24卷3期

• Link 公衛論壇 Public Health Forum
• 衛生署組織再造：心理健康機制之建立Reform of the Department of Health in Taiwan: The Establishment of Mental Health
• 張珏
  Chueh Chang
• 無
  none
• 無
  none
• 185 - 188
• 10.6288/TJPH2005-24-03-01

• Link 公衛論壇 Public Health Forum
• 擴大健康服務提供者和健康照護專業在長期照護服務的角色Expanding the Role of Health Service Providers and the Health Care Profession in the Delivery of long-term Care
• 吳淑瓊、莊坤洋、戴玉慈、李世代、張宏哲、戴桂英、陳秀玫
  Shwu-Chong Wu, Kun-Yang Chuang, Yu-Tzu Dai, Shyh-Dye Lee, Hong-Jer Chang, Guey-Ing Day, Hsiu-Mei Chen
• 無
  none
• 無
  none
• 189 - 191
• 10.6288/TJPH2005-24-03-02

• Link 公衛論壇 Public Health Forum
• 正視物質濫用Comments on Substance Abuse in Taiwan
• 宋鴻樟、陳秋瑩
  Fung-Chang Sung, Chiu-Ying Chen
• 無
  none
• 無
  none
• 192 - 196
• 10.6288/TJPH2005-24-03-03

• Link 綜論 Review Article
• 健康綜合測量的發展與啓示Development and Prospects for Summary Measures of Population Health
• 梁玲郁、黃旭明、藍忠孚
  Ling-Yu Liang, Shiuh-Ming Huang, Chung-Fu Lan
• 全球疾病負擔 ； 國家疾病負檐 ； 健康綜合測量 ； 失能調整人年 ； 健康調整平均餘命
  GBD (Global Burden of Disease) ; NBD (National Burden of Disease) ; SMPH (Summary Measures Population Health) ; DALYs (Disability-Adjusted of Life Years) ; HALE (Health-Adjusted Life Expectancy)
• 公元2000年世界健康報告採用失能調整人年(DALYs)及失能調整平均餘命(DALE)為評估健康績效之單位，此指標是一種健康綜合測量(SMPH)。健康綜合測量是以同一測量單位表示致死性及非致死性健康成果，此單位具有比較、分解及評估各類不同傷病之功能。健康綜合測量種類繁多，不同測量指數、有不同的失能定義、不同的測量方法、不同的價值判斷及不同結果。本文簡介健康綜合測量的概念、種類、目的、道德（價值觀）、技術面及應用此技術時，當注意事項及限制。
  The World Health Report 2000 adopted DALYs and DALE to measure the performance of the health system. DALYs and DALE are two kinds of Summary Measures of Population Health (SMPH). SMPH combines information on fatal and non-fatal health outcomes into a single numerical index. This index can be used to compare, decompose and evaluate the health status of the population. Several kinds of SMPH have been developed, which have different methods to obtain a complex of social and personal attributes that represent the health status. Different approaches of SMPH lead to different results. This paper introduces fundamental theories, typology, purposes, key ethics and issues and the technical methodology of SMPH.
• 197 - 208
• 10.6288/TJPH2005-24-03-04

• Link 原著 Original Article
• 台灣地區男性大腸癌與攝護腺癌篩檢狀況Colorectal and Prostate Cancer Screening Practices among Men in Taiwan
• 廖建彰、王心怡、林端雄、謝長堯、宋鴻樟
  Chien-Chang Liao, Hsin Y Wang, Ruey S. Lin, Chang-Yao Hsieh, Fung-Chang Sung
• 大腸癌；攝護腺癌；篩檢率
  colon cancer ; prostate cancer ; screening practice
• 目標：本文報導台灣地區50歲以上男性在近年實行大腸癌與攝護腺癌篩檢的程度和相關因素。方法：利用隨機抽樣的方式，進行以成年人（≧20歲）為對象的電話訪問，問卷內容包括受訪者的基本人口社經資料、癌症篩檢經歷以及生活形態。結果：本文分析其中521名50歲以上男性受訪者的大腸癌和攝護腺癌篩檢經驗，其中有122人(23.4%)曾經做過大腸癌篩檢，68人(l3.0%)有過攝護腺癌篩檢的經驗。籍貫(P=0.034)或職業(P=0.001)是和大腸癌篩檢有相關的顯著因素。60歲以上受訪者的攝護腺癌篩檢率高於50-59歲受訪者的篩檢率（l7.7%對7.9%）(P=0.013)，吃檳鄉(P=0.05)或沒有運動習慣(P=0.05)的受訪者比較不做大腸癌篩檢，抽菸的男性亦較傾向不做攝護線癌篩檢(P=0.05)，癌症認知程度對提昇篩檢攝護線癌(P＜0.001)比大腸直腸癌更顯著(P=0.118)。結論：國人的大腸癌或攝護腺癌篩檢率普遍低落，和癌症認知差異的相關，攝護腺癌篩檢實踐的比大腸癌的明顯。有不健康的生活形態之男性其篩檢率更低，顯示這方面的癌症預防應該加以重視。
  Objective: This study investigated the screening practices of colorectal cancer and prostate cancer among men who aged 50 years and above in Taiwan. Methods: Using a random telephone dialing system, we interviewed adults aged 20 years and above to collect information about their socio-demographic characteristics, cancer screening experiences and lifestyles. Results: Among 521 men aged 50 and above, 122(23.4%) had undergone colorectal cancer screening, and 68(13.0%) had experienced prostate cancer screening. Ethnicity (p=0.034) and occupation (p=0.00l) were factors significantly associated with the colorectal cancer screening. Men of 60 years old and above were more likely to have had the prostate cancer screening than were men of 50-59 years old (p=0.0l3). Smokers were also less likely to have had prostate cancer screening practice than nonsmokers (p=0.05). The rate of colon cancer screening was lowered for betel nut users (p=0.05) or for men did not exercise (p=0.05). Prostate cancer screening was significantly associated with cancer knowledge level. Conclusion: This study showed that only a small portion of men have experienced screening test for the colorectal cancer and prostate cancer in Taiwan. Intensified promotion of these screening practices is needed, especially for those with an unhealthy lifestyle and lack of the cancer knowledge.
• 209 - 216
• 10.6288/TJPH2005-24-03-05

• Link 原著 Original Article
• 台灣愛滋病毒母子垂直感染個案之分析探討Case Analysis of Current mother-to-child HIV Transmission in Taiwan
• 黃彥芳、 謝雅汶、蔡淑芬、歐乃銘、 蘇益仁
  Yen-Fang Haung, Ya-Wen Hsieh, Su-Fen Tsai, Nai-Ming Ou, Ih-Jen Su
• 愛滋病毒 ； 母子垂直感染 ； 健康權法令
  HIV ; mother-to-child transmission ; MTCT
• 目標：國內自1988年通報第l例母子垂直感染愛滋病毒個案，至2003年底累積9名個案。本文旨在了解個案感染之相關因素及預後，以收防微杜漸之效。方法：母子垂直感染個案為獲自所研析疾病管制局1988至2003年的通報資料庫，我們進一步透過家庭訪視收集感染疾病史相關資料，再以描述性統計歸納。結果：9名個案，男4名、女5名。通報時年齡最大8歲、最小1歲。9名個案分別由8位愛滋母親所生（3位外國籍），其中7位懷孕生產皆不知已感染，l位已知感染但隱瞞感染事實，8位母親懷孕產檢皆無愛滋病毒篩檢，造成9位愛滋嬰兒皆未有預防措施而感染。又4對夫妻雙方皆感染，3位小孩因父母一方刻意隱瞞造成對方感染而發生。結論：為防治國內母子愛滋病毒垂直感染，全民健保應提供孕婦愛滋病毒諮商篩檢服務，並研議保障感染者配偶和性伴侶相對健康權的法令等政策。
  Objectives: This report described factors and prognoses associated with HIV vertical transmission cases in Taiwan. Methods: Descriptive statistical analysis was performed on childhood HIV/AIDS using a data bank obtained from the Center for Disease Control in Taiwan. Trained public health nurses were employed to interview with patients, mothers or their family members for collecting information on infection history. Results: Nine HIV vertical transmission cases had been reported by 2003 in Taiwan since 1988, 4 boys and 5 girls ages between 1 years old and 8 years old at diagnosis. They were born to 8 HIV infected mothers and 4 infected fathers. None of these mothers had been tested for HIV for prenatal care. Among the mothers, 7 had no knowledge of their HIV status at pregnancy, 1 person who gave birth to 2 infected cases intentionally kept secret of their infected status, and 3 persons were immigrants from other Asian countries. Two persons (one mother and one father) didn't reveal their HIV status to their spouse that induced 3 vertical transmission cases. Conclusion: This study suggests that HIV counseling and testing should be provided to all pregnant women in Taiwan. Along with a more vigorous policy, mandated by law to protect the spouse or partners of the infected.
• 217 - 223
• 10.6288/TJPH2005-24-03-06

• Link 原著 Original Article
• 高中職學生對藥物濫用認知調查－以參與反毒大使活動之學校為對象Awareness of Illegal Drug Use in Senior and Vocational High School Students That Participated in the anti-drug Ambassador Campaign
• 李佳琪、朱日僑、陳黛娜、賴璟賢、李志恒
  Chia-Chi Lee, Jih-Chiao Chu, Dai-Na Chen, Jiin-Shian Lai, Jin-Heng Li
• 藥物濫用；青少年；危害認知；毒品；非法用藥
  illegal drugs ; drug abuse ; anti-drug ; teenagers ; knowledge of drug abuse
• 目標：本研究調查台灣地區高中職學生對於藥物濫用與犯罪行為之認知及對親友藥物濫用特徵的了解程度。方法：由國內高中職學校依自由雅薦參選校園反毒大使活動之132所學校學生為目標族群；每校取五十名學生進行自填式結構問卷調查。結果：有效回收問卷計6,414份，96.5%的學生知道施用毒品是犯罪行為，98.0%的學生知道毒品的害處，其中危害認知的途徑以學校(46.8%)和媒體(31.7%)為主。同學或親友有藥物濫用情形者占13.8%，其中以安非他命(50.8%)、強力膠(36.5%)、搖頭丸(29.3%)及大麻(24.1%)為濫用藥物的前四位。而毒品主要來源為由朋友或同學提供(54.5%)及向KTV、PUB、電動玩具店等場所購買(38.1%)。結論：安非他命類的藥物為高中職學生所認知同學或親友使用之最大宗；而實際藥物濫用程度可能比我們所調查的高。
  Objectives: This study investigated the knowledge of drug abuse among senior and vocational high school students and their acknowledgment of drug abuse by their friends and relatives. Methods: We conducted a questionnaire survey among students at 132 high schools that had participated in the Anti-Drug Ambassador Campaign. Fifty students were selected from each school. Results: Among 6,414 students who responded to this survey, 96.5% acknowledged the use of illegitimate drugs as criminal. Students were more likely to learn of the health effects of illegal drugs at school (46.8%) and from the media (31.7%). Overall, 13.8% of students that became aware of the illegal behavior among their classmates and relatives, the use of (Meth) amphetamine (50.8%), glue (36.5%), MDMA (29.3%), and marijuana (24.1%) had surged. These drugs were obtained through friends/classmates (54.5%) and entertainment places, such as KTV's, MTV's, PUBS, Cafe's, restaurants, and video arcades (38.1%). Conclusion: Amphetamine and its derivatives accounted for the largest share of the illegal drug use that high school students were aware of. The prevalence of drug abuse in Taiwan might be greater than we are aware of.
• 224 - 229
• 10.6288/TJPH2005-24-03-07

• Link 原著 Original Article
• 領導型態與團體效能相關性探討：以大台北地區醫院品管圈為例The Relationship between Leadership Style and Group Effectiveness: An Example of Quality Control Circles of Hospitals in Taipei Area
• 曾勤媛、蘇慧芳、謝碧晴
  Chyn-Yuan Tzeng, Hui-Fang Su, Pi-Ching Hsieh
• 領導型態 ； 團體效能 ； 品管圈
  Leadership style ; Group effectiveness ; Quality control circles
• 無
  Objectives: The aim of the study was to examine the association between the leadership styles and group effectiveness of quality control circles (QCCs) of hospitals accredited at the level beyond regional teaching in the Taipei area. Methods: Based on the predictive corelational design, data were collected from target members of QCCs by using structured questionnaires modified from Stogdill's LBDQ-? and Hwang's group effectiveness questionnaires from May 2002 to June 2002. At a group response rate of 86.8%, 263 QCC groups including 1994 cases from 16 hospitals in the Taipei area were enrolled for analysis using individual circle members as the study targets. Results: The result of logistic regression analysis revealed significantly positive association between combined task and consideration-oriented leadership and group effectiveness (OR=1.47, p<.001). Multiple regression analysis also showed considerably positive association between combined task and consideration-oriented leadership and group effectiveness (ß=.052, p<.001). The results were consistent with the leadership of combined product center and people center as the best one to promote the group effectiveness reported by O'Donnell & O'Donnell and the characteristics of democratic leadership style in the managing grid theory proposed by Blake and Mouton. Conclusions: This study discovers the leadership style of combined task and consideration-orientation is a basic aspect in the training course of enhancing hospital QCC effectiveness, can promote human relations and group interactions, and, moreover, achieves persistently high group effectiveness.
• 230 - 238
• 10.6288/TJPH2005-24-03-08

• Link 原著 Original Article
• 民眾如何看待健康教育訊息：深度訪談嚼檳榔的計程車司機Lay Perspectives of Health Education Information: in-depth Interviews with Areca Quid Chewing Taxi Drivers
• 郭淑珍、丁志音、陳怡君
  Shu-Chen Kuo, Chih-Yin Lew-Ting, Yi-Chun Chen
• 嚼檳榔 ； 計程車司機 ； 健康教育訊息 ； 常民知識
  areca quid chewing ; taxi driver ; health education information ; lay knowledge
• 目標：本研究探索嚼食檳榔的計程車司機，如何思考所接收到的檳榔相關健康訊息。方法：研究者利用深度訪談的方式，自2003年l月至8月訪問了44位嚼檳榔的計程車司機。結果：本研究大部分受訪司機，都曾由不同管道接觸檳榔危害的相關訊息，但是對於檳榔的健康危害，卻有更寬廣的看法。有些司機會從個人的健康狀況、體質與基因、是否實踐某些健康生活方式、是否做好口腔清潔工作等因素，以為檳榔危害的整體考量。有些司機認為自己是檳榔「專家」，他們認為只有嚼檳榔的「量」過多，或是嚼「錯」檳榔才會產生健康危害。少數司機認為生活中危害健康的因素無所不在，或是有比「健康」更重要的事情，所以檳榔的健康危害不足為道。結論：嚼檳榔的計程車司機並非是無知者，需要更多、更好的檳榔危害知識。本研究訪談的司機將其所接收到檳榔相關訊息與其原本的健康知識、生活經驗相連，重新詮釋檳榔危害的訊息，並採取相關行動。公衛專家需由常民觀點思考健康訊息，才能與民眾對話，進一步達成改變的契機。
  Objectives: This study examined areca quid chewing taxi drivers' perspectives of areca quid related health information. Methods: Accompanied by an ex-taxi driver, the author visited one taxi driver for each interview at drivers' rest areas or waiting lines in Taipei. The interview conversation focused on the health effects of the behavior and the driver's thoughts. Results: A total of 44 areca quid chewing taxi drivers were interviewed in-depth between January and August 2003. Most taxi drivers received areca quid related health information from a variety of channels. However, they had very broad view of areca quid information. Some drivers identified their health status, constitution or genes, participation in a healthy lifestyle, and oral hygiene practices in determining the health risk of areca quid chewing. Some drivers considered themselves areca quid experts, and suggested that the health risk of areca quid was from an ”overdose” or chewing the ”wrong” kind of areca quid. A few drivers believed areca quid health information to be trivial. They said the hazardous environment and their daily survival were far more important than the health risk of chewing areca quid. Conclusions: Areca quid chewing taxi drivers are not uneducated individuals who require more or better areca quid health information. They integrated areca quid information with their own personal health knowledge and their daily experience, reinterpreted areca quid information, and took action. In order to communicate with the public and to change health behavior, public health experts need to recognize the significance of lay knowledge.
• 239 - 253
• 10.6288/TJPH2005-24-03-09

• Link 實務 Public Health Practice
• 臺灣地區大學在學生生活品質及其相關因素初探A Preliminary Investigation on the Quality of Life and Its Correlation among College Students in Taiwan
• 高月慈
  Yueh-Tzu Kao
• 生活品質 ； 大學生 ； 臺灣
  quality of life ; college students ; Taiwan
• 目標：自評的健康相關生活品質可用於評量個人的身心健康狀態，而目前國內有關在學大學生的生活品質的探究有限，本研究目的在於探討這一群體的生活品質的預測因子及相關因素。方法：採立意取樣，於臺灣北、中、南、東四區，選取15所大學院校參與，再以方便取樣方式施發1735份問卷，剔除無效問卷，共得1470份有效問卷。問卷內容包括：自尊、社會支持、生活品質及個人基本資料。使用的統計方法有描述性統計、多階層?歸、變異數分析、Scheffe事後比較及t檢定。結果：生活品質的顯著預測因子包括自尊、社會支持、性別。男生、自尊及社會支持高者，其自評生活品質為高。有關學校類別及學校地區的事後比較顯示，公立學校學生自評生活品質高於就讀私立學校及宗教設立學校的學生；就讀於中部地區的學生自評生活品質高於就讀北部及南部地區的學生。結論：研究結果顯示，在探研大學生生活品質的議題上，除考量自尊、社會支持、性別外，環境因素，如學校類別或學校地區也應列入考量。
  Objectives: Self-reported health-related quality of life has been utilized as an indicator for individuals' health. Yet, research regarding college students' quality of life is scant in Taiwan. Therefore, the purpose of this study is to examine the quality of life among college students in Taiwan. Methods: 1735 students from 15 selected universities were invited to participate in the study. Among them, there were 1470 valid responses. A questionnaire was designed to test the following variables: self-esteem, social support, quality of life and demographic information. A hierarchical multiple regression model, ANOVA, Scheffe Post-hoc and t-test were chosen for data analyses. Results: the valid predictors for overall quality of life were self-esteem, social support, and gender. The results of the Post-hoc test indicated that public school students reported higher quality of life than students studying in private or religion-connected schools; moreover, students studying in central Taiwan reported higher quality of life, compared to their counterparts whose schools were in northern and southern areas. Conclusions: both individual factors, e.g. self-esteem, and environmental factors, e.g. school type, all have to be taken into account when dealing with the issue regarding quality of life.
• 254 - 263
• 10.6288/TJPH2005-24-03-10