28卷2期

• Link 綜論 Review Article
• 職業性腕隧道症候群Occupational Carpal Tunnel Syndrome
• 洪怡珣、謝仕福、洪于琇、林銘川
  Yi-Shiung Horng, Shih-Fu Hsieh, Yu-Shiow Horng, Ming-Chuan Lin
• 腕隧道症候群 ； 神經傳導速度檢查 ； 超音波檢查 ； 人因工程危險因子
  carpal tunnel syndrome ; nerve conduction velocity study ; ultrasonography ; ergonomic risk factor
• 職業性腕隧道症候群盛行於諸多須使用震動性手工具、手腕部重複性動作或過度用力的行業，許多國家包括台灣已將其列為職業病。近年來諸多研究致力於各種手腕部動作及角度對腕隧道壓力的影響，以期找出職業性腕隧道症候群的危險因子。神經傳導速度檢查常被用來診斷腕隧道症候群，但其有偽陰性及偽陽性之可能。近年來超音波亦被嘗試用來診斷腕隧道症候群，然而其診斷標準尚未有共識。未來若能建立腕隧道症候群之超音波診斷標準，當可彌補神經傳導速度檢查之不足。職業性腕隧道症候群之治療，除了可以藉由配戴副木、藥物、物理治療、局部類固醇注射或手術治療以減輕症狀之外，若能於高危險的職場進行人因工程評估，藉由改善工作流程、姿勢或器具等方法，減少危害因子的暴露，將可達到預防的目的。總而言之，本篇文章擬由危險因子、致病機轉、臨床診斷以及治療等方面進行文獻回顧，並針對目前臨床診斷治療可能遭遇之問題進行探討及建議。
  Occupational carpal tunnel syndrome is common in occupations that involve the use of vibrating manual tools or tasks with highly repetitive and forceful manual exertion. Carpal tunnel syndrome has been recognized as an occupational disease in many countries, including Taiwan. In recent years, many studies have evaluated the effects of hand/wrist posture and repetitive motion on carpal tunnel pressure. The purpose of these studies has been to identify risk factors for occupational carpal tunnel syndrome and to identify innovative approaches to the management of these risk factors. Nerve conduction velocity studies have been used as a diagnostic tool for carpal tunnel syndrome. However, false positive and false negative results have been reported. Ultrasonography has been applied to evaluating carpal tunnel syndrome, but there is still a lack of consensus regarding its diagnostic criteria. With more effort on the establishment of accurate diagnostic criteria, ultrasonography could be used as an alternative diagnostic method for carpal tunnel syndrome. Treatment of carpal tunnel syndrome includes the use of splints, physiotherapy, drug therapy, local steroid injection, and surgery. Secondary prevention could be achieved through implementation of ergonomic programs and in providing sound ergonomic working areas to reduce injury in high-risk groups. In this review, we highlight difficulties in the clinical diagnosis of occupational carpal tunnel syndrome and suggest strategies for its management. We also review risk factors, pathogenesis, diagnosis, and treatment of occupational carpal tunnel syndrome.
• 85 - 92
• 10.6288/TJPH2009-28-02-01

• Link 原著 Original Article
• 社區藥局戒菸諮詢站之成效評估初探Preliminary Evaluation of a Smoking Cessation Counseling Program Provided by Community Pharmacists
• 姜郁美、郭鐘隆、 闕妤榛、邱怡玲、黃久美
  Yu-Mei Chiang, Jong-Long Guo, Yu-Chen Chueh, Yi-Ling Chiu, Chiu-Mieh Huang
• 社區藥局 ； 介入 ； 戒菸諮詢
  community pharmacy ; intervention ; smoking cessation counseling
• 目標：本研究欲評估社區藥局戒菸諮詢站之成效，以供日後政策推動與進行宣導教育時作為依據與參考。方法：台北縣市30位社區藥師接受16小時的訓練後提供民眾戒菸諮詢服務，以上網登錄方式蒐集個案相關資料，收案當天有485人，持續完成於收案當天、收案後第1、3和7天共四次諮詢有279人，追蹤完成率為57.53%。而在第6個月追蹤到209人。結果：研究發現民眾接受諮詢後的第3天、第7天及第6個月追蹤，其點戒菸率分別為32.3%，48.7%，22.6%。於第7天時，重度菸癮者較輕度菸癮者的戒菸比例低（勝算比＝0.33），藥師評估需要替代療法者較不需要者的戒菸比例低（勝算比＝0.32）。於第6個月時，已婚者相較之下戒菸的比例較高（勝算比＝2.25），重度菸癮者較輕度菸癮者在戒菸的比例為低（勝算比0.25），藥師評估需要替代療法者、或近期再評估者較不需要者的戒菸比例低（勝算比＝0.03, 0.04）。結論：本研究4次共約1小時的總諮詢時間即能在第7天有近5成的個案戒菸，是將來宣導或藥師研習時可強化藥師推動社區藥局戒菸諮詢的動機。然而第6個月的戒菸個案降至22.6%，如何協助民眾持續戒菸將是未來藥師執行戒菸諮詢時需努力之處。
  Objectives: The aim of the study is to assess the effects of a smoking cessation counseling program provided by community pharmacists. Methods: Thirty community pharmacists from the municipality and county of Taipei participated in a 16-hour training course, and then offered a smoking cessation counseling service. Data on participants were collected through online registration. A total of 485 volunteers were recruited on the first visit. Upon completion of recruitment, three consecutive follow-ups were conducted on the first, third and seventh days after the first visit. By the third follow-up, 279 volunteers remained in the program, achieving a completion rate of 57.53%. At the end of the sixth month, a total of 209 participants remained in the program. Results: Study results revealed that the smoking cessation rates on the third and seventh day, as well as the sixth month after receiving counseling, were 32.3%, 48.7% and 22.6%, respectively. On the seventh day, the smoking cessation rate was significantly lower in participants with a severe tobacco addiction than those with a minor addition (odds ratio=0.33). Participants who required nicotine replacement therapy (NRT) as assessed by pharmacists had a lower smoking cessation rate than those who didn’t (odds ratio=0.32). In the sixth month, married smokers tended to have a higher smoking cessation rate than single smokers (odds ratio=2.25). The recurrent cessation rate was also lower in participants with severe tobacco addiction compared with those of minor addiction (odds ratio=0.25). Compared with participants who did not require an NRT, a lower cessation rate was observed in participants in need of a NRT and those in need, but to a lesser extent (odds ratio=0.03, 0.04). Conclusions: The findings serve as a foundation for the implementation and promotion of a smoking cessation policy and related education. Four counseling sessions with a total of approxmate, one hour of counseling resulted in nearly half of the participants quitting smoking by the seventh day. The results of this study will serve as an incentive to encourage the promotion of smoking cessation counseling services at community pharmacies; however, the smoking cessation rate declined to 22.6% in the sixth month after counseling. When pharmacists provide smoking cessation counseling in the future, a focus on how to assist smokers to quit permanently is needed.
• 93 - 102
• 10.6288/TJPH2009-28-02-02

• Link 原著 Original Article
• 台灣地區老人自殺之流行病學分析：1985-2006An Epidemiologic Analysis of Elderly Suicide in Taiwan: 1985-2006
• 劉慧俐
  Hui-Li Liu
• 老人 ； 自殺死亡率 ； 流行病學 ； 防治 ； 台灣地區
  elderly ; suicide rate ; epidemiology ; prevention and control ; Taiwan
• 目標：近十幾年來老年人自殺死亡逐年增加，本研究旨在描述自1985至2006年間老人自殺死亡率的長期趨勢，並分析其年代、年齡及世代效應。在人口老化趨勢下，老人自殺議題，應該受到各界的關心及重視。方法：利用行政院衛生署1985-2006年之死因統計資料，透過整理自殺老人(ICD9: E950-959)在性別、年齡、婚姻狀況、和縣市別及所使用之自殺方式與自殺月份的差異，並以Spearman's correlation coefficient及Wilcoxon matched-pair signed-rank test檢定。結果：2006年台灣地區65歲以上老人自殺死亡率為每十萬人口38.84人（其中男性50.78，女性27.18）。針對1985-2006年台灣地區老人自殺死亡率分析，男性自殺率高於女性，約1.69倍；以年齡來看，75歲以上高於65-74歲自殺死亡率，約1.45倍。就婚姻狀況來看，未婚之男性自殺死亡率較高，女生則是喪偶者自殺死亡率較高。以自殺者之自殺方式來看，老人大多採用吊勒方法，其次為固體或液體物質中毒的方法；自1993起，其他如：跳樓、溺水等的自殺死亡式逐漸增加。以自殺者之自殺月份來看，老人自殺多在4-7月（春夏季），而1-2月及12月則較少（冬季）。以縣市別來看，1985年至1992年所有縣市自殺死亡率皆呈下降趨勢；1993年至2006年，大多數的縣市自殺死亡率呈上升趨勢，惟有澎湖縣、桃園縣、高雄縣及宜蘭縣自殺死亡率呈現下降趨勢。世代效應在本研究並未出現，反而是年齡與時期的影響較深。結論：台灣老年人自殺確有愈嚴重的趨勢，加以經濟不景氣，全球金融海嘯影響，自殺防治工作不容延怠。
  Objectives: The mortality rate of suicide has increased among the elderly aged 65 years and above in recent years. This study was conducted to examine the long-term trends in elderly suicide mortality in Taiwan from 1985 to 2006 and to analyze the effects of age, time period, and cohort. Since the elderly population is expected to increase rapidly in Taiwan, the issue of the rising mortality rate among the elderly warrants further investigation. Methods: Data used in the analysis were obtained from the Death Certification data file provided by the Department of Health (DOH) from 1985 to 2006 on annual mortality for persons over age 65 with external cause-of-death codes E950-E959 and. Spearman's correlation coefficient and Wilcoxon matchedpair signed-rank test analysis were used to examine the relationship between study year and suicide rate, age, marital status, region as well as method-specific suicide rates for both sexes. Results: The elderly mortality rate of suicide was 38.84/105 (50.78 for male, 27.18 for female) in 2006. From 1985 through 2006, the suicide rate had steadily decreased, but an intriguing reversal has been observed since 1993. The gender ratio among the elderly was 1.69. The mortality rate of suicide rose significantly among those aged 85 years and above. Never married males and windowed females have the highest age-adjusted sex and marital status-specific rates. The modes of suicide changed, with hanging, strangulation, and suffocation most commonly used by bothgenders, but they increased significantly in jumping from a high place and drowning use. Seasonal trends showed a significant peak in April-July. Winter months and the Chinese New Year period had the lowest occurrence. Suicide rates among older Taiwan residents vary by region with the rate increasing in all regions since 1993 expected Penghu, Taoyuan, Kaohsiung, Ilan county. From an age-period-cohort analysis, the age and period were more important determinants than the cohort was. Conclusions: In conclusion, suicide is a serious issue among the elderly. The public health and social welfare interventions necessary to alleviate this social and human problem cannot be delayed.
• 103 - 114
• 10.6288/TJPH2009-28-02-03

• Link 原著 Original Article
• 促進社區民眾健走行為計畫之成效Effectiveness of Promoting Walking Behavior for Community Residents
• 林莉茹、李蘭、黃瓊華、古乃先、張奕涵
  Li-Ju Lin, Lee-Lan Yen, Chun-Hwa Huang, Nai-Hsien Ku, Yi-Han Chang
• 健走 ； 社區 ； 介入 ； 社會認知理論
  walking ; community ; intervention ; social cognitive theory
• 目標：促進社區民眾之健走行為，並評量計畫執行後之成效。方法：台北市某健康服務中心為促進社區民眾健走行為，立意選取台北市某一行政區內的四個社區進行實驗計畫。其中，兩個社區分別視為「增強組」（36人）或「觀摩組」（39人）；另外兩個社區則視為「自學組」（42人），亦即實驗計畫中所謂的「對照組」。介入活動之執行期間為六個月，增強組（獎勵持續執行健走行為者）和觀摩組（模仿並執行講師示範的健走行為）之介入策略係參考社會認知理論設計；自學組之介入策略是傳統寄發衛教單張的做法。為評量計畫執行後之成效，研究者利用自行設計的問卷，於介入策略執行前與執行後，分別收集「前測」與「後測」資料。將每位參與民眾的前測與後測資料連結後，進行資料分析。結果：促進社區民眾健走行為計畫執行後，三組民眾之健走行為，不論以「每週健走次數」、「每週健走量」或「健走的行為階段」為衡量指標，均比計畫執行前顯著增加或變好。控制其他影響因素後，不論是「每週健走次數」、「每週健走量」或「健走的行為階段」，均呈現「增強組」及「觀摩組」顯著優於「自學組」的結果。結論：由地方衛生機關執行之促進社區民眾健走行為計畫是有效的，而且應用社會認知理論所設計的增強及觀摩介入策略，均顯著優於傳統的自學方式。
  Objectives: The study evaluated the effectiveness of walking intervention programs for community residents. Methods: Residents from four communities in a district of Taipei city were included in this study. One community was assigned to ”reinforcement group” (n=36), another was assigned to ”observing-learning group” (n=39), the other two communities were assigned to ”self-learning group” (n=42). For six months these three groups received the following intervention strategies: (1) the ”reinforcement group” residents were rewarded for walking behavior according to their performance, (2) the ”observing-learning group” observed and imitated demonstrations by the lecturers; (3) the ”self-learning group” received written materials. Data was collected before and after the intervention through a questionnaire developed by researchers. Results: At the end of the intervention program all three groups had improved their walking behavior in terms of frequency of weekly walking, time spent in weekly walking, and the stage of walking behavior. After controlling for other factors, the ”reinforcement group” and the ”observation-learning group” increased the frequency of weekly walking, time spent in weekly walking, and the stage of walking behavior, more than the ”self-learning group”. Conclusions: It is feasible for local public health centers to assist community groups to set up a walking intervention program. Intervention strategies designed by the application of social cognitive theory are superior to self-learning.
• 115 - 123
• 10.6288/TJPH2009-28-02-04

• Link 原著 Original Article
• 探討超音波影像結石定位體外震波碎石的療效Exploration of the Curative Effect of ultrasound-based real-time Lithotripsy
• 陳志榮、鐘威昇、李麗花
  Chih-Jung Chen, Wei-Sheng Chung, Li-Hua Lee
• 尿路結石 ； 超音波碎石術 ； 結石碎裂率 ； 結石廓清率 ； 有效商
  urinary calculi ; ultrasound lithotripsy ; stone fragmentation rate ; stone free rate ; efficiency quotient
• 目標：探討體外震波碎石治療泌尿系統結石的療效和安全性。方法：2004-2007年於花東某區域醫院門診接受體外震波碎石術的病人為研究對象，總共1542位完成治療前和治療後一週、兩週、四週、三個月的相關資料收集，內容包含測量血壓、腹部X光攝影和腎臟超音波、小便分析及併發症的監測等。結果：腎結石者佔86.3%、輸尿管結石佔13.7%，治療平均花費22.7分鐘，過程未使用任何麻醉藥或止痛劑。震波治療後結石碎裂率為93.6%、廓清率78%，再次接受體外震波碎石者佔9.21%，接受輔助治療者佔2.39%，且與結石位置及大小有統計上明顯的差異(p≦.05)，治療有效商0.67。治療後和兩週後血壓有明顯下降；術後四週的尿液分析，血尿者完全改善且無感染發生，亦未發生皮下瘀青或腎臟血腫等傳統合併症，完成三個月之追蹤為86.7%。結論：本研究顯示體外震波碎石術有不錯的療效及很少的併發症，可能是自動雙定位結石追蹤系統提高碎石機對結石命中的機率，而將腎臟組織傷害降至最低，進而減少併發症的發生。
  Objectives: To explore the curative effect and safety of extracorporeal shock wave lithotripsy (ESWL) in the treatment of urinary calculi. Methods: From 2004-2007, 1542 patients received ESWL in a clinic of an Eastern Taiwan regional hospital. Blood pressure determination, abdominal x-ray, renal ultrasound, urinalysis, and assessment of complications were conducted prior to treatment and 1-, 2-, and 4-weeks, and 3-months post-treatment. Results: Urinary calculi were predominantly renal calculi (86.3%), with the remainder (13.7%) being ureteral calculi. Treatment averaged 22.7 minutes and never involved any anesthetic or analgesic. The fragmentation rate was 93.6% and stone free rate was 78%. ESWL re-treatment and auxillary treatment was necessary in 9.21% and 2.39% of cases, respectively. A statistically significant difference (p=0.05) was evident in the position and size of calculi. The efficiency quotient was 0.67. Blood pressure was significantly lower 2-weeks after treatment. Postoperative urinalysis 4-weeks post-treatment revealed total resolution of hematuria. Infection did not recur. Traditional complications such as subcutaneous bruises or renal hematuria never occurred. The 3-month tracking rate was 86.7%. Conclusions: ESWL is curative with fewer complications. These attributes reflect the enhanced targeting of calculi and lessened renal tissue damage.
• 124 - 131
• 10.6288/TJPH2009-28-02-05

• Link 原著 Original Article
• 某市養護機構住民身體被約束之狀況及相關因素之研究A Study on Status and Factors Associated with the Use of Physical Restraints among Residents of long-term Care Institutions in a City
• 黃惠璣、李中一
  Hui-Chi Huang, Chung-Yi Li
• 機構住民 ； 身體約束 ； 預防跌倒 ； 約束政策
  residents ; physical restraint ; preventing fall ; restraint policy
• 目標：本研究目的為了解養護機構對住民實施身體約束之比率及其相關因素。方法：本研究為橫斷面研究設計，以抽取機率與機構人數多寡成比例(Probability proportional to size, PPS)的方法從某市178所養護機構中選取20家共848名住民為本研究樣本。住民約束情形與疾病史資料分別以觀察及調閱病歷方式蒐集之，而身體功能、平衡能力、與肌力之資料亦是透過觀察或測量而獲得。本研究利用χ^2與simple t test比較受約束與未受約束住民特性之差異，也利用邏輯斯迴歸模式分析與住民接受約束或多重約束之顯著相關因素。結果：機構住民被約束及多重被約束的比率分別為74.1% (95% confidence interval, CI=71.2-77.0%)和47.8% (95% CI=39.9%-55.6%)。相較於無約束住民，約束住民有顯著較高中風、失智、與壓瘡的比率，入住時間也較久。此外，被約束住民的日常生活功能(Activity of Daily Living, ADL)、認知功能檢查(Mini Mental State Examination, MMSE)、左右腿及腳的肌力得分都顯著地較無約束住民差。住民被約束的原因以預防跌倒佔最多數(79.8%)。多變量分析發現，ADL得分增加與較低的被約束勝算(Adjusted Odds Ratio, AOR=0.98, 95% CI=0.97-0.99)及被多重約束(AOR=0.95, 95% CI=0.93-0.97)有顯著相關；此外，家屬簽署同意書與「甲等」機構住民被約束的勝算比也顯著較高。結論：相較於歐美國家，本研究顯示台灣機構住民身體被約束比率明顯偏高，本研究也發現約束比率高低與家屬簽同意書、機構評鑑等級及住民日常生活身體功能有顯著相關。
  Objectives: To investigate the rate of and factors associated with the use of physical restraints among residents of long-term care institutions. Methods: This is a cross-sectional study involving 848 residents sampled from 20 residential institutions using probability proportional to size (PPS) across a total of 178 residential institutions in one city. Information on the use of physical restraints and disease history was collected using observation and chart review. Physical functioning, balance and leg muscle power were also measured and recorded. ?^2 and simple t test were used to compare differences in characteristics between residents who were and were not physically restrained. A logistic regression model was used to identify factors significantly associated with odds of any type of physical restraint use or multiple physical restraint use. Results: The rate of any physical restraint use and multiple physical restraint use was estimated at 74.1% (95% confidence interval, CI=71.2-77.0%) and 47.8% (95% CI=39.9%-55.6%). Compared to those not physically restrained, residents who were physically restrained had a higher rate of cerebrovascular disease, dementia and pressure sores, and had been resident in the institution for longer. Restrained residents had a significant deficit in their scores for activity of daily living (ADL), Mini Mental State Examination (MMSE) and muscle power of both legs. The leading reason given for using physical restraints was ”preventing a fall” (79.8%). Multivariate analysis showed that an increased ADL score was significantly associated with reduced odds of the use of any physical restraint (Adjusted Odds Ratio, AOR=0.98, 95% CI=0.97-0.99) or the use of multiple physical restraints (AOR=0.95, 95% CI=0.93-0.97). Residents from institutions with a second grade by accreditation, whose families had signed an agreement for physical restraints, also showed a significantly increased AOR for the use of physical restraints. Conclusions: The use rate of physical restraint was higher in this Taiwanese residential sample compared to rates found in Europe and United States. Use rate varied within the institution and was associated with signed agreement and poorer physical functioning as indicated by the residents' ADL scores.
• 132 - 143
• 10.6288/TJPH2009-28-02-06

• Link 原著 Original Article
• 採用動靜脈瘻管或人工血管之血液透析病人住院醫療利用之分析Analysis on Hospital Utilization in Hemodialysis Patients with Different Types of Access
• 洪燕妮、吳肖琪、吳義勇、柯博仁
  Yen-Ni Hung, Shiao-Chi Wu, Yee-Yung Ng, Po-Jen Ko
• 血管通路 ； 血液透析 ； 醫療利用 ； 住院天數 ； 住院費用
  vascular access ; hemodialysis ; hospital utilization ; length of stay ; expenditure
• 目標：了解國內採用動靜脈瘻管或人工血管之血液透析病人住院醫療利用情形。方法：採回溯性世代研究法，以衛生署提供之健保門住診申報資料，選取2002年新透析病人，以其第一次建置血管通路為起始點追蹤其一年內之住院醫療利用，住院主因依美國腎臟資料系統(USRDS)分為8大類，自變項為血管通路類型，控制變項為性別、年齡、共病症、血管通路建置時間，以複迴歸模式分析住院利用之相關因素。結果：研究對象計6,228人，不論住院人次、天數及費用由8大類住院主因來看，均以血管通路問題(23.92%-25.32%)及泌尿系統(22.03%-26.29%)為主；人工血管在透析後一年內的8大類住院次數、住院天數、住院費用均較自體動靜脈瘻管平均值高；控制其他變項後，血管通路類型對住院次數、住院天數、住院費用仍有顯著影響。結論：血管通路問題是住院主因，不同血管通路類型之住院利用及費用有顯著不同，採用人工血管較自體動靜脈瘻管有更高的住院利用，宜鼓勵提高自體動靜脈瘻管的建置率，另外，如何在臨床及病人自我照護方面，避免血管通路的感染及栓塞值得重視。
  Objectives: To analyze the hospital utilization of end stage renal failure (ESRD) patients with different types of dialysis access in Taiwan. Methods: This analysis used claims data for all newly developed ESRD patients in 2002 from the Taiwan National Health Insurance (NHI) database provided by the Department of Health (DOH). Patients who died in the first year were excluded. We tracked all subjects for 12 months from the start of their dialysis access and reviewed data regarding the number of hospital admissions, length of stay, and expenditure. We grouped causes of admission according to the United States Renal Data System (USRDS) and used multiple regression to analyze the correlation between hospital utilization and type of vascular access by controlling other variables such as gender, age, co-morbidities, and time of access creation. Results: The leading causes of admission for 6,228 newly developed ESRD patients in 2002 were dialysis access related problems (23.92%-25.32%) and urology system related problems (22.03%-26.29%). The number of admissions, length of stay, and inpatient expenditure of ateriovenous graft (AVG) patients were significantly greater than those of arteriovenous fistula (AVF) patients during the first year post access creation. Conclusions: ESRD patients in Taiwan who accessed dialysis through AVG utilized more hospital resources than those with AVF. We encourage increasing the percentage of AVF creation rate for access. Lowering the incidence of access infection and thrombosis may also reduce medical expenditure on ESRD patients since access related problems were the leading cause of hospitalization of those patients.
• 144 - 154
• 10.6288/TJPH2009-28-02-07

• Link 實務 Public Health Practice
• 我國勞工健康檢查制度之現況與問題Current Conditions and Problems Regarding the System of Occupational Health Examination in Taiwan
• 鍾佩樺、尤素芬、鄭雅文
  Pei-Hua Chung, Su-Fen You, Ya-Wen Cheng
• 職業健康檢查 ； 職業健康 ； 政策
  occupational health examination ; occupational health ; policy
• 目標：勞工健康檢查是「職業健康服務」制度中相當重要的一環。對於工作者而言，是瞭解在職中的健康變化、早期偵測疾病的重要依據，更有助於釐清職業危害暴露對於健康的影響，甚至在離職退休後發現罹患職業病，亦是尋求補償認定的重要依據。本研究旨在探討我國勞工健康檢查制度現況與實務操作層面之問題。方法：研究材料主要來自15位相關人士之深度訪談（包括受僱者、工會代表、企業管理者，以及醫療健檢部門之執行者），並舉辦一次專家座談會，徵詢3位職業醫學與1位勞工安全衛生專家之意見。結果：我國勞工健檢雖有完整的制度設計，但實務運作上卻是問題重重，包括市場低價競爭、與全民健保成人健檢資源重疊、職業風險暴露記載不全、健檢資料缺乏有效的利用與管理、異常個案缺乏後續追蹤管理、職業醫學角色模糊、健檢資料保管與隱私權等問題。結論：本研究指出我國勞工健檢制度之問題，並提出改善建議。
  Objectives: Occupational health examination plays an important role in occupational health services. Its functions are to trace changes in workers' health status, to detect work-related health problems at an early stage, and most importantly, to clarify the impacts of occupational hazards on workers' health. Documenting the occupational health status of workers may also provide valuable information when disputes occur in compensation claims. This study was designed to examine current conditions and problems with the system of occupational health examination in Taiwan. Methods: In-depth interviews with 15 stakeholders, including employees, union representatives, managers of enterprises, and executives of medical care facilities, were conducted. Experts' opinions were solicited through panel discussion with 3 occupational physicians and 1 professional specializing in occupational safety and health. Results: Many problems exist with the system of occupational health examination despite the fact that the system, enacted by the Labor Safety and Health Act, is well established in Taiwan. Problems include vicious market competition, poor coordination with the health examination services provided by National Health Insurance, a lack of occupational risk profiles, poor management of health data, a lack of follow-up programs, passive to no participation of occupational health professionals, and poor regulation with regard to the protection of workers' privacy. Conclusions: We identified several problems evident in the current system of the occupational health examination, and made recommendations for improvement.
• 155 - 166
• 10.6288/TJPH2009-28-02-08