24卷5期

• Link 原著 Original Article
• 醫院網站服務品質與使用者就醫意向之關係探討A Study of the Service Quality of Hospital Websites and Users' Intention of Health Service Utilization
• 鍾國彪、周其宏、郭年眞
  Kuo-Piao Chung, Chi-Hung Chou, Nien-Chen Kuo
• 醫院網站 ； 使用者現況 ； 就醫意向
  hospital website ; user's status quo ; intention of service utilization
• 目標：本研究的目的主要在於瞭解國內醫院網站使用者的現況，並探討服務品質與使用者就醫意向之間的關係。方法：有14家醫學中心及區域醫院參與研究，以網路問卷調查民眾使用醫院網站情形與對網站服務品質的看法，以及未來選擇就醫或推薦的意向。結果：自91年11月19日起至92年1月7日止，共回收1018份有效問卷（回覆率58.0%），其中以女性居多(75.1%)，其中52%的填答者使用網站前，就常至該醫院就醫，而利用醫院網站最主要的目的，是為自己尋找健康或疾病資訊(56.7%)，最常使用的服務項目，是查詢門診時間(75.1%)，且填答者對醫院網站的重視程度，多抱持正面態度。填答者對網站服務品質的看法，在大部分的題目上對品質的期望都顯著的高於實際的感受。經由邏輯斯迴歸分析發現，填答者的特質及網站服務品質特定構面期望與感受的落差，會影響網站使用者就醫的意向或向親友推薦的意向。結論：由研究結果顯示，在控制個人特質等因素後，醫院網站服務品質會影響網站使用者就醫或推薦的意向，因此建議醫院經營者應重視網站提供的資訊與服務，透過醫院網站作為媒介，強化與病患之關係。
  Objectives: The purposes of this study were to understand the status quo of hospital websites users and explore the relationship between service quality and users' intention of service utilization. Methods: Fourteen domestic medical centers and regional hospitals voluntarily joined the study. Data collection was carried out by a self-administered website questionnaire that included current utilization, opinions about service quality of hospital website and intention of service utilization. Results: The period of data collection ran from November 2002 to January 2003 and 1,018 valid questionnaires were obtained with a 58.0 percent response rate. Most respondents were female (75.1%), 52 percent of the respondents had previous service experience with those specific hospitals. The main purpose in using a specific hospital's website was to search for health or disease related information (56.7%); the most frequent function they used was inquiring about the ambulatory care schedule (75.1%); furthermore, respondents had positive attitudes toward the degree of emphasis on hospital websites. Users' expectations of the service quality of the hospital website were significantly higher than their perceptions for most of the items and such expectation-perception difference in specific aspects will impact on the intention of utilization in the future or their intention to recommend hospital's services to friends and families. Conclusion: After adjusting for personal characteristics, the difference between users' expected and perceived service quality of the hospital website will impact on their own and recommendation intention for service utilization. Thus, hospital administrators should pay more attention to website information and services, and enhance hospital's relationship with patients by way of the hospital's website services.
• 375 - 384
• 10.6288/TJPH2005-24-05-01

• Link 原著 Original Article
• 醫院引進及擴張新醫療科技之影響因素與結果Antecedents and Consequences of the Adoption and Expansion of New Medical Technology in Hospitals
• 羅萱
  Hsuan Lo
• 醫療科技 ； 引進 ； 擴張 ； 效率
  medical technology ; adoption ; expansion ; efficiency
• 目標：本研究目的在瞭解醫院引進與擴張多種新醫療科技的決定因素，及擴張醫療科技設備後對組織營運的影響。方法：利用次級資料進行縱貫性研究，研究群體為民國83-91年台灣地區所有層級的綜合型醫院。以負二項迴歸之隨機效果模式，分析組織與環境因素對新引進醫療科技的影響；以一般線性迴歸之隨機效果模式，分析新引進醫療科技對次年醫療科技利用量的影響。結果：描述性分析結果發現，民國83年至91年間擁有一種或擴張多種高科技醫療儀器的醫院比率有增加的情況。迴歸模式分析發現，醫院權屬別、科別數、規模、及醫療儀器利用量等因素對新引進醫療儀器機率為正向顯著影響，而醫療儀器種類數為負向顯著影響；然而，新引進醫療儀器種類數對次年醫療科技利用量則為負向顯著影響。結論：第一組織特徵因素是影響醫院引進及擴張新醫療科技種類的重要因素，尤其生存壓力較大的組織（如私立醫院）、異質醫療專業需求高的及資源與能力強的組織（如規模大、科別多及利用量高的醫院），引進及擴張新醫療科技種類機率越高；第二、組織若過度的擴張多種醫療科技，將導致較低的醫療科技利用量。
  Objectives: The purposes of this study are to examine the effects of organizational and environmental factors on the adoption and expansion of new medical technology in hospitals and to examine the effects the adoption and expansion of new medical technology on hospitals’ performance. Methods: We analyzed a panel of hospitals in Taiwan between 1994 and 2002 and used the secondary data from the governmental archive. Negative binomial regression with the random effects model is used to examine the effects of organizational and environmental factors on the adoption or expansion of new medical technology. In addition, the random effects general regression model is used to examine the effects of the adoption and expansion of new medical technology on organizational efficiency. Results: Regression models showed that private hospitals, sizes, the number of specialties, and medical technology utilizations had positive impacts on the adoption and expansion of new medical technology, and the numbers of medical technology categories had a negative effect. However, increases in the adoption and expansion of new medical technology had a negative impact on organizational efficiency under controlling the categories of medical technology. Conclusions: Our study suggests that organizational factors are key determinants of the adoption and expansion of new medical technology, and that the greater the survival pressure (e.g., private hospitals), diversity of medical demand and the more capabilities and experience of the hospital (e.g., large size, more numbers of specialties, and high utility) the greater the likelihood the hospital will adopt and expand new medical technology. Further, we suggest that over-adoption and over-expansion of new medical technologies will reduce medical technology utilization unless the categories of medical technologies were also considered.
• 385 - 393
• 10.6288/TJPH2005-24-05-02

• Link 原著 Original Article
• 牙醫總額預算制度對牙醫服務量與價格的影響The Influence of Global Dental Budgets on Dental Service Volume and Price
• 何瑛、黃偉堯
  Ying Ho, Wei-Yao Huang
• 醫療行為 ； 總額預算 ； 所得最大化
  behavior?;?global budget?;?income-maximizing
• 無
  Objectives: This study aims to examine how dentists responded in service volume and price with a focus on the effect of the global budget according to the income-maximizing concept. Method: By measuring the change in fees over time in townships to study the dentists' behavior pre and post introduction of the global budget and follow the effects between township from 1996 to 2001. 291 townships with complete claim data from 1996 to 2001 in Taiwan were examined. We used the number of visits and the average price per claim to analyze dentists' behavior response with t-test and regression. Results: Between 1997 and 1999, the number of visits per township increased from 73,702 to 80,332 (t=9.3, p<0.001); the average price per claim per township increased from 863 to 948 NT. dollars (t=19.4, p<0.001). The results of multiple regressions showed that dental global budget had a positive relationship with the number of visits and the average price per claim (ß=6,629.23, p<0.0l; ß=84.41, p<0.001) after controlling for urbanization, population, dependency ratio and dentist-population ratio. Conclusions: In response to the introduction of global budget, dentists would increase the volume or price of services, especially price.
• 394 - 401
• 10.6288/TJPH2005-24-05-03

• Link 原著 Original Article
• 國中學生電玩遊戲成癮傾向與自覺健康狀態之關係探討The Study of Relationship between electric-game Addiction and the self-evaluated Health Status of Junior High School Students
• 馮嘉玉、晏涵文
  Jia-Yuh Ferng, Hen-Wen Yen
• 國中學生 ； 電玩遊戲 ； 電玩遊戲成癮 ； 健康
  ?junior high school students?;?electric-game?;?electric-game addiction?;?health
• 目標：了解影響目前國中學生電玩遊戲成癮傾向的可能因素，並分析此成癮傾向與青少年健康狀態間的關聯性。方法：以分層集群抽樣方法選取台北縣市國二學生樣本，共計487人，進行橫斷式問卷調查。並依據「電玩遊戲成癮量表」、「身心健康量表」、「自尊量表」、「人際關係量表」之得分，進行電玩遊戲成癮傾向與整體自覺健康狀態的關聯性分析。結果：男性，一週休閒時數越長，且學業成績越差者，電玩遊戲成癮傾向越高。而電玩進戲成癮傾向越高的國中生，其身心健康、自尊及人際關係筆自覺健康狀態也越差，其中尤以人際關係與電玩遊戲成癮傾向的關聯性最為密切。結論：電玩遊戲成癮傾向與國中學生自覺健康狀態間有密切的關聯性，且兩者可能形成互為因果的急性循環。
  Objectives: This study aims to understand the factors of junior high school students' electric- game addiction and to analyze the relationship between the addiction and the health status of students. Method: This study is a cross-sectional survey using stratified cluster-sampling method to choose 487 second-grade students from 11 public junior high schools in Taipei. Based on the results of the ”Electric-Game Addiction Scale”, ”Physical and Emotional Fitness Scale”, ”Self-Esteem Scale” and ”Human Relations Scale”, the researcher analyzed the relationships between electric-game addiction and the self-evaluated health status of junior high school students. Results: The longer the leisure time and the higher the level of electric-game addition, the worse school achievement was for male students. The stronger the level of electric-game addiction, the worse the self-evaluated health status. Moreover, ”interpersonal relations” was the factor which most closely related to the level of electric-game addition. Conclusions: There is an obvious relation between the level of electric-game addiction and students' self-evaluated health status. The consequence of this may be the creation of a vicious circle.
• 402 - 410
• 10.6288/TJPH2005-24-05-04

• Link 原著 Original Article
• 花蓮地區青少女懷孕之家庭因素探討Family Characteristics of Adolescent Pregnancy in the Hualien District
• 張慈桂、李燕嗚
  Tzu-Kuei Chang, Yin-Ming Li
• 青少女懷孕 ； 家庭特性 ； 家庭支持功能 ； 花蓮地區
  Teenage pregnancy ; family characteristic ; family support ; Hualien district
• 目標：青少女懷孕生育衍生對孕婦及嬰兒健康的不良結果，是探討青少年健康及人口政策時重要的議題。本研究以青少年生育問題嚴重的花蓮地區之懷孕婦女為對象，依年齡分為青少女孕婦及成年孕婦組，比較分析兩組孕婦家庭特性的差異。方法：本研究於1998年11月至1999年6月15日期間，在花蓮市兩所教學醫院接受產前檢查或生產的1263名孕婦為研究對象。以結構式問卷經面訪方式，調查孕婦之人口學變項、家庭因素及家庭支持功能。結果：青少女孕婦以居住於偏遠地區(36.3%)及原住民(62.1%)較多。控制了孕婦個人及家庭相關因素之後，發現孕婦未婚（OR為8.8）、無業(OR=3.9)、母親曾未成年生育(OR=3.1)，及其姐妹曾未成年生育(OR=2.4)是影響青少女懷孕的重要因素。結論：青少女懷孕除了個人因素外，家庭中其它女性（母親、姐妹）曾青少年生育亦是重要的因素。對於青少女懷孕生育的問題，除了加強青少年期之性知識及避孕方式的宣導外，更應從家庭因素著手，透過以學校、衛生及社會福利機構的輔導及協助，建立青少女孕婦的照護及輔導網絡，減少因低齡生育所衍生的不利年輕孕婦及其所生小兒之身心健康的社會問題。
  Objective: Pregnancy in adolescence is well known to be a major cause of adverse effects both to the newborns, baby, and the pregnanct adolescent. This problem is more common in eastern Taiwan. The aim of this study is to investigate the family factors associated with teenage pregnancy in the Hualien district. Method: This study was conducted by face-to-face interviewing pregnant women who visited prenatal care clinics or delivered a baby at either of the two teaching hospitals in the Hualien city, from November 1998 to 15th June 1999. Pregnancy women's demographic characteristics, their parents' ages, ethnicity, ages of the first childbearing of their mothers and sisters, and how they perceived their family function were all recorded. Results: Teenage mothers were more likely to be found in the aboriginal district (62.1%) and remote areas (36.3%). Multiple logistic regression analysis showed that teenage mothers were more likely to remain unmarried (OR=8.8), be unemployed (OR=3.9), and their mothers (OR=3.1) and, sisters (OR=2.4) were also more likely to have teenage childbearing experience. Conclusion: Family factors played crucial roles in teenage pregnancy, particularly experience of teenage childbearing in their family. Programs for the prevention of teenage pregnancy and their adverse consequence are needed in the Hualien district. For teenage mothers, sex education and contraception, counseling and assistant network are needed. Schools, health care facilities and social welfare institutes should collaborate in caring for teenage mothers and their children.
• 411 - 419
• 10.6288/TJPH2005-24-05-05

• Link 原著 Original Article
• 醫護人員照顧高危險性傳染疾病病患之壓力量表的發展與測試－以SARS為例Psychometric Evaluation of the Stress Scale of Caring for Highly Infectious Disease Patients among Health Care Workers-Based on SARS
• 莊寶玉、羅美芳
  Pao-Yu Chuang, Meei-Fang Lou
• 嚴重急性呼吸道症候群 ； 壓力 ； 醫護人員
  Severe Acute Respiratory Syndrome SARS ; stress ; health care workers HCWs
• 目標：本研究目的期能發展一份具有信效度且適用於醫護人員在照顧類似SARS高危險性傳染疾病病患時的壓力量表，作為日後相關壓力研究之工具。方法：藉由7名照顧SARS病患的醫護人員之訪談結果整理結構式問卷；聘請專家檢定內容效度。於某醫學中心採立意取樣方式收案，計有效問卷495份；利用中國人健康量表作效標關聯效度檢定；以因素分析檢測建構效度，使用內在一致性Cronbach's α來測試信度。結果：本壓力量表共32題內容效度指標0.92；經因素分析萃取出擔心與社會隔絕、防護裝備引起的不適、感染控制的困難與焦慮、照顧病患的負擔等四個因素，可解釋48.82%變異量；四個分量表與中國人健康量表均達顯著相關，總分之相關係數為0.63；四個分量表之內在一致性Cronbach's α介於0.84～0.90之間。結論：本壓力量表具有良好的內在一致性、同時效度及初步建立之建構效度，未來若有類似情況，可利用本壓力量表對工作人員做即時檢測。
  Objectives: The purpose of this study is to develop a reliable and valid instrument to measure the stress among health care workers (HCWs) while taking care of patients with highly infectious disease such as Severe Acute Respiratory Syndrome (SARS). Methods: Structural questionnaires were developed following interviews with 7 HCWs who took care of patients with SARS. The validity of the contents was evaluated by experts. A total of 495 valid questionnaires were received by purposive sampling among HCWs in a tertiary medical center. The criterion- related validity was tested by a 30-item Chinese Health Questionnaire (CHQ-30). The construct validity was tested by factor analysis. Reliability was measured by Cronbach's a coefficient utilizing internal consistency. Results: The content validity index (CVI) of the 32-item stress rating scale was 0.92. After factor analysis, four factors were extracted. Those included the worry of social isolation, the discomfort caused by the protective equipment, the difficulties and anxiety of infection control, the workload of caring for patients. Four factors accounted for 48.82% of the total variance. Four stress subscales were very significantly related to the CHQ-30 score, r=0.63. The Cronbach's a coefficient for the stress subscale ranged from 0.84 to 0.90. Conclusions: The results demonstrated that the instrument had a satisfactory internal consistency, concurrent validity and preliminary construct validity. It could be utilized by hospital administrators in the measurement of HCW's stress level if similar critical situations of such epidemic proportions were to occur.
• 420 - 430
• 10.6288/TJPH2005-24-05-06

• Link 原著 Original Article
• 花蓮縣學齡前嬰幼兒桿菌性痢疾之配對病例對照研究A Matched case-control Study of Shigellosis in Children under the Age of Five in Hualien County
• 江亭誼、江大雄、蕭正光
  Ting-Yi Chiang, Donald Dah-Shyong Jiang, Cheng-Kuang Shaw
• 桿菌性痢疾 ； 配對病例對照研究 ； 危險對比值 ； 危險因子
  shigellosis ; matched case-control study ; risk factor ; odds ratio
• 目標：本研究探討花蓮地區五歲以下之嬰幼兒罹患桿菌性痢疾的相關危險因子。方法：研究採用配對病例對照研究法和半結構式問卷收集資料，並以條件式邏輯式迴歸進行分析。透過家庭訪視收集人口學特徵、臨床症狀、暴露史與個人衛生習慣等資料，以條件式邏輯式迴歸之粗危險對比值，以及調整後的危險對比值做為瞭解罹患桿菌性痢疾的相關指標。結果：研究發現調整種族與居住地後，單變項分析結果顯示，幼兒習慣吸吮手指、經常性將玩具或物品放入口中、其他幼童取物餵食、未清潔口腔之行為、廁所與非自家人共用、未安裝或使用損壞之紗窗（門）等因素分別和感染桿菌性痢疾有統計上的相關。多變項分析結果顯示，調整種族與居住地後，吸吮手指危險對比值5.75（95%信賴區間1.32~24.53）、廁所與非自家人共用之危險對比值13.74（95%信賴區間為2.56~73.70）兩者皆達統計學上之顯著相關。結論：吸吮手指、廁所與非自家人共用為花蓮地區五歲以下之嬰幼兒感染桿菌性痢疾之主要危險因素，因此改善家庭年幼成員之衛生習慣對於防治桿菌性痢疾是相當重要的。
  Objective: This purpose of this study was to investigate the risk factors of shigellosis among children aged under five in Hualien. Methods: A matched case-control method and semi-structured questionnaires were performed to identify risk factors associated with shigellosis. Data included demographic characteristics, clinical symptoms, exposure history, and personal hygiene. Exposure status was determined during a home visit. Both crude and adjusted odds ratios for risk factors associated with shigellosis were estimated respectively using conditional logistic regression analysis. Results: The findings showed that the variables ”finger sucking”, ”put toys and goods into mouth frequently”, ”fed by younger family members”, ”lack of oral-hygiene behavior”, ”sharing latrine or using outdoor toilet”, ”use of screened windows and doors” had significant relationship with the infection of shigellosis respectively. After adjusted for race and living residence, ”finger sucking” (AOR=5.75; 95% CL, 1.32~24.53) and ”sharing latrine or using outdoor toilet” (AOR=13.74; 95% CL, 2.56~73.70) were both associated with shigellosis infection. Conclusion: This study indicated that ”finger sucking” and ”sharing latrine or using outdoor toilet” were two major risk factors related to shigellosis infection among children aged under five in Hualien. Improving personal hygiene practices in young children at home was very important for shigellosis prevention and control.
• 431 - 439
• 10.6288/TJPH2005-24-05-07

• Link 原著 Original Article
• 全民健保實施前後影響子宮頸抹片篩檢之因素及成果Utilization Factors and Effects of National Health Insurance on Cervical Pap Smear Tests in Taiwan
• 陳慈怡、李嬿如、游山林、陳建仁、謝長堯、 陳素秋
  Tzu-I Chen, Yen-Lu Lee, San-Lin You, Chien-Jen Chen, Chang-Yao Hsieh, Su-Chiu Chen
• 子宮頸抹片 ； 全民健保 ； 篩檢成果 ； 定期篩檢
  cervical Pap smear test ; national health insurance ; screening outcome ; regular screening
• 目標：子宮頸癌是台灣地區女性好發的癌症之一，也是最容易早期發現且治癒效果佳的疾病，因此是最適合進行篩檢的疾病之一。本研究目的即以世代追蹤研究設計探討健保實施前後，影響此世代接受篩檢的原因及成果。方法：本研究自1991年起，對於台灣地區七個鄉鎮，30-64歲10，780位已婚婦女進行子宮頸癌篩檢計畫，結合健保子宮頸癌篩檢資料檔、全國癌症登記檔及死亡檔，追蹤十年之篩檢相關資料，以Multinomial Logistic Regression、Cox's Proportional Hazard Model分析探討之。結果：研究發現年齡較高、教育程度較低、加入計畫案到健保前無定期篩檢之婦女，較不定期接受篩檢。而進入計畫案前曾有篩檢過或曾因婦科疾病就醫、加入計畫案到健保前有定期篩檢、健保前無保險及曾子宮頸抹片或攝影為陽性者較會定期接受篩檢，定期接受篩檢對於篩檢成果較佳。結論：雖然我們目前沒有足夠的證據說每年、每兩年及每三年的篩檢成果何者較佳，但若能鼓勵高危險婦女定期篩檢，則可提早發現子宮頸癌前病變及治療，進而節省醫療資源。
  Objectives: In Taiwan, although cervical cancer is one of the most common cancerous conditions in females, it is the easiest to detect early by the cervical Papnicolaou (Pap) smear test and therefore treat effectively. The purpose of this study is to evaluate the utilization factors and effects of universal health insurance on cervical Pap smear tests in Taiwan. Method: This study invited 10,780 married women aged 30-64 years old living in seven communities of Taiwan since 1991. Database sources were from the cervical cancer research project and linked to the national files of the cervical neoplasia screening registry, cancer registry, and death certification from the department of health. Multinomial Logistic Regression and Cox's Proportional Hazard Model analysis were performed. Result: The low utilization factors of regular Pap smear tests were a low education level, and irregular Pap smear tests prior to the beginning of national health insurance. On the other hand, high utilization factors included women who had ever had the cervical Pap smear test or gynecological diseases prior to study entry, no insurance, Pap smear test/cervicgraphy positive finding or regular Pap smear tests prior to July 1995. The results of regular Pap smear tests were better than irregular ones. Conclusion: Although we thoroughly analyzed the results of regular one-year, two-year, and three-year Pap smear test outcomes, it is unclear as to which time period was better. However the women at a high risk of developing cervical cancer are encouraged to have regular Pap smear tests for the early detection and treatment of cervical neoplasia, therefore effecively saving medical costs.
• 440 - 451
• 10.6288/TJPH2005-24-05-08

• Link 原著 Original Article
• 2001～2003年台灣登革熱／登革出血熱的流行病學探討Epidemiology of Dengue Fever/Dengue Hemorrhagic Fever in Taiwan, 2001~2003
• 吳民惠、黃高彬、 蔡季君、吳宗樹、黃彥彰、金傳春
  Min-Huei Wu, Kao-Pin Hwang, Jih-Jin Tasi, Tsung-Shu Wu, Yen-Chang Huang, Chwan-Chuen King
• 登革熱 ； 登革出血熱 ； 流行病學 ； 血清流行病學 ； 流行潛力
  dengue fever DF ; dengue hemorrhagic fever DHF ; epidemiology ; serology ; epidemic potential
• 無
  Objective: The largest epidemic of dengue hemorrhagic fever (DHF) caused by dengue virus serotype 2 (DEN-2) since 1942 occurred in 2002. The purpose of this study is to determinate the important epidemiological characteristics of DHF in 2002~2003. Methods: Epidemiological and serological data were collected by field investigations and defined by scholars. Results: (1) the percentage of DHF cases in 2002 significantly increased from 27th~35th week [5.74% (99/1626)] to the 36th~44th week [7.77% (199/2361)] and 45th~2003 1st week [10.18% (103/909)] (p<0.000l); (2) DHF cases occurred more frequently in patients with underlying diseases; and (3) DHF had significant associations with the patient's self-described past dengue history (p=0.005) but smaller-scale serological data did not (p=0.08). Conclusions: The rapid infection of large human populations might increase the dimension of virus variability and allow the virus to have a higher epidemic potential. Future studies on pathogenesis of DHF are needed to emphasize the interactions between virus evolution and alternating hosts through transmission chains.
• 452 - 459
• 10.6288/TJPH2005-24-05-09