21卷2期

• Link 綜論 Review Article
• 台灣地區糖尿病流行病學Epidemiology of Diabetes Mellitus in Taiwan
• 周碧瑟、董道興、李佳琳、莊紹源、 林敬恆、楊南屏
  Pesus Chou, Tao-Hsin Tung, Chia-Lin Li, Shao-Yuan Chuang, Cheng-Heng Lin, Nan-Ping Yang
• 糖尿病 ； 流行病學 ； 併發症
  diabetes mellitus ; epidemiology ; complications
• 糖尿病 (Diabetes Mellitus) 主要可區分為第1型糖尿病 (Type 1 diabetes) 及第2型糖尿病 (Type 2 diabetes) 。由於盛行率及發生率的逐年增加，糖尿病已成為現階段主要的公共衛生課題。據估計全世界糖尿病病人數至2025年將上升至3億人(5.4%)。由於糖尿病患者常會伴隨併發症，包括大血管病變（如心臟血管疾病）、小血管病變（如視網膜病變、腎臟病變）及末梢神經病變，若不能有效控制血糖，以小血管病變而言，將會導致失明或末期腎病變，而末梢神經病變則將導致截肢等嚴重後遺症。 本文主要從實證醫學 (evidence-based medicine) 的角度，討論目前台灣地區糖尿及其併發症相關流行病學現況，希望藉由相關的文獻探討，以提供更多公共衛生訊息，並作為衛生機關日後建立相關篩檢及保健政策的參考，以便做好糖尿病病人之健康管理工作。（台灣衛誌 2002；21(2)：83-96）
  Diabetes Mellitus can be divided into type 1 and type 2 diabetes. Because of its increasing prevalence and incidence, diabetes mellitus has become a major public health challenge. Based on the current trends, the population of diabetic individuals will swell to a staggering 300 million and have increased in prevalence to an estimated 5.4% by the year 2025. Those who have poor blood sugar control would have sequential complications, including macro vascular diseases (CVD), micro- vascular diseases (retinopathy and nephropathy), and neuropathy. Furthermore, these complication may progress to severe states, including blindness, end-stage renal disease, and amputation. From the evidence-based medical viewpoint, this article is especially focused on discussing the epidemiology of diabetes mellitus and its complications in Taiwan. We hope that this literatur review could provide more information in establishing screening strategies and health management programs popular diabetic subjects.(Taiwan J Public Health. 2002;21(2):83-96)
• 83 - 96
• 10.6288/TJPH2002-21-02-01

• Link 綜論 Review Article
• 污染防治設施興建與民眾抗爭問題之探討AnInvestigation for the Problem of Mass Demonstration Against the Construction of Pollution Control Facilities
• 莊德豐
  Der-Fong Juang
• 環境衛生 ； 污染治設施 ； 環保設施 ； 環境保護政策
  Environmental health ; pollution control facilities ; environmental protection facilities ; environmental protection policy
• 政府為解決國內日益嚴重之環境污染問題、維護社區之環境衛生、提升國內之環境品質及全體國民之健康，遂逐步規劃建設污染防治設施（或環保設施），特別是衛生掩埋場、焚化爐及污水處理廠等。然當此類污染防治設施興建前，經常遭受附近居民激烈之反抗，嚴重者更可能使整個建設工作無法推動。針對民眾健康問題而言，若污染防治設施緊鄰居興建，對民眾之健康可能有潛在之威脅。但為能有效推動政府之環境保護政策，污染防治設施之興建更是無法避免，而如何能兼顧兩者且獲得平衡，乃值得探討及評估之問題。因此，本文將由國內污染防治設施之興建對環境保護政策之推動及民意衝突之問題進行探討，並以法治制層面進行剖析，以求得較可行之解決辦法，使未來國內污染防治設施之興建阻力得以減輕，同時可保障人民權利和健康，並達成公私利益平衡，希望藉以謀求政府與民眾之雙贏局面。（台灣衛誌 2002；21 (2)：97-106）
  To resolve the increasing environmental pollution problems, protect the environmental health of the community and upgrade the environmental quality and health of all citizens, the government has been planning to construct pollution control facilities (or environmental protection facilities) such as sanitary landfill, incinerator, wastewater treatment plant, and so on. However, the people living nearby always protest against the construction of the facility, and this may obstruct the development of the pollution control work. Although a potential risk to the civilian health might exist if the pollution control facility is constructed near the community, the construction of pollution control facilities is still be necessary to effectively promote the national environmental protection policy. Therefore, it is important to investigate and evaluate how to obtain a balance between the reduction of mass demonstration and the promotion of environmental protection policy. This article will discuss the problems regarding the construction of pollution control facilities and analyze them from a legislation point of view. It is hoped that the discussion and the conclusion of this article can provide available solutions in reducing any possible resistance, protecting civil rights and civilian health, reaching a balance between public and private benefits, and hopefully obtaining a winning solution for both government and citizens.(Taiwan J Public Health. 2002;21(2):97-106)
• 97 - 106
• 10.6288/TJPH2002-21-02-02

• Link 原著 Original Article
• 同儕比較回饋對醫師開立檢驗行為的影響，四個月的觀察Effect of Peer Comparison Feedback on Test Ordering Behaviour of Physicians: A Four-Month Observation
• 喻小珠、趙坤郁、黃凱琳、 王世叡、張玉君、黃靜宜、賴淑芬、莊惠真、黃昭聲
  Sheau-Ju Yuh, Kun-Yu Chao, Kai-Lin Hwang, Soo-Ray Wang, Yu-Jun Chang, Chin-Yi Huang, Shu-Fen Lai, Tammy Chuang, Chiau-Seng Hwang
• 介入性研究 ； 同儕比較 ； 回饋 ； 檢驗量 ； 檢驗支出
  intervention study ; peer comparison ; feedback ; number of tests ; laboratory expenditure
• 無
  Objectives: To test the hypothesis that it may be possible to reduce the number of tests and laboratory expenditure by periodic peer comparison paper feedback to physicians on statistic data of the number of tests which they prescribed. Methods: A prospective controlled trial was conducted at the outpatient clinics of Changhua Christian Hospital. Physicians from two different departments were selected as intervention group and control group to avoid contamination between groups. Among all the departments in this hospital, patients in the Department of Internal Medicine and the Department of Family Medicine have the most similar disease patterns. Five sex-, age-, and years of practice-matched physicians from each of the two departments were selected. Physicians from the Department of Family Medicine received monthly feedback from January through April in 1999 on their own statistic data of the number of tests per prescription of the preceding month. Physicians from the Department of Internal Medicine received no intervention. Prescriptions of these 10 physicians from January through April in 1998 were used as baseline data. Results: Number of prescriptions during the intervention period was 11,730 for feedback group and 7,263 for control group. During the study period, mean number of tests per prescription decreased in the feedback group (P<0.0l) and increased in the control group (P<0.0l)Laboratory expenditure decreased in the feedback group (P<0.00l), but had no significant change in the control group (P=0.11), Conclusions: Periodic peer comparison paper feedback to physicians on statistic data of the number of tests they prescribed can effectively reduce the number of tests and laboratory expenditure.(Taiwan J Public Health. 2002;21(2):107-114)
• 107 - 114
• 10.6288/TJPH2002-21-02-03

• Link 原著 Original Article
• 各級醫院糖尿病慢性合併症住院現況探討Comparison in Diabetes-Related Complications for Inpatients Among University Medical Centers, Regional Hospitals and District Hospitals
• 魏榮男、宋鴻樟、林瑞雄、李中一、莊明雄、王博仁、周劍文、童瑞年、莊立民
  Jung-Nan Wei, Fung-Chang Sung, Chien-Wen Chou, Chung-Yi Li, Ming-Sion Tsuang, Po-Jen Wang, Chien-Wen Chou, Jai-Nien Tung, Lee-Ming Chuang
• 糖尿病 ； 住院 ； 慢性合併症 ； 治療效果 ； 自我照護行為
  diabetes mellitus ; inpatient ; chronic complication ; treatment effectiveness ; self-care behavior
• 目標：比較國內各級醫院糖尿病慢性合併症住院現況，並探討患者的居家自我照護行為。方法：以民國89年6月1日至90年5月31日期間因糖尿病慢性合併症住院的病患為對象，依據北中南分佈分層隨機抽樣，從醫學中心、區域醫院與地區醫院三個層級分別抽出4、3與6家醫院，抽出168、150與138名住院病人。以問卷訪視收集人口、醫療行為資料，並自病人病歷抄錄合併症、醫療檢測及住院資料。結果：各級醫院糖尿病人過去幾年平均住院約4次，腦血管病變比率（介於18.9~28.1%），心血管疾病（介於49.2~55.1%）和腎臟病變（介於43.8~57.4%）之比率，均無明顯統計差異。下肢血管病變（介於7.4~16.2%）和神經病變（介於14.2~33.5%）之比率均以醫學中心的最高，視網膜病變（介於29.7~46.0%）則以區域醫院的住院病人比率最高。定期追蹤率以地區醫院為最低，只有66.4%，各級醫院病人沒有自我監測血糖的有40.8~77.3%，也以地區醫院為最高。結論：糖尿病住院患者大多有多種合併症，重複住院的比率相當高，各級醫院對住院患者遵照醫囑與日常自我照護行為的衛生教育都有很大的改善空間。（台灣衛誌 2002；21（2）：115-122）
  Objectives: The purpose of this study was to investigate and compare the rate of chronic complications for diabetic inpatients among three levels of medical facilities. Diabetic care and patients' self-homecare behaviors were also investigated. Methods: A total of 456 inpatients with diabetes mellitus were recruited from 4 university medical centers (UMC), 3 regional hospitals (RH) and 6 district hospitals (DH) in Taiwan, during June 2000 and May 2001. Patients were interviewed for information in demographic characteristics and health care behaviors. Medical records were reviewed for diabetic care provided to patients and diabetes-related complications diagnosed for them. Results: Patients have been hospitalized for approximately 4 events in average. No significant difference was found in the rates of cardiovascular disease (49.2%-55.1 %), nephropathy (43.8%-57.4%) and cerebrovascular disease (18.9-28.1%) for hospitalized patients, among the 3 levels of hospital. While the UMC inpatients had the highest prevalence rates of diabetic foot (16.2%) and neurophathy (33.5%), the RH inpatients had the highest rate of retinopathy (46. 0%). The rate of regular follow-up check was the lowest (66.4%) for inpatients of DR. They were also less likely than patients of UMC and RH to have self-monitoring of plasma sugar or urine sugar. Conclusions: A good proportion of diabetes inpatients have multiple diabetes-related complications with frequent hospitalizations. Patients cared at DH need greater attention in diabetic care than that at UMC and RH. Standard diabetes care protocol for complication prevention should be implemented.(Taiwan J Public Health. 2002;21(2):115-122)
• 115 - 122
• 10.6288/TJPH2002-21-02-04

• Link 原著 Original Article
• 台灣地區各級醫院任用醫管人力之現況分析The Employment Status of Hospital Management Professionals in Taiwan's Hospitals
• 曾淑芬、楊銘欽、陳瑊箖
  Su-Fen Tseng, Ming-Chin Yang, Jin-Liang Chen
• 醫務管理(醫管) ； 人力資源管理 ； 醫院任用
  hospital management ; human resource management ; hospital employment
• 目標：本研究之目的為調查醫管人力在各級醫院的實際任用及配置情況，並探討醫院對醫管人力用人的可能考量原因。方法：於88年1月至4月間，以郵寄問卷請衛生署84年至86年間評鑑合格的醫院之院長（計507家）填寫，共回收有效問卷143份（回收率28.6%）。結果：（1）醫院規模越大者，其實際任用之醫管人力數越多。（2）各醫院對醫管人力的學歷要求以選擇研究所者居多。（3）醫管人力在院內配置的單位以病歷室最多。（4）私立醫院及財團法人醫院，或院長年齡在41~50歲且其具研究所學歷者，其院內已任用醫管人力的勝算比較高。（5）醫院任用醫管人力的理由以「重視醫管專業與實務經驗」及「對醫院經營管理有實質幫助」為主，而無任用之醫院則以「國內醫管人才之實務訓練不夠」與「控制人事成本」等理由居多。結論：任用醫管專業人力的醫院數增加，對人力專業素質的要求亦隨之提出，未來應釐清醫管專業在醫療機構內的職責功能與角色定位，俾做為醫管人力培育制度改進的參考。（台灣衛誌 2002；21（2）：123-132）
  Objectives: The purpose of this study were to investigate the tendency of hospitals to hirehospital management (HM) professionals, and to examine the employment status of these professionals in the hospital. Methods: Subjects were 507 hospitals accredited by the Department of Health in Taiwan. Questionnaires were distributed by mail, and 145 were returned, with a total response rate of 28.6%. Results: 1. The larger the hospitals, the more the HM professionals were hired. 2. Most hospitals (district hospitals excluded) required these HM employees to have graduate degrees. 3. Most of the HM employees were assigned to the Departments of Medical Records. 4. Private and non-profit proprietary hospitals or those with superintendents between 41-60 years old having graduate degrees were more likely to hire HM professionals. 5. The main reasons for hospitals to employ HM professionals were ”to emphasis on the professions and experiences of hospital manager” and ”they are helpful for practical management of a hospital”. On the other hand, the main reasons for hospitals not to employ HM professionals were ”the training of HM profession was insufficient” and ”to control the cost of personnel affairs”. Conclusions: This study showed that as more hospitals hire HM professionals, they require better qualifications. We suggest that it is important to define the roles and responsibilities of HM professionals. It would be helpful to modify the education program and improve the quality of hospital managementpersonnel.(Taiwan J Public Health. 2002;21(2):123-132)
• 123 - 132
• 10.6288/TJPH2002-21-02-05

• Link 原著 Original Article
• 牙科處置藥品及材料成本相對值之初探TheRelative Value Units of Drugs and Materials Costs for Dental Procedures
• 陳琇玲、黃文駿、溫信財、楊志良
  Hsiu-Ling Chen, Wen-Jiun Huang, Hsyien-Chia Wen, Chih-Liang Yaung
• 牙科 ； 藥品及材料成本 ； 相對值
  dentistry ; cost of drugs and materials ; relative value units (RVUs)
• 無
  Objectives: Drugs and materials account for 15 % of the costs in dental services. We exam med their relative value units (RVUs) to establish the resource-based relative value scales for dental procedures in the future. Methods: Upon recommendation of the National Dental Association of the Republic of China, a Technical Consulting Group (TCG) was formed to select 25 dental services and procedures (S/Ps) to be investigated. We asked the TCG to draw up the list of necessary but non-common drugs and materials used for each S/P. A TCG member with accounting training approved the list. We then sampled four dental clinics to examine the costs required for each of the 25 S/Ps and transferred them to RVUs. The results thus obtained were used to explore the RVUs of the drugs and materials costs of the non-surveyed S/Ps by TCG members separately. Results: The RVUs showed excellent correlation between the four dental clinics (P <0.01) and between the TCG members (P<0.001). The RVUs of the drugs and materials costs required for 79 dental S/Ps were established. Conclusions:(1)We have established the RVUs of the drugs and materials costs required for 79 most important dental services. (2)It is hard to research the cost of drugs and materials for dental S/Ps. (3)It is better to establish the list of necessary but non-common drugs and materials used for each S/P by a TCG and to investigate the specific costs required through the cooperation of clinics. (4)The results can be used to establish the resource-based relative value scales for dental procedures.(Taiwan J Public Health. 2002;21(2):133-139)
• 133 - 139
• 10.6288/TJPH2002-21-02-06

• Link 原著 Original Article
• 台灣旅館業餐飲人員工作動作特性與肌肉骨胳傷病之橫斷式研究A Cross-Sectional Study of Musculoskeletal Disorders in Relation to Work Movement Characteristics Among Hotel Foodservice Employees in Taiwan
• 全中妤、杜宗禮、葉文裕、李中一
  Jong-Yu Adol Chyuan, Chung-Li Du, Wen-Yu Yeh, Chung-Yi Li
• 餐飲工作人員 ； 工作相關之肌肉體骼傷害 ； 橫斷式研究 ； 盛行率
  foodservice employees ; musculoskeletal disorder ; cross-sectional study ; prevalence rate
• 目標：估計台灣地區國際觀光旅館中餐飲服務人員肌肉骨骼傷病(MSD)盛行率與嚴重程度，及其與動作項目頻率之相關性。方法：本研究利用橫斷式研究設計，於2001年1至4月期間利用結構式問卷針對台灣地區24家國際觀光旅館總共905位同意接受訪視之餐飲服務人員進行面對面訪視，蒐集的資料包括人口學特徵、日常活動狀況、工作條件和工作中所使用動作項目之種頻與頻率、以及自覺MSD的部位以及疼痛嚴重程度，並利用多變量線性迴歸估計每個動作項目頻率分數與個別身體部位疼痛分數間之相關性。結果：「廚師／助廚／廚工」樣本所自訴的下背／腰疼痛盛行率最高(52.6%)，而「清潔人員」與「外場服務人員」則以肩部疼痛之盛行率最高，分別為63.4%與64.3%。「廚師／助廚／廚工」樣本疼痛分數平均值最高的部位為肩、上手臂、上背、與膝關節；「清潔人員」與「外場服務人員」最覺疼痛的部位則分別為膝關節與腳踝／足部。多變量迴歸分析所顯示較強的相關性包括：肩部疼痛與「需經常彎腰從地面抬取重物」或「持續搬抬重物達一分鐘以上」等動作；手指／手腕疼痛與「手腕持續旋轉搓繞」或「手腕經常出力彎曲」等動作；以及下背／腰部疼痛與「需經常彎腰從地面抬取重物」。結論：台灣地區旅館業現職餐飲服務人員自訴身體部位別MSD盛行率約介21.5%(大腿)至58.9%(肩部)之間；此外，下背／腰部的疼痛也很普遍(盛行率=54.7%)。而數據顯示：與餐飲服務人員肩部疼痛相關性較強的動作為搬運重物，而與下背／腰痛相關性較強的動作則是經常彎腰從地面抬取重物。(台灣衛誌 2002；21(2)：140-149)
  Objectives: To estimate the prevalence and severity of musculoskeletal disorders (MSD) and to assess the relationship between MSD and work movement characteristics in a sample of hotel foodservice employees in Taiwan. Methods: A cross-sectional survey was conducted between January and April in 2001 among a convenient sample of 905 foodservice individuals from 24 hotel restaurants all over Taiwan to collect information on individual's demographic characteristics, daily activities, work . movement characteristics, and perceived presence and severity of body part specific MSD. Multiple linear regression models were used to assess the adjusted relationship between work movement frequency and body part specific MSD. Results: Lower back/waist pain was most prevalent (52.6%) among kitchen staff whereas both sanitation and dining room staff suffered mostly from shoulder pain with prevalence rates of 63.4% and 64.3%, respectively. With respect to the severity, the kitchen staff who suffered from MSD had the highest severity score for several body parts including the shoulder, upper arm, upper back, and knee joint. The highest body part specific severity score for the sanitation and dining room staff was the knee joint and ankle/foot, respectively. The multiple linear regression analysis suggested stronger associations for shoulder pain and ”frequent bending while moving/lifting heavy objects” or ”frequent long-lasting moving/lifting objects”; finger/wrist pain and ”continual twisting of the wrist” or ”frequently vigorous action of the wrist”; and low back/waist pain and ”frequent bending while moving/lifting heavy objects,” Conclusions: Our data suggested that the body part specific prevalence rate of MSD was between 21.5% (upper leg) and 58.9% (shoulder) among hotel food service workers in Taiwan. The prevalence for lower back! waist pain (54.7%) was second only to shoulder or neck pain in the study participants. Analysis of correlation suggests that moving/lifting heavy objects showed a stronger association with shoulder pain than did any other work movement. On the other hand, lower back/waist pain had a relatively strong association with postures such as stooping.(Taiwan J Public Health. 2002;21(2):140-149)
• 140 - 149
• 10.6288/TJPH2002-21-02-07

• Link 實務 Public Health Practice
• 全民健康保險學術資料庫基本檔的應用經驗Issues on Using the Basic Files of the National Health Insurance Research Database
• 文羽苹、江東亮
  Yu-Ping Wen, Tung-Liang Chiang
• 全民健康保險學術資料庫
  National Health Insurance Research Database
• 目標：提供全民健康保險學術資料庫基本資料檔的使用經驗，簡述利用資料庫計算醫院數等基本數據的相關問題及因應對策。方法：採用單一檔單一數值、費用檔連結、外部資料連結三種計算方法，並與衛生統計、全民健康保險統計比較結果。結果：三種方法計算結果有所出入。使用該資料庫的重要問題包括：(1)資料處理：醫院代號變換造成不同檔案間連結的困難；(2)數量計算：資料庫流水帳的特性使計算手續繁雜；(3)誤差估計：部分計算結果與其他資料差異很大，且難以估計誤差。結論：該資料庫內容豐富，惟處理程序繁複，資料的動態本質應是以上問題的主要原因。國衛院宜作較詳細的使用說明，並考慮與其他資料的連結，以發揮全民健保資料庫的最大功能。(台灣衛誌 2002；21(2)：150-155)
  Objectives: To share experience on using the National Health Insurance Research Database to calculate basic information, including the number of hospitals, physicians, and beds, and claims amount. Methods: Three methods were used to calculate those figures: single file-unique value, c1aims-data-linking, and outside-source-linking. The results were compared to those from the Health and Vital Statistics and the National Health Insurance Annual Statistics Report. Results: Three types of difficulties in using the database are as follows: (l) Data management: hospital 10 changes causes problems in linking files within the database. (2) Figures-calculating: the data in fact record a series of events, like accounting journals. Therefore, many steps need to be taken to produce correct figures, as in making ledgers from journals. (3) Bias assessment: estimates generated from the database can be quite different from those of other sources. However, it is difficult to perform a valid bias assessment. These problems are likely to have resulted from the dynamic nature of the database. Conclusions: The database provides rich information on institutional and contractual changes. However, clearer user instructions are needed. In addition, functions of the database can be enhanced if it is allowed to match with other major databases.(Taiwan J Public Health. 2002;21(2):150-155)
• 150 - 155
• 10.6288/TJPH2002-21-02-08