25卷3期

• Link 綜論 Review Article
• 奈米科技的健康風險管理Health Risk Management of Nanotechnologies
• 鄭尊仁、林宜平、雷侑蓁
  Tsun-Jen Cheng, Yi-Ping Lin, Yu-Chen Lei
• 奈米科技；奈米毒理學；健康風險評估；健康風險管理
  Nanotechnologies ; Nanotoxicology ; Health Risk Assessment ; Health Risk Management
• 近年來隨著奈米科技的發展，奈米材料可能的健康危害也開始引發關注，為了預防奈米微粒可能產生的健康危害，有需要進行健康風險管理。健康風險管理的基礎是健康風險評估，目前奈米毒理學家認為與健康危害有關的奈米材料主要是游離奈米微粒材質，與這些微粒毒性有關的因子，包括粒徑、表面積、表面特性及形狀等，不過奈米材料毒理研究尚在起步階段，測試的奈米材料也還有限，目前研究顯示奈米微粒進入呼吸道後可引起肺部發炎及纖維化反應，在疾病動物引起血栓。至於劑量反應評估，目前只有極少數資料，比較值得注意的是有些疾病動物比較容易受到奈米微粒影響。奈米微粒可經由呼吸道、皮膚或腸胃道進入人體，不過目前奈米微粒的量測儀器多屬研究用途，暴露評估相關資料很少，所以根據目前的科學證據，仍無法推估奈米微粒之健康風險。英國及歐盟為預防新興科技對人體及環境造成重大危害，在進行奈米科技的初步風險分析之後，即開始調查民眾的風險認知，建議修訂或增添現有法規，並對奈米科技的健康風險管理提出建議。
  Objective: With the advent of nanotechnologies, potential health hazards of nanoparticles have raised great concern. To prevent the potential hazards of new materials, health risk management of nanotechnologies is necessary. Health risk assessment is the basis of risk management. Currently, nanotoxicologists agree that it is the free nanomaterials that may cause health hazards, and the factors associated with hazards are its size, surface area, coating and shape. However, the toxicity studies of nanoparticles are limited on few materials. Studies have shown that nanoparticles can cause lung inflammation and fibrosis, and thrombosis in diseased animals. The dose-response relationship for nanoparticles is not clear. However, it is noted that diseased animals are more susceptible to nanoparticle exposure. Nanoparticles may enter human bodies through inhalation, ingestion and skin penetration. Because of the lack of portable measurement instruments, the data on exposure assessment remain limited. Thus, based on our current knowledge, it is not possible to draw a conclusion on risk characterization on nanoparticles. Further, we review the risk analysis reports from the United Kingdom and the European Commission. In order to manage the risk of nanotechnologies, they suggest launching an incremental process using existing legislative structures.
• 169 - 176
• 10.6288/TJPH2006-25-03-01

• Link 原著 Original Article
• 護理人員對護理工作認知與離職傾向之探討Exploring the Attitudes of Nursing Staffs toward Job Perception and Turnover Intention
• 陳國瑚、陳麗如、蘇喜
  Kuo-Hu Chen, Li-Ru Chen, Syi Su
• 護理工作認知 ； 離職傾向
  job perception of nursing ; turnover intention
• 無
  Objective: The objective of this research was to explore the attitudes of nursing staffs toward job perception and turnover intention, and to find the relationship among demographic factors, job factors, job perception and turnover intention of nursing staff. Methods: Nursing staff from the regional and district hospitals in Taipei county were enrolled in the survey by self-administered questionnaire. 1767 responses were received resulting in a response rate of 61.6% Results: Reports of ANOVA revealed that turnover intention varied significantly according to job factors and to demographic factors including schooling, age, gender and marital status. Results of stepwise multiple regression indicated that demographic factors, job factors and job perception were all important predictors of turnover intention of nursing staff (Adjust R^2=0.771, F=139.105, p<0.001). Job perception was a negative predictor of turnover intention, also meaning that higher job perception yielded a lower turnover intention. Conclusions: Managers of hospitals should promote positive job perception of nursing staff, especially those new employees with higher withdraw rates, to reduce turnover intention. This can be achieved by strengthening nursing identity, promoting people interaction, and improving organizational circumstances. This study may serve as a reference and utility for nursing practitioners and medical managers who focus on researching or solving this problem.
• 177 - 188
• 10.6288/TJPH2006-25-03-02

• Link 原著 Original Article
• 處方資訊用於台灣風險校正模型之初探A Pilot Study on Applying Prescription Information to Risk Adjustment Models in Taiwan
• 謝孟甫、張睿詒
  Meng-Fu Hsieh, Ray-E Chang
• 風險校正 ； 處方用藥 ； 診斷 ； 論人計酬
  risk adjustment ; prescription ; diagnosis ; capitation fee
• 目標：風險校正可避免論人計酬制度所帶來就醫公平與風險選擇的問題。診斷和處方資訊包含豐富的臨床訊息，利用其進行風險校正近年來國際發展蓬勃。相較於國際，過去研究顯示國內風險校正因子具有相當之預測力及發展性。全民健保藥品費用約佔門診醫療支出的1/3，其中慢性疾病藥費又佔相當比率。故本研究欲探討處方資訊對台灣風險校正模型預測力之改善。方法：利用國家衛生研究院全民健保資料承保資料抽樣歸人檔資料，選取於2000年全年在保且2001年至少一個月在保之保險對象共167,518人為研究樣本。分析採加權最小平方迴歸模型，運用前一年人口統計因子、診斷基礎因子、用藥處方因子以及附加處方資訊診斷因子，建立4個風險校正模型，並以跨樣本PR^2和預測比評估不同模型之預測力。結果：各模型中，在整體預測力上，人口統計模型偏低，其餘三模型均有大幅提升，而以附加處方資訊診斷模型之預測力最高。對特定群體的預測力，人口統計模型的預測比表現在4個模型中仍是最差，其餘三個模型之預測準確程度又以附加處方資訊診斷模型和TASGs模型表現較佳，而對特定疾病群附加處方資訊診斷模型又較TASGs模型為佳。結論：較多的醫療資訊，可使風險校正模型具有更好的預測能力。增加處方資訊確可更進一步提升風險校正模型預測能力。同時在特定之慢性病族群上，也具有更精確之預測能力，此有助於風險選擇的抑制並達成效率目標。未來應可針對我國用藥型態修正，並與更多診斷資訊整合。
  Objective: Using risk adjustment to set premium subsidies can reduce risk selection and ensure the equity of access to care. Diagnosis-based adjusters and prescribed drugs adjusters have attracted the research attention due to their recent rich clinical messages recently and have thus been studied intensively. Results of previous studies in Taiwan demonstrated the outstanding predictability of risk adjusters using Taiwan's NHI data. The medical expense structure of Taiwan's NHI shows that one-third of outpatient medical expenses is spent on prescription drugs, and chronic disease prescriptions account for the main portion. This study intends to investigate the improvement inthe predictability of risk adjustment models in Taiwan by introducing prescription information. Methods: From a database containing a panel of 200,000 individuals randomly selected from the NHI's beneficiaries, 167,518 individuals who had a full twelve months of eligibility in 2000 and were still enrolled on January 1, 2001 were selected as the study sample. Through weighted least square regression, demographic adjusters, diagnosis-based adjusters, prescription adjusters and diagnosis-based adjusters attaching prescription information were employed to establish four risk adjustment models. PR^2 and predictive ratio were employed to evaluate the predictability of various models through cross-sample validation. Results: The predictability of the demographic model was markedly inferior to the other three models. Of the other three models, the model with prescription and diagnosis information outperformed the other two. Although the overall predictability of the model with prescription and diagnosis information is slightly higher than that of the TASGs model, it has more accurate predictions in terms of expenditures of several subgroups, particularly the subgroups with chronic diseases. Conclusions: More clinical information improves the predictability of risk adjustment models, and prescription information does contribute to the improvement on the predictability of Taiwan's risk adjustment models, in particular on the predictions concerning the expenditures of individuals with chronic diseases. This should be of assistance in obtaining the objectives of reducing the selection incentive and improving efficiency. Future studies should incorporate Taiwan's practice patterns of prescribing drugs as well as more integration with diagnosis information.
• 189 - 200
• 10.6288/TJPH2006-25-03-03

• Link 原著 Original Article
• 台灣高血壓門診診療型態之分析探討Patterns of Diagnosis and Treatment of Hypertension in Taiwan
• 李宣緯、葉玲玲、黃達夫
  Hsuan-Wei Li, Ling-Ling Yeh, Andrew T. Huang
• 高血壓 ； 診療型態 ； 實證醫學 ； 診療準則 ； 醫療利用
  hypertension ; evidence-based medicine ; practice guideline ; patterns of diagnosis and treatment ; medical utilization
• 目標：藉由分析國內高血壓門診診療型態，進一步探討與高血壓實證醫學臨床診療準則之差異，以作為推動高血壓醫療品質相關衛生政策之參考。方法：本研究以2000年全國健保門診申報資料進行次級資料分析。針對主、次診斷碼符合自發性高血壓的門診人次，檢視其醫療利用與診斷檢查型態，並選擇其中具合併症的高血壓個案進行用藥型態分析，繼而與實證醫學臨床診療準則進行比較。結果：國內高血壓門診人次主要集中在醫學中心和基層醫療單位；以個案數而言，將近八成的高血壓個案固定於同一家醫療院所接受照護，且一年內平均每位個案門診次數為6.71次。若以高血壓實證醫學臨床診療準則為比較基礎，國內高血壓病人接受常規診斷檢查的比率偏低，且使用診療準則列為禁忌用藥的比率偏高。結論：國內高血壓疾病不論是診斷檢查型態或用藥型態，均與高血壓實證醫學臨床診療準則之建議有些差異。建議衛生主管機關應針對醫師與民眾進行宣導教育，而醫療服務提供者在診治病人時，亦建議參考實證醫學臨床診療準則，以提供病人更完善之醫療照護服務。
  Objectives: By using evidence-based practice guidelines developed in the United States, Great Britain and recommended by the World Health Organization (WHO) as references, this study attempted to analyze the pattern of ambulatory diagnosis and treatment of hypertension in Taiwan in the hope that these findings will contribute to the development of future quality guidelines for Taiwan. Methods: The study examined the outpatient claims data of the Bureau of National Health Insurance (BNHI) in the year 2000 and applied them for secondary data analysis. Based on the evidence-based guidelines, we then made a comparison in the practice pattern of hypertension in Taiwan. In addition, we also investigated the drug utilization among patients who presented with co-morbidities to see whether suboptimal treatment was in anyway linked to the development of co-morbid conditions. Results: The utilization rates of the hypertensive ambulatory care took place at a higher frequency in medical centers and clinics that offered primary care than in the regional and district hospitals. Eighty percent of the hypertensive patients sought their care from the same hospital, and the average number of visits was 6.71 per annum. Compared with the evidence-based guidelines, the yearly utilization rates were lower, but the frequency of inappropriate drug prescriptions was significantly higher in Taiwan. Conclusion: The pattern of diagnosis or drug use in hypertensive patients in Taiwan was significantly different from the evidence-based guidelines developed in the United States, Great Britain and recommended by the WHO. We urge that physicians practice according to the established, evidence-based guidelines to treat ambulatory hypertensive patients in order to assure the quality of care. We also encourage the BNHI to monitor the adherence to the guidelines on an ongoing basis.
• 201 - 213
• 10.6288/TJPH2006-25-03-04

• Link 原著 Original Article
• 女性安非他命使用者之強暴受害經驗、保險套使用與以性換藥或金錢之行為：愛滋病防治初探性研究Sexual Violence Victimization and Condom Use in Relation to Exchange of Sexual Services by Female Methamphetamine Prisoners: An Exploratory Study of HIV Prevention
• 李思賢
  Tony Szu-Hsien Lee
• 保險套 ； 女性藥物使用者 ； 愛滋防治 ； 糖果妹 ； 強暴受害經驗
  Condom ; Female Drug Users ; HIV Prevention ; Sugar Girl ; Victims of Rape
• 目標：在台灣街頭，「糖果妹」指的是女性藥癮者以性換藥或金錢的術語。本研究目的是探討台灣地區女性安非他命戒治者以性換取藥物或金錢的行為及其相關因子。方法：因為本研究調查的行為相當敏感，所以在說明研究並詢問女性藥物戒治者參與研究的意願後，請研究參與者簽署研究同意書。最後有270位18歲以上、識字、曾經使用過安非他命的女性戒治者填寫問卷。結果：在270位參與者中，有86位(32%)曾經以性換藥或金錢；只有15%在最後一次性交時有使用保險套。分析結果發現以性換藥或金錢的參與者的平均年齡較大、第一次使用非法藥物時年齡較小、較可能有多重性伴侶、以及有被強暴的經驗。結論：本研究結果發現女性藥物戒治者以性換藥或金錢的狀況是存在的，而且整體參與者的保險套使用率相當低，足以讓愛滋及其他性傳染病有感染與擴散機會。本研究建議針對女性安非他命使用者的愛滋防治計畫不僅需要促進保險套的使用，同時亦需要提供強暴受害經驗的心理諮商。
  Objectives: In Taiwan, the street term ”sugar girl” refers to an individual who performs a sex act in exchange for drugs or money. This study aimed to determine factors associated with exchange of sexual services by female methamphetamine offenders in Taiwan. Methods: Given the personal nature of the collected data, eligible participants were asked to indicate their willingness to participate by signing consent forms. Surveys were conducted on 270 literate female prisoners aged over 18 with a history of methamphetamine offense. Results: Of the 270 participants, 86 (32%) had previously exchanged sex for drugs or money. Only 15% had used a condom during their last sexual intercourse. The results showed that women who exchanged sex were more likely to be older, have used illicit substances at an earlier age, have multiple partners, and have been raped. Conclusions: The findings provide evidence that exchanging sex and sexual violence were common, and condom use rates are low enough to encourage transmission of HIV and other STDs. Intervention programs need to not only promote condom use but also need to provide counseling to victims of rape.
• 214 - 222
• 10.6288/TJPH2006-25-03-05

• Link 原著 Original Article
• 2000年台灣腦中風發生率與盛行率的城鄉差異Urban and Rural Difference in Prevalence and Incidence of Stroke in 2000 in Taiwan
• 廖建彰、李采娟、林瑞雄、宋鴻樟
  Chien-Chang Liao, Tsai-Chung Li, Ruey S. Lin, Fung-Chang Sung
• 中風 ； 盛行率 ； 發生率 ； 台灣
  Stroke ; Prevalence ; Incidence ; Taiwan
• 目的：中風是全球主要死因之一，在台灣是第二大死因。本研究報導2000年台灣中風發生率與盛行率。方法：我們使用2000年台灣全民健康保險承保抽樣歸人檔，依年齡、性別、中風型態與都市化程度，估計腦血管疾病的發生率與盛行率。抽樣檔總計共有200,000位民眾，年齡都在一歲以上。而中風病例是根據國際疾病分類法第9版來定義，包括住院病患及門診病患。結果：本研究結果顯示，腦血管疾病的粗盛行率與發生率分別為19.8/1,000及6.87/1,000，男性的中風盛行率比女性的來得高（20.7/1,000對18.9/1,000，p=0.003）。而經過年齡校正後的中風發生率卻是女性稍高於男性(6.64/1,0002對6.71/1,000)。與其他都市化地區民眾相較，住在低都市化地區的民眾有較高的中風危險(OR=1.32，95%CI=1.22-1.43)，但在多變項羅吉斯回歸中並不顯著。與年輕的民眾相較，中風危險在45-64歲即開始大幅增加(OR=6.9，95%CI=5.9-8.0)、65-79歲(OR=19.2，95%CI=16.5-22.3)及≧80歲(OR=20.8，95%CI=19.6-25.7)。結論：本研究發現，台灣2000年的中風盛生率偏高，男女發生率相近，城鄉差異小，較高年齡者其中風的危險性也高。應對特定年齡族群進行適切的介入，推動中風防治措施如高血壓等，以減少中風之發生。
  Objectives: Stroke is one of the leading causes of death worldwide, and the second most lethal cause of death in Taiwan. This study reported the urban and rural difference in prevalence and incidence of stroke in Taiwan. Methods: We used the data of 2000 cohort sample of National Health Insurance to estimate the prevalence and incidence of stroke. Data for information on age, sex, disease status, and urbanization were used in this study. This cohort consists of 200,000 persons of all ages except infants. Cases of stroke were identified according to International Classification of Disease 9th edition (ICD9) for both inpatient and out patients. Results: The crude prevalence and incidence of stroke were 19.8/1,000 and 6.87/1,000, respectively, in 2000. Men had a higher prevalence than women had (20.7/1,000 vs. 18.9/1,000, p=0.003). However, the age-adjusted incidence of stroke was slightly higher in women than in men (6.71/1,000 vs. 6.64/1,000, p=0.23). The results of logistic regression analysis showed that people lived in the least urbanized area were also at higher risk of stroke (OR=1.32, 95%CI=1.22-1.43), compared with those lived in the highest urbanized area. This disparity disappeared in the multivariate logistic regression. Compared with those younger, people had higher risk of stroke incidence were those aged 45-64 (OR=6.9, 95%CI=5.9-8.0), 65-79 (OR=19.2, 95%CI=16.5-22.3), and ?80 (OR=20.8, 95%CI=19.6-25.7) years. Conclusion: Our findings suggest that there is a high prevalence of stroke in Taiwan in 2000, but no risk differences between males and females, and between urban and rural areas. Age-specific intervention approaches are necessary to halt the incidence of stroke events and associated risk such as hypertension prevention for the elderly.
• 223 - 230
• 10.6288/TJPH2006-25-03-06

• Link 原著 Original Article
• 護理之家護理人員心理社會因子與肌肉骨骼傷害相關性之追蹤研究A Follow-Up Study of Psychosocial Risk Factors for Musculoskeletal Disorders among Nursing Personnel in a Nursing Home
• 馮兆康、毛義方
  Chao-Kang Feng, I-Fang Mao
• 肌肉骨骼傷害 ； 心理社會 ； 護理人員 ； 前瞻性研究
  musculoskeletal disorders ; psychosocial ; nursing personnel ; follow-up study
• 目標：許多國家的研究顯示，在護理之家工作的護理人員有很高的肌肉骨骼傷害率。本追蹤研究的主要目的在於評估位於彰化某護理之家女性護理人員之頸、肩與下背部之肌肉骨骼傷害發生率，以及探討與上述三部位肌肉骨骼傷害有關之職場心理社會因子。方法：本研究是一個為期1年的追蹤研究，基線資料共有80位女性護理人員受訪，其中75位經過1年追蹤後完成第2次受訪。兩次調查都以人員面訪之方式收集問卷中的資料，問卷主要變項包括自覺身體部位之肌肉骨骼傷害、個人特徵、自覺身體負荷情形以及心理社會因子（如工作控制、病人之情緒負荷、時間壓力、工作滿意及社會支持）。結果：此75位受訪者，頸部、肩部及下背部傷害之年發生率分別為38.2%、54.8%及55.9%。單變項分析顯示，時間壓力及自覺身體負荷與頸部傷害有關；時間壓力及病患情緒負荷與肩部傷害有關；下背傷害則僅與現職年資有關。經過邏輯斯複迴歸分析，自覺身體負荷大及時間壓力大者有較高發生頸部傷害之機會；時間壓力大者有發生較高肩部傷害機會；現職年資越短則有較高發生下背部傷害機會。結論：護理人員之肌肉骨骼傷害是多因性的，而時間壓力是發生肌肉骨骼傷害最有關之心理社會因子，建議在成本控制許可下，院方多聘護理人員以減輕工作負擔，進而降低時間壓力對肌肉骨骼傷害之影響。
  Objectives: Nursing personnel working in nursing homes have quite a high musculoskeletal disorders (MSDs) rate in many countries. The aims of this follow-up study were to access the incidences and to explore the work-related psychosocial factors for neck, shoulder and low back disorder among female nursing personnel at a nursing home located in Chunghua. Methods: In this one year follow-up study, the baseline data comprised 80 female nursing personnel to complete a questionnaire by face-to-face interview. Of these, 75 (93.8%) completed a second questionnaire 1-year later. The variables of this questionnaire including self-reported MSDs in different body regions, personal characteristics, perceived physical exertion and psychosocial factors such as job control, emotional demand of clients, time pressure, job satisfaction and social support. Results: Of the 75 subjects, the 1-year incidence rate of neck, shoulder and low back disorder were 38.2%, 54.8% and 55.9%, respectively. Univariate analysis showed that time pressure and perceived physical exertion were related to neck disorders; time pressure and emotional demand of clients were related to shoulder disorders; and current work-years were related to low back disorders. Multiple logistic regression analysis revealed that the higher the perceived physical exertion and the higher the time pressure, the greater the risk of neck disorders; the higher time pressure, the greater the risk of shoulder disorders; while the less the current work-years, the more the risk of low back disorders. Conclusions: This study indicated that factors related with incident MSDs were multiple. In particular, time pressure was the most important psychosocial factor. For lowering time pressure and physical loading and also decreasing MSDs occurrence among nursing personnel, this study suggests that the employer should hire more staff under cost controls.
• 231 - 241
• 10.6288/TJPH2006-25-03-07

• Link 實務 Public Health Practice
• 事故傷害外因註碼：國際疾病分類第九版與第十版之比較External Cause of Injury Coding: A Comparison of the Ninth and Tenth Revisions of International Classification of Diseases
• 呂宗學、江東亮
  Tsung-Hsueh Lu, Tong-Liang Chiang
• 死因 ； 死因統計 ； 國際疾病分類 ； 外因 ； 事故傷害防制
  cause of death ; cause of death statistics ; International Classification of Disease ; external causes ; injury prevention
• 目標：比較國際疾病分類第十版與第九版對於事故傷害外因註碼分類架構的差異，提供事故傷害死因統計使用者參考。方法：首先進行相關文獻回顧，接下來針對四個主要外因（陸上運輸、跌倒、溺水與中毒）及意圖與機轉矩陣進行第十版與第九版單一註碼之對應比較。結果：外因註碼在第九版還是補充分類，但是在第十版已經成為正式章節。第十版外因註碼三位碼有372個分類項，第九版只有192個分類項。第十版還增加了發生地碼與活動碼兩種選擇性第四位碼，提供更多環境與情況相關訊息。第十版陸上運輸事故之外因註碼採取矩陣分類架構，一個完整註碼要同時包括受傷者與對方的用路型態相關訊息（譬如行人、腳踏車、機車或汽車等）。第十版跌倒新增的註碼大多與老人有關（譬如被其他人搬運或扶持、輪椅或其他傢俱相關跌倒）。第九版溺水外因註碼重視活動相關訊息（譬如運動、娛樂或工作），第十版重視發生地與情況相關訊息（譬如澡盆、游泳池或大自然水中）。第十版還特別將溺水區分當時在（游泳池游泳）與跌入（游泳池）兩種訊息，有相當不同的防制意涵。中毒是第十版唯一分類項數目少於第九版的主要外因。相較於第九版，第十版的意圖與機轉矩陣分類架構較完整，每一意圖（意外、自殺、他殺或不確定）都有相關機轉（跌倒、溺水、中毒、撞擊或火燙傷等）的註碼。結論：就分類架構而言，第十版事故傷害外因註碼的確比第九版可以提供更多環境與情況相關訊息。可惜台灣第九版死因統計只註碼三位碼，因此許多與事故傷害防制相關的第四碼訊息無法獲得。台灣第十版將使用四位碼註碼，事故傷害外因註碼訊息可用性應該會提高。
  Objective: To contrast the differences in the classification scheme of external cause of injury (ECI) coding between the Tenth and Ninth Revision of International Classification of Diseases (ICD-9 and ICD-10). Methods: We first reviewed the relevant references and then contrasted each code of four main ECI (i.e., land transport, falls, drowning and poisoning) and intent and mechanism matrix between ICD-9 and ICD-10. Results: The ECI was a supplement in ICD-9 and became a formal chapter in ICD-10. The number of 3-digit codes is 372 and 192 in ICD-10 and ICD-9, respectively. Two optional 4 digit codes (i.e., place of injury and activity) were added in ICD-10, which could provide more information on environmental events and circumstances. A matrix classification scheme was used for land transport coding in ICD-10, a complete code should include the road user type (e.g., pedestrian, bicycle, motorcycle or car) of both victim and counterpart. Most of the newly added codes in ICD-10 for falls are elderly-related (e.g., being carried or supported by other persons, involving wheelchair or other furniture). The 4th digit of drowning codes concerned more on activities (e.g., sports, recreations or work related) in ICD-9. Nevertheless, in ICD-10 more information was required regarding to place and circumstances (e.g., bath-tub, swimming pool or natural water). Besides, ICD-10 further classified drowning as 'while in' (e.g., swimming pool) or 'fall into' (e.g., swimming pool), which had different implication for injury prevention. Poisoning was the only main ECI of which the number of codes decreased from ICD-9 to ICD-10. Conclusions: With regard to the classification scheme, ECI in ICD-10 could provide more information on environmental events and circumstances compared with ICD-9. However, the 4th digit-related information was not available in Taiwan because only 3-digit codes were used for ICD-9. The 4-digit codes will be used in Taiwan for ICD-10, the ECI information will be increased.
• 242 - 251
• 10.6288/TJPH2006-25-03-08