小組執行週邊靜脈注射之病患，於靜脈留置針拔除時以觀察表，搜集病患資料。共收錄824名病患，2609次之靜脈注射經驗，病患分為兩組，兩組之平均年齡、男女性別比例、平均住院日數、潛在疾病、注射部位及導管維持日數等資料，並無顯著差異，但使用透氣膠膜組中內科病患較多。各項拔管原因中，除透氣膠膜組較安全膠布組有較多比例之移位、脫出外，其餘如到期、浮漏等拔管原因及感染合併症，並無顯著差異；每次注射費用安全膠布組節省3.103元。以上結果可作為臨床選擇敷料之參考。
  This study was conducted to compare two dressings, transparent dressing and tape dressing, for their infection rates and complications associated with the dressings. The sample population came from the in-patients who have their IV therapy while staying in a regional general hospital. The IV team members were in charge with collecting the patient data while replacing the IV insertion. Eight hundred and twenty four patients with 2609 catheter insertions were recruited. Patients were randomly divided into two groups, one group was with transparent dressing and the other was with tape dressing when patients had their catheters secured. Male/female ratio, average days of hospitalization, underlying diseases, insertion sites, catheter lasting days, were found no difference between two groups. The need for replacement, such as time interval due, symptom of infiltration, IV occlusion, presence of pain, phlebitis, dislocation, were found no significance difference in this study. However, the patients with transparent dressing frequently dislocated and plug-out than patients with tape dressing. Moreover, the complications associated with infection were found no difference between two groups. The cost of tape dressing was 3.103 NT dollars less than transparent in every use. Therefore, the result was provided a reference of choosing dressing in clinical field.
• 468 - 473
• 10.6288/CJPH1998-17-06-04

• Link 原著 Original Article
• 趨勢面分析法在癌症地圖繪製上的應用：以臺灣的乳癌死亡率為例Trend Surface Analysis for Cancer Mapping: Application to Breast Cancer Mortality in Taiwan
• 廖勇柏、李文宗、陳建仁
  Yung-Po Liaw, Wen-Chung Lee, Chien-Jen Chen
• 趨勢面分析 ； 地理資訊系統 ； 卜瓦松迴歸 ； 乳癌
  trend surface analysis ; geographical information system ; Poisson regression ; breast cancer
• 疾病的地理變異，是流行病學的重要課題。然而，傳統地圖繪製方法，以行政區域為單位常無法清楚看出地理分佈的趨勢，且常面臨死亡率不穩定，干擾地圖判讀的問題。本文利用一種統計技術稱為趨勢面分析，及結合地理資訊系統進行癌症地圖繪製。本研究以1982~1991年臺灣本島346個行政區域之乳癌死亡資料為例進行示範，並與傳統地圖繪製方法比較。結果顯示，透過一次趨勢面分析、二次趨勢面分析至五次趨勢面分析之動態變化，可一目瞭然看出死亡率聚集擴散之傾向，以往地廣人稀鄉鎮死亡率劇烈變動之現象，亦不復可見。相對危險性較高之地區清楚地集中在大都會區，包括台北縣、市，台中縣、市，台南市以及高雄市。反之，西南沿海及山地鄉，其相對危險性則較低。本文作者期待趨勢面分析法在公共衛生領域之應用能更加開展普及。
  The geographic variation in the occurrence of diseases is an important issue in epidemiology. The traditional mortality mapping technique, which is based on administrative areas, suffers from the problem of instability and has difficulty in identifying spatial patterns and trends of potential interest. In this paper, the authors apply the trend surface analytic technique to model mortality rates and then use the ”Geographical Information System” (GIS) to draw maps. Data of female breast cancer mortality in the 346 administrative areas in Taiwan from 1982 to 1991 were used as an example. As compared to the traditional method, it is found that the trend surface analytic technique stabilizes mortality rates especially in areas with small populations, such as in the mountainous areas. Moreover, the technique, with the building of the 1st to the 5th order models, can provide a dynamic exhibition of patterns and trends which leads to clues about clustering and diffusion process in the mortality. The study finds higher breast cancer mortality to be clustered in several main metropolitan areas including Taipei City/County, Taichung City/County, Tainan City and Kaohsiung City. The southwestern coastal areas and the mountainous areas reveal lower mortality. It is hoped that the trend surface analysis becomes a standard public-health tool in the days to come.
• 474 - 484
• 10.6288/CJPH1998-17-06-05

• Link 原著 Original Article
• 醫療資源綜合評估指標之建立Development of a Holistic Index to Evaluate the Distributions of Health Care Resources
• 洪正芳、楊銘欽、黃子賢、虞善琦、楊錦坤、 張彥輝
  Cheng-Fang Hung, Ming-Chin Yang, Tzyy-Shyan Huang, Shan-Chi Yu, Chin-Kun Yang, Yen-Hui Chang
• 醫療資源 ； 多目標價值模式 ； 綜合評估指標 ； 醫療可近性
  health care resources ; MAUT Multi-attribute Technique ; holistic index ; the accessibility of health services
• 民眾醫療可近性是國家醫療體系相當重要的課題，由於目前國內醫療資源分佈不均，城鄉差距過大，造成部份地區醫療資源的重複浪費，而有些地區之醫療資源卻不足。固然政府相關單位有心評估並解決此一問題，卻缺乏能真正反映醫療資源分佈狀況之整體性評估指標。本研究之目的在發展一套方法來建立綜合評估指標，以瞭解醫療資源分佈之情況，並作為改善醫療資源分佈不均之決策參考。本研究運用多目標決策模式(MAUT)透過國內相關領域六位專家之電話訪談與專家會議建立起一綜合評估指標。會後我們提供每位專家有關全台灣六十三個醫療次區域之相關資料，由每位專家來評定每個次區域醫療資源需求之程度。這些主觀判斷與專家所建立之綜合評估模式所得之六十三個次區域評估分數做比較，我們發現，此模式能可靠的預測專家之判斷，其中模式解釋每位專家81%以上之變異，亦解釋專家評估平均值之93%的變異，另外傳統單一評估指標與綜合評估指標之評估結果明顯不同，本研究可以做為改善民眾醫療可近性之參考。
  The accessibility of health services is an important issue in our health care system. The unbalanced distribution of our health care resources results in the inefficient utilization of the resources. In recent years our government intend to evaluate and alleviate the problems, and need a holistic index to understand the variation of the distributions of the resources. This research uses the Multi-Attribute Utility Technique (MAUT) to develop a holistic index. We hold an expert panel meeting that consists of six related experts in the field to build the MAUT model. After the meeting, every expert rates the sixty-three sub-areas in Taiwan. In a comparison of every expert subjective judgment and the model scores, we find that the MAUT model can predict experts' judgments well. This model explains at least 81% of the variance of each expert, and 93% of the variance of the experts' average scores. The holistic index also shows quite different results from those of the conventional index. The results can be used as a reference to improve the accessibility of health services in Taiwan.
• 485 - 494
• 10.6288/CJPH1998-17-06-06

• Link 原著 Original Article
• 臺灣地區十年來阿片類止痛藥使用趨勢之探討The Trends of Requirements in Medical Opioid Analgesics from 1987 through 1996 in Taiwan
• 許俊卿、李志恒
  Chun-Ching Hsu, Jih-Heng Li
• 嗎啡 ； 可待因 ； 配西汀 ； 麻醉藥品使用量
  morphine ; codeine ; pethidine ; narcotic consumption
• 調查臺灣地區1987年至1996年十年間阿片類止痛藥使用量成長情形，嗎啡口服劑成長17倍，注射劑成長9倍；可待因口服劑成長1.4倍，注射劑成長1.7倍；配西汀口服劑成長1.6倍，注射劑未見成長；吩坦尼注射劑成長2.7倍。嗎啡口服劑每年均為正成長，年成長率平均為38%，注射劑則除1989及1993兩年為負成長外，其餘為正成長，於1992年高達116%。可待因口服及注射劑年成長率為正負互見：配西汀口服及注射劑之年成長率都在±20%內，無大幅衰退或增加；吩坦尼注射劑年成長率則在5%~17%之間。嗎啡為WHO推薦之癌症疼痛治療主要用藥，臺灣地區使用量快速成長，但如以1991至1995年之每百萬人口每天嗎啡使用量為例，僅及英國的四十一分之一、美國的二十五分之一、日本的四分之一，顯示我國癌症疼痛治療仍有努力的空間。阻礙阿片類止痛藥使用的因素很多，仍需調查確切原因，同時應對醫事人員加強正確癌症疼痛醫療之教育，使癌症疼痛病人能獲得更妥善的醫療照顧。
  Selected narcotic drugs purchased by, manufactured by and managed by the National Narcotics Bureau between 1987 and 1996 in Taiwan were reviewed for the requirement trend. The requirement for morphine has increased 17 and 9 folds in oral (o) and injectable (i) preparations, respectively. The increases in other opioids were less substantial: 1.4 (o) and 1.7 (i) folds for codeine; 1.6 (o) folds and no (i) increase for pethidine; and 2.7 (i) folds for fentanyl. The use of oral morphine has constantly increased with an average annual growth ratio of 38% except that a slight lag was observed in 1989 and 1993. The use of morphine injections has steady increase with the highest growth of 116% in 1992. For oral and injectable forms of codeine and pethidine, the annual growth ratios have remained stagnant. The annual growths of fentanyl injections ranged between 5% and 17%. The growth of using morphine seemed very rapid, yet the average daily morphine consumption in Taiwan was still far behind that of many developed countries. Based on the ”defined daily doses” per million people, the daily morphine requirement compared with that of other nations was much lower in Taiwan: one to 41 compared with the U.K., one to 25 compared with the U.S., or one to four compared with Japan. In summary, the amount of narcotics supplements in the past in Taiwan suggests that patients might have received inadequate palliative care for cancer pain and other medical events. Further investigation on factors that might impede the use of opioid analgesics is expected. In addition, educational programs for medical professionals on proper pain controls are imperatively required.
• 495 - 503
• 10.6288/CJPH1998-17-06-07

• Link 原著 Original Article
• 某醫學中心家庭醫學科病人候診與看診時間之研究On the Waiting Time and Visiting Time of Outpatient Services
• 蘇喜、李敏禎、劉嘉玲
  Syi Su, Ming-Gen Lee, Gia-Ling Lieu
• 門診 ； 候診時間 ； 看診時間
  outpatient department ; waiting time ; visiting time
• 研究係以一家醫學中心的家庭醫學科為對象，實際記錄門診病人到診、醫師叫號及離開診間的時間。於1994年12月19日至24日及1995年1月12日至24日間，分別收集初診（初診診間）及複診（一般診間）病人就診過程的時間資料。結果顯示，在初診診間方面，82.5%為現場掛號病人；17.4%為預約掛號病人；現場掛號病人平均候診時間為72.1分鐘，平均看診時間為17.4分鐘；預約掛號病人，平均候診時間為42.1分鐘，平均看診時間為13.0分鐘。在一般診間方面，31.9%為現場掛號病人，68.1%為預約掛號病人；現場掛號病人平均候診時間為81.9分鐘，平均看診時間為7.7分鐘：預約掛號病人，平均候診時間為40.8分鐘，平均看診時間為5.8分鐘。普遍病人認為可接受的候診及看診時間分別為16~30分鐘(50.6%)及6~10分鐘(49.6%)。若比較病人就醫的時間差異，在候診時間方面，不論初複診病人，現場掛號的候診時間都比預約掛號來得久；在看診時間方面，一般診間現場掛號的看診時間比預約掛號來得久，但在初診診間則無顯著差異。若比較醫師的看診時間，則初診診間比一般診間來的長。若比較不同疾病的看診時間，在一般診間並無顯著不同，但在初診診間則有顯著不同。對於等候時間的研究，若能利用等候理論並建立模擬模式，則等候問題將可被改善，且醫院的人力規劃及資源的分配，也將更為適當。
  This study using a family medicine department as subject, tries to explore the actual behavior of outpatient services. From Dec. 19 to Dec. 241994, the first-visit patients' arrival time, waiting time, and physicians consulting time were gathered. The same sets of data were collected for repeated-visit patients from Jan. 12 to Jan. 24, 1995. This data revealed that the satisfied mean waiting time and mean doctor-contact time of patients were 16-30 minutes and 6-10 minutes respectively. No matter what kind of patient visits, it is also found that the waiting time of on-site registration is much longer than that of the pre-registered. The research figured out that the most important strategy to solve the related problem of waiting time is to establish a simulation model based on the queuing theory for the subject hospital.
• 504 - 511
• 10.6288/CJPH1998-17-06-08

• Link 原著 Original Article
• 台灣的衛生服務研究分析，1970-1995Analysis of Studies on Health Services Research in Taiwan from 1970 to 1995
• 劉嘉年
  Chia-Nien Liu
• 衛生服務研究
  health services research
• 本研究回溯台灣地區699篇於1970到1995年間完成的衛生服務研究，探討其範疇與發展趨勢，主要結果如下：(1)研究數量逐年增加，近七成的研究論文於1990~1995年的六年間完成。(2)研究範疇中以「醫療機構」、「公共衛生計畫與基層醫療組織」研究為主。(3)調查研究法、與內容分析法及個案研究法是最受採用的研究型態；(4)75%的第一作者是大專院校系所的教師與研究生；(5)研究收案地區以北部較多(33.5%)，針對東部與離島的研究較少(1.7%)；(6)研究取向方面，1970年代以「衛生人力」、「公共衛生計畫與基層醫療組織」、「衛生服務需求與利用度」及「健康照護的社會與行為面」研究最早出現，1980年起有關「醫療品質」、「醫療機構」、「藥事服務研究」、及「醫療費用、支付制度與財務」的研究才陸續發表，「衛生服務研究法」及「醫療科技」的研究則於1988年後受到重視。
  The objective of this study is to report the status and characteristics of studies on health services research in Taiwan from 1970 to 1995. A total of 699 health services research reports were identified and analyzed in terms of authors' background, area of research focus. The major results of the study indicate that: (1) Health services research in Taiwan has increased in recent years. About 70% of the papers were done between 1990 and 1995. (2) The major subjects of the studies were health facilities and health plans and organizations of primary care. (3) Survey, content analysis, and case study were the most frequency adopted methods in conducting health services research. (4) The first authors of 75% of the studies were public health professors and graduate students. (5) 33.5% of the studies were done in north Taiwan. Only 1.7% of the studies were done in east Taiwan and in the off-shore islands. (6) In the 1970's, the chief subjects of the studies were health manpower, health plans and organizations of primary care, utilization of health services, and social-behavior aspects of health care. In the 1980's, the studies dealt with quality of health services, health facilities, pharmacy-related health services research, and costs and payment systems. The fields of research methods and medical technology were not developed until 1988.
• 512 - 520
• 10.6288/CJPH1998-17-06-09