27卷5期

• Link 原著 Original Article
• 職場疲勞量表的編製與信效度分析Development and Validation of an Occupational Burnout Inventory
• 葉婉榆、鄭雅文、陳美如、邱文祥
  Wan-Yu Yeh, Ya-Wen Cheng, Mei-Ju Chen, Allen Wen-Hsiang Chiu
• 疲勞 ； 職場疲勞量表 ； 工作壓力 ； 信度 ； 效度
  burnout ; burnout inventory ; work stress ; reliability ; validity
• 目標：編製中文版職場疲勞量表，並進行信效度檢驗。方法：以2007年台北市職場身心健康狀況調查之參與者為對象，包括男女性受僱工作者各2891、2704名，其中服務業員工佔52%，製造與水電燃氣業員工佔48%。此量表包括「個人疲勞」、「工作疲勞」、「服務對象疲勞」與「工作過度投入」四個分量表。問春也測量工作特質。自評健康狀況。工作壓力感受與工作滿意度。結果：四個分量表的Cronbach's alpha coefficients均在0.84以上。因素分析顯示，「個人疲勞」與「工作疲勞」題目歸屬於同一因素，而「服務對象疲勞」與「工作過度投入」的題目則分別屬於第二、第三個因素。此量表得分與其他工作。健康指標的相關性，大致而言符合預期：以「工作疲勞」為例，疲勞指數與工作負荷（在男女性相關係數均0.49）。工作壓力感受（男050，女053）。心理困擾程度（男068，女065）呈正相關；與自評健康（男-0.36，女-0.38）。工作滿意度（男-0.40，女-0.45）呈負相關。結論：此量表信效度良好，可做為評估職場健康之工具，亦有助於工作者健康意識的提升。
  Objectives: This study was designed to evaluate the reliability and validity of an occupational burnout inventory. Methods: Study subjects were participants of a workplace health survey conducted by the City Government of Taipei, including 2891 male and 2704 female paid employees. Among them, 52% were employed in service sectors, 48% in industrial sectors. A self administered questionnaire was used that included four subscales-personal burnout, work-related burnout, client-related burnout, and over-commitment to work. Also included were measures for work conditions, self-rated health status, perceived work stress and job satisfaction. Results: Cronbach's alpha coefficients for the four subscales were all above 0.84. Exploratory factor analysis showed that all items of the ”personal burnout” and ”work-related burnout” subscales loaded on the first factor, while items of the ”client-related burnout” and ”over-commitment to work” subscale closely corresponded to the second and the third factor, respectively. The four dimensions of our occupational burnout inventory correlated with burnout-related factors in expected directions; for example, the ”work burnout” scores for men and women were both positively associated with job demands (correlation coefficient=0.49 for men and women), perception of job stress (0.50 for men, 0.53 for women) and levels of psychological distress (0.68 for men, 0.65 for women), and were negatively associated with self-rated health status (-0.36 for men, -0.38 for women) and job satisfaction (-0.40 for men, -0.45 for women). These associations were consistent with prior hypotheses. Conclusions: The occupational burnout inventory in this study was found to be a reliable and valid tool for assessment of burnout problems. It can be applied as a screening tool in the workplace, and can help to identify high-risk groups for burnout as well as to improve employees' health consciousness.
• 349 - 364
• 10.6288/TJPH2008-27-05-01

• Link 原著 Original Article
• 花蓮縣山地鄉與非山地鄉死亡率趨勢之探討，1986-2005年Mortality Trends between Aboriginal and non-aboriginal Areas in Hualien, 1986-2005
• 蔡淑芬、張慈桂
  Sue-Fen Tsai, Tzu-Kuei Chang
• 標準化死亡率 ； 山地鄉 ； 非山地鄉 ； 花蓮縣
  Standardized mortality rate ; aboriginal areas ; non-aboriginal areas ; Hualien
• 目標：花蓮縣有三個山地鄉，分別為秀林、萬榮、卓溪，透過對山地鄉及非山地鄉民眾的死亡率趨勢探討分析，可進一步瞭解民眾之健康狀況及差距。本研究目的為呈現1986∼2005年花蓮縣山地鄉及非山地鄉的死亡率及重要死因，並比較健保實施前後十年之變化，期能提出相關之政策建議。方法：研究資料來自「衛生署死因統計檔」及「台閩地區人口統計」，以花蓮縣2000年人口組成為標準人口，用直接標準法計算標準化死亡率，並比較趨勢。結果：花蓮縣山地鄉之死亡率從1986年每十萬人口1575人到2005年1509人，非山地鄉從1986年每十萬人口1054人到2005年765人，不同區域均有下降之情形；兩區域之死亡率相對比值在1986年為1.49，到2005年為1.97，其差距反而拉開；事故傷害、慢性肝炎及肝硬化及肺結核之死亡率均有下降，但山地鄉仍高於非山地鄉。結論：花蓮縣山地鄉與非山地鄉之死亡率呈現下降趨勢，但其死亡率差距卻拉開，未來應針對造成差距拉大的原因進一步釐清。
  Objectives: Hualien county includes three aboriginal areas and can be used as a good example to illustrate the health differences between aboriginal and non-aboriginal regions. The aim of this study is to demonstrate the mortality trends between these two populations in their respective regions in Hualien from 1986 to 2005, and to compare the mortality rate before and after the launching of national health insurance in 1995. Methods: Mortality data comes from the Mortality Registry conducted by the Department of Health, from 1986 to 2005. Census data are based on the Taiwan-Fukein Demographic Fact Book from the Ministry of the Interior. We used the 5-year demographic distribution of Hualien in 2000 as the standardized population to calculate the direct standardized mortality rate. Results: The mortality rate in aboriginal areas decreased from 1575 (per 100,000) in 1986 to 1509 in 2005. The same trend was also evident in the nonaboriginal area (1054 persons/per 100,000 in 1986 to 765 in 2005). But the relative ratio of the mortality rate between aboriginal and non-aboriginal regions rose from 1.49 in 1986 to 1.97 in 2005. The mortality rates due to accidents, cirrhosis of the liver, and tuberculosis declined, but aboriginal areas still had a higher rate than the non-aboriginal area. Conclusions: The overall mortality rate in Hualien decreased from 1986 to 2005, irrespective of whether a region was classified as aboriginal or non-aboriginal. But the mortality trends between the two populations in their respective regions were significantly different. An increasing health disparity was evident in this study during the study period. This indicates that additional studies to determine the risk factors that affect health in aboriginal areas are needed in the future.
• 365 - 372
• 10.6288/TJPH2008-27-05-02

• Link 原著 Original Article
• 醫院結核病個案管理模式之探討Analysis of Tuberculosis Case Management Models in Hospitals
• 李婉萍、許玫玲、吳怡君、湯澡薰、黃國哲、莊志杰
  Wang-Ping Lee, Mei-Ling Sheu, Yi-Chun Wu, Chao-Hsiun Tang, Kuo-Cherh Huang, Jyh-Jye Juang
• 個案管理模式 ； 醫療給付改善方案試辦計畫 ； 結核病 ； 醫院
  Case management model ; Pay-for-quality demonstration program ; Tuberculosis ; Hospital
• 目標：本論文旨在瞭解目前醫院結核病個案管理模式的內涵，並進一步探討「結核病醫療給付改善方案」試辦計畫等因素對於醫院採取的個案管理模式內涵之影響。方法：本研究的研究母群體為衛生署90-93年度醫院評鑑結果屬於地區（含）以上之醫院，共有462家，問卷填答對象則為上述醫院中負責執行結核病個案管理工作之人員。研究人員於民國95年3月初開始寄發問卷，最後的實際有效研究樣本數為234家醫院。結果：樣本醫院所採行之結核病個案管理模式的內涵可歸類為人力配置、收案管理、資料建立、治療管理、護理指導、回診管理及轉介管理等七項。統計分析結果顯示，除了轉介管理此要項外，加入「結核病醫療給付改善方案」試辦計畫的醫院在人力配置等要項均優於未加入該試辦計畫的醫院。結論：研究結果顯示「結核病醫療給付改善方案」試辦計畫對醫院有正面的影響力，本研究對於衛生主管機關並提出「有計畫性地培育醫院結核病防治人才」等六項建議。
  Objectives: The purpose of this study was to investigate the current management of tuberculosis patients in Taiwan's hospitals and to analyze the impact of hospital characteristics on the inclusion of various components of the model for tuberculosis case management. Methods: Using the 2001-2004 hospital accreditation data, the study population comprised more than 462 district hospitals in Taiwan. The survey was conducted in early March 2006 by mailing self-administered questionnaires to the individuals in charge of managing tuberculosis patients in those hospitals. The final effective sample size was 234. Results: The results showed that, except for the referral management aspect, hospitals that were participating in the pay-for-quality demonstration program performed better in terms of manpower allocation, admission management, and the like. Conclusions: This study demonstrated that the pay-for-quality demonstration program did exert a positive influence on management of tuberculosis patients in these hospitals. Six policy recommendations, such as increasing the training of tuberculosis case managers, were proposed on the basis of these research findings.
• 373 - 384
• 10.6288/TJPH2008-27-05-03

• Link 原著 Original Article
• 健康行為形成的生命歷程探討：以計程車司機嚼檳榔行為為例On the Lifecourse of the Formation of Health Behavior: The Example of Areca Quid Chewing of Taxi Drivers
• 郭淑珍
  Shu-Chen Kuo
• 健康不平箏 ； 生命歷程 ； 嚼檳榔行為
  health inequalities ; lifecourse ; areca quid chewing
• 目標：在健康不平等的研究中，對早期家庭生活所扮演的角色討論較有限，本研究以嚼檳榔行為例，分析影響嚼檳榔行為形成與持續的社會機制，主要藉由生命歷程(lifecourse)觀點來解釋研究結果。方法：研究者到計程車司機活動的場域（排班點與休息處），透過深入訪談去收集相關資料。結果：本研究發現參與研究的計程車司機會開始嚼檳榔，主要是與其早期居住地的鄰里、社區之社會環境以及早期職業環境有關。在早期居住地的鄰里、社區之社會環境影響可以分為其成長於檳榔產區、家裡賣檳榔、以及男性家人給予等方面來說明。在早期職業環境影響可以分為體力勞動工作、與運輸相關的工作、以及社交應酬的工作。結論：從生命歷程的研究觀點，生命歷程不同階段所處的社會經濟位置，對健康行為的形成有不同的機制，司機們原生家庭的社會層級位置、早期職業環境脈絡與其開始嚼食檳榔行為有相關。透過此研究，對於早期生命歷程如何影響健康相關行為形成有初步的了解，期待未來有更多的相關研究，以便進一步釐清社會層級影響健康的機轉。
  Objectives: In health inequality research, there are few discussions of subjects in the early stages of family life. This study uses the approach of lifecourse to discuss the relationship between the early social status of areca quid-chewing taxi drivers and the development of their areca quid-chewing behavior. Methods: Data were collected through in-depth interviews with taxi drivers while they were relaxing or were waiting in lines in Taipei. Results: For those taxi drivers participating in this research, the start of their areca quid chewing was associated with the social context of their early residence and their early work environment. The factors that influenced the social context of their early residence included areca quid production areas near the areas where they grew up, their families who ran areca quid stalls, and male family members who were also areca quid chewers. The factors that influenced the early work context included physically demanding manual labor, transportation-related work, and a work-related social network. Conclusions: From the viewpoint of a lifecourse study, the socioeconomic positions that we assume in different stages of our life influence the formation of our health behavior. The social status of the taxi drivers' families of origin and their early work context are related to their adoption of areca quid chewing. This study gives a preliminary understanding of how social status affects the formation of health-related behavior, and we expect in the future there will be more related research to help us further clarify how social status shapes the decisions we make regarding our health.
• 385 - 398
• 10.6288/TJPH2008-27-05-04

• Link 原著 Original Article
• 台北縣市高職學生開始使用成癮物質之危險與保護因子追蹤研究A Prospective Study of the Risk and Protective Factors of Substance Use among Vocational High School Students in Taipei
• 李景美、張鳳琴、賴香如、 江振東、李碧霞、陳雯昭、張瑜真
  Ching-Mei Lee, Fong-Ching Chang, Hsiang-Ru Lai, Jeng-Tung Chiang, Pi-Hsia Lee, Wen-Jau Chen, Yu-Chen Chang
• 吸菸 ； 飲酒 ； 嚼檳榔 ； 使用成癮藥物 ； 青少年
  smoking ; alcohol use ; betel-quid chewing ; illicit drug use ; youth
• 目標：本三年追蹤研究旨在探討高職學生開始使用成癮物質(吸菸、飲酒、嚼檳榔、使用成癮藥物)的情況，及其危險與保護因子長期的變化情形。方法：從高一至高三計有1763名台北縣市高職學生完成三年追蹤調查(2000-2002)問卷填答，以邏輯迴歸檢視開始使用成癮物質之危險與保護因子的變化情形。結果：由高一未使用成癮物質者追蹤至高三時分別有166名(11.0%)、184名(13.1%)、40名(2.3%)、28名(1.6%)學生表示開始吸菸、飲酒、嚼檳榔與使用成癮藥物。開始使用成癮物質者較未使用者在高一時顯著有較多的危險因子（如同儕使用、邀約使用、涉足不良場所、使用其他成癮物質如菸、酒等），且危險因子在高一至高三間增加幅度較大。相對的，開始使用者在高一時的保護因子（如拒絕成癮物質自我效能、反對使用的態度等）顯著較少，且保護因子由高一至高三減少幅度也較大。結論：高一時有較多的危險因子與較少的保護因子及長期變化危險因子的增加與保護因子的減少皆顯著預測高職生開始使用成癮物質的行為。
  Objectives: This three-year longitudinal study examined changes in the patterns of risk and protective factors of substance initiation (smoking, alcohol use, betel quid chewing, and illicit drug use) among a vocational high school student cohort in Taipei. Methods: A total of 1763 10th graders were followed to the 12th grade (2000-2002). Logistic regression was used to examine the baseline and longitudinal changes in risk and protective factors for substance initiation. Results: Among students who did not use any substances in grade 10, 166 (11.0%), 184 (13.1%), 40 (2.3%), and 28 (1.6%) students initiated smoking, alcohol use, betel quid chewing, and illicit drug use by grade 12, respectively. In the 10th grade, higher risk factors, such as peer use, being offered the substance by another person, concomitant substance use (i.e., smoking and alcohol use), and lower protective factors, such as refusal selp-efficacy and presence of an antisubstance use attitude, predicted youth substance initiation by grade 12. Increases in risk factors and decreases in protective factors from the 10th to 12th grades were significantly associated with substance use initiation in youths. Conclusions: The risk and protective factors in grade 10 and longitudinal changes from grade 10 to 12 predicted youth substance use initiation.
• 399 - 410
• 10.6288/TJPH2008-27-05-05

• Link 原著 Original Article
• 心與靈的健康觀與疾病觀－以現代泰雅族原住民為例As Long as My Mind and Soul Are Healthy-A Study of Health and Illness Cognition among Aboriginal People in Taiwan, Atayal Tribe
• 陳芬苓、徐菁苹
  Fen-Ling Chen, Ching-Pin Shu
• 原住民 ； 泰雅族 ； 健康與疾病觀 ； 心理健康
  aboriginal people ; Atayal tribe ; health and illness cognition ; mental health
• 目標：瞭解原住民族詮釋健康與疾病的特殊性，由其文化脈絡下的生病詮釋，探索原住民對生病與健康的看法，及與現代西醫溝通的困境。方法：以深入訪談法及觀察法收集資料，以桃園縣復興鄉的泰雅族村民為對象，以滾雪球抽樣方式訪談二十二位醫護人員及村民。結果：泰雅族的疾病觀念認為疾病是生命自然循環中的一部份，因此當疾病發生的時候，不是亟思於將疾病去除於生活的軌道，而是如何將病痛納入生活軌道的一部份，繼續運作下去。在泰雅族人的健康觀念中，心理健康與社會健康是健康的人所應具備的基本要素，也是身體不健康的根源。結論：原住民族自有詮釋身體與自然關係的生命價值觀，他們重視心理健康、對疾病正向思考模式、強調人與自然、人與靈的和諧相處、並重視社會健康概念等，許多觀念值得漢民族學習，對他們疾病與健康觀的瞭解強化我們對本土不同社會文化疾病觀的瞭解。
  Objectives: This study explored how aboriginal people in Taiwan define 'healthy people,' including mental and physical health, and how they view the existence of disease. Methods: In-depth interviews and observation were conducted with the Atayal People in the Fu-shing village of Taoyuan County. There were 22 health-related workers and villagers who were interviewed. Results: The Atayal people regard health and disease as a natural circle of life. If disease develops, their goal is to live with the disease as best they can instead of getting rid of it. They also emphasize the importance of mental health and social health, and regard their failing as the root of physical disease. Conclusions: Aboriginal people have valuable perspectives towards health and illness which are worthy for us to learn. They value mental health and healthy social relationships within families and throughout the community. They also have a grounded view of the relationships between humans and nature, and apply positive thinking when disease strikes. The understanding of aboriginal perspectives towards health and illness enhances our knowledge of health and illness viewpoints in terms of cultural differences.
• 411 - 420
• 10.6288/TJPH2008-27-05-06

• Link 實務 Public Health Practice
• 醫院導入學習型組織的變革模式探討－以某地區教學醫院為例An Organizational Change Model of a Hospital Initiated by a Learning Organization: A Case Study in a Community Teaching Hospital
• 蘇崑山、李昭華、楊遠誠
  Kun-Shan Kun, Chao-Hua Li, Yuan-Cheng Yang
• 學習型組織 ； 組織變革
  learning organization ; organizational change
• 目標：探討醫院導入學習型組織，以促動組織變革的模式為何？並歸納出哪些行動對於誘導變革朝向預定目標有幫助？方法：我們將研究個案長達六年多來推動學習型組織的學習歷史，透過訪談稿、觀察記錄及會議記錄，多方面資料的質性分析來探討。結果：一、醫院能夠持續推動學習型組織並促使組織變革轉型的原因，是來自於變革小組組成實踐社群的先導群，且推動的目的能順應組織階段的需求，達成組織階段的目標。二、並以專案式的團隊學習模式，發展學習型組織的核心能力，作為組織發展再轉型的能量，促使組織的變革轉型。三、在醫院組織變革的過程中，醫院導入學習型組織工具與新的學習架構，與醫院的脈絡(contexts)互動後，產生出阻力和助力，而促使變革經歷轉型，所遇的變革挑戰來自於變革代理人需調適轉型的成效和阻力，使變革活動和組織的願景相結合，產生出醫院品質管理的組織績效。結論：藉由調適，學習，再轉型的過程模式，個案能持續應用學習型組織的理論於實務，逐步邁向學習型組織。
  Objectives: To explore an organizational change model of a hospital initiated by a Learning Organization (LO), and to induce factors that will facilitate the fulfillment of both short-term goals and long-term visions. Methods: A longitudinal case study was implemented at a hospital that had six years of prior interactions with a LO, and qualitative data analysis was performed on the learning history, interview transcripts, observation notes and meeting records. Results: (1) The continuation of a LO is due to the steering committee's practice of alignment between the promotion of the LO and the organizational goals. (2) Then, the learning capacity of a LO is expanded through team-learning projects, which promote organizational development and the shift of organizational change to different phases. (3) In the transformational process, difficulties are encountered because the facilitators must face impediments arising from interactions between new organizational learning tools and organizational contexts. A necessary task is for change agents to monitor the periodic effects of change and ensure that the change activities meet the demands of medical quality control, so that change can be compatible with an organization's mission and performances. Conclusions: The process model of adaptation, learning, and re-transformation calls for the continuous application of the LO concept to the hands-on practices of a hospital and makes a learning organization accessible.
• 421 - 433
• 10.6288/TJPH2008-27-05-07

• Link 實務 Public Health Practice
• 建立臨床醫師對於醫學影像儲傳系統之滿意度指標Developing an Indicator for Measuring Clinicians' Satisfaction of Using PACS
• 郭金順、陳俞成、俞芹英、劉忠峰
  Chin-Shun Kuo, Yu-Cheng Chen, Chin-Yin Yu, Chung-Feng Liu
• 醫學影像儲傳系統 ； 臨床醫師 ； 終端電腦使用者滿意 ； 服務品質
  Picture Archiving and Communication System PACS ; Clinician ; End User Computing Satisfaction ; Service Quality
• 目標：以調查研究法(Survey)，提出衡量臨床醫師對於使用醫學影像儲傳系統(PictureArchiving and Communication System, PACS)之滿意度指標。方法：研究架構主要是以Doll和Torkzadeh於1988所發展資訊的內容、資訊的正確性、資訊的輸出格式、容易使用與即時性等五大構面之終端電腦使用者滿意(EUCS, End user computing satisfaction)衡量指標以及資訊系統之「服務品質」構面為基礎，研究對象為南部某醫學中心之臨床科醫師。結果：研究問卷共發出364份，回收有效問卷174份，回收率為47.8%。因素分析後共萃取出包含18項變數之3個因素可用於衡量臨床醫師對於PACS之使用滿意度。結論：3個因素依內容特性命名為「資訊品質」、「系統品質」與「服務品質」，與DeLone和McLean於2003所提之資訊系統成功模式之概念相符合。研究結果亦發現，不同科別對於「資訊品質」之滿意度沒有顯著差異，但是「系統品質」與「服務品質」則顯示內科的滿意度高於外科。
  Objectives: The purpose of this research is to develop structured indicators in order to measure clinicians' satisfaction with PACS. Methods: This research framework is mainly based on the five constructs of the Doll and Torkzadeh's model of end user computing satisfaction (EUCS). The sixth construct, information system service quality, is taken from literature review and practical observation. Results: Out of 364 questionnaires that were sent to the clinicians of a medical center, 174 valid ones were returned, which showed a high response rate of 47.8%. After factor analysis processing, three factors with 18 measurement items were extracted, which were used to measure clinicians’ satisfaction toward using PACS. Conclusions: The results from the questionnaires revealed that there were three predominant quantification factors, which were named ”information quality,” ”system quality” and ”service quality,” and are similar to the concept expressed in the DeLone and McLean's updated IS Success Model. The results of this study also show there is no difference in satisfaction among different clinical departments regarding the information quality; however, clinicians of internal medicine showed a higher satisfaction than surgeons for system quality and service quality.
• 434 - 446
• 10.6288/TJPH2008-27-05-08