28卷3期

• Link 原著 Original Article
• 八字步行及十公尺障礙物步行與年齡及身體組成之相關The Relationships of 8-figure Walking and 10 m hurdle-walking with Age and Body Composition
• 彭雪英
  Hsuen-Ying Peng
• 八字步行 ； 十公尺障礙物步行 ； 年齡 ； 身體組成 ； 中老年人
  8-figure walking ; 10 m hurdle-walking ; age ; body composition ; the elderly
• 無
  Objectives: Two indices of functional gait ability were developed in Japan: the 8-figure walking (8FW) and 10m hurdle-walking (10mHW). This study aimed to investigate the relationship between these two indices and physical characteristics in Taiwanese elderly. Results will help in establishing physical fitness indices of Taiwanese elderly. Methods: Some 110 residents > 40 years living in the Neihu area around Taipei were recruited. Subjects were aged 65.6±9.6 years, 157.3±6.7 cm tall, weighed 70.9±10.1 kg, and had body mass index (BMI) 24.5±3.4. Results: The average values of 8FW and 10mHW were 16.1±4.1 sec and 10.1±2.7 sec, respectively. Age moderately correlated with 8FW (r=0.618, p<0.01) and 10mHW (r=0.473, p<0.01). BMI also weakly correlated with 8FW (r=0.210, p<0.05) and 10mHW (r=0.300, p<0.01). Partial correlation analysis was conducted to examine the relationship between physical characteristics and the two items. When age was controlled for, BMI weakly correlated with 8FW (r=0.198, p<0.05) and 10mHW (r=0.294, p<0.01). When BMI was controlled for, age was further moderately correlated with 8FW (r=0.615, p<0.01) and 10mHW (r=0.470, p<0.01). Conclusions: Both 8FW and 10mHW significantly correlated with age and BMI in Taiwanese elderly, indicating strong correlation of functional gait ability with physical characteristics in this population.
• 167 - 174
• 10.6288/TJPH2009-28-03-01

• Link 原著 Original Article
• 長期照護機構住民醫療利用分析－以中部四縣市為例Medical Care Utilization in long-term-care Organizations in Central Taiwan
• 陳雪姝、蔡淑鈴、黃欽印
  Sheue-Shu Chen, Shu-Ling Tsai, Chin-Yin Huang
• 長期照護 ； 醫療利用 ； 固定影響
  long-term care ; medical care utilization ; fixed effect
• 目標：人口老化所衍生之老人醫療照護在台灣已是迫切之問題。本研究的目標在分析台灣長期照護機構與非機構（社區）內老人全民健保醫療利用之現況與差異。方法：本研究為實驗對照研究，以1:1隨機配對方式選取與實驗組相同控制變項（含基本特性、疾病種類與疾病嚴重度等）之老人為對照組。在扣除對照組之固定影響(fixed effect)，計算出兩組醫療利用之差異。結果：以每人年門住診平均醫療利用而言，機構組之全民健保醫療費用較非機構組高出18%，達統計上顯著性差異；又收容疾病嚴重度較高之護理之家組，較非機構組之全民健保醫療利用差距仍高，差距縮小至12%，但未達統計上顯著性差異。結論：長期照護機構老人住民醫療利用，在全民健保醫療給付之誘因下，確存在較高之利用率，其中可能隱含供給誘發需求。未來台灣人口將快速老化，相關機關應及早規劃長期照護保險之財務與給付制度，以使全民健保的醫療功能更臻完善。
  Objectives: The purpose of this research was to investigate differences in medical care utilization between elderly residents of long-term-care organizations and community residents under the National Health Insurance (NHI) program in Taiwan. Methods: A case-control study design using the fixed-effects model was employed. The experimental group was made up of elderly residents of long-term-care organizations. In order to obtain a precise estimate and control for possible confounding variables, the individual random matching method was used to select the community residents who made up the control group on the controlling variables (i.e., age, sex, disease severity, specific diseases, etc.). Results: The average rate of medical care utilization of the experimental group was 18% higher than that of the control group; this difference was statistically significant. Surprisingly, the average rate of medical care utilization of nursing-home residents was only 12% higher than that of the community residents, with no statistically significant difference between the two test groups. Conclusions: Supply-induced demand may exist in the medical care utilization of long-term-care organizations under the NHI program. The study results are important for planning long-term-care insurance programs to meet the requirements of the aging population of Taiwan.
• 175 - 183
• 10.6288/TJPH2009-28-03-02

• Link 原著 Original Article
• 提供者服務量與膀胱癌病患進行膀胱根除術之結果分析Role of Surgeon Volume and Hospital Volume in Radical Cystectomy Outcomes of Bladder Cancer Patients
• 劉嘉年
  Chia-Nien Liu
• 結果 ； 醫師服務量 ； 醫院服務量 ； 膀胱根除術 ； 多層級模式
  Outcomes ; Surgeon volume ; Hospital volume ; Radical cystectomy ; Multilevel model Analysis
• 目標：針對罹患膀胱癌且進行膀胱根除術的病患，以多層級模式分析其醫師、醫院手術量與手術結果的關係。方法：採次級資料分析法，資料來源為全民健保學術研究資料庫。研究對象為2002~2005年間因膀胱癌(ICD-9-CM code188，236.7)住院，同時接受膀胱根除術(ICD-9-CM，code 57.7)者為對象。在提供者服務量變項方面，醫師分成高、中、低手術量三組，醫院分成高、低手術量兩組。結果變項以手術短期結果為主，包含住院死亡率、併發症、與超長住院。本研究以多層級模式處理階層性資料，以減少群集效應。結果：2002~2005年間罹患膀胱癌且接受膀胱切除術病患有1,045人，院內死亡者有21人(2.01%)，住院期間發生手術併發症者有129人(12.34%)，住院超過30日者235人(22.49%)。在控制影響因素之後，發現醫師手術量越高的分組，其住院死亡率、併發症比率與超長住院比率越低；而醫院手術量則與住院死亡率、併發症、以及超長住院無關。結論：醫師手術量越高者其手術結果較佳，醫師手術量比醫院手術量對結果更具影響力。
  Objectives: This study used a multilevel model to analyze the relationship between procedure volume and radical cystectomy outcomes of bladder cancer patients. Methods: We conducted a secondary data analysis study of the association between annual cystectomy volumes and outcome indicators. A total of 1,045 patients from 2002 to 2005, diagnosed with bladder cancer (ICD-9-CM codes 188, 236.7) and treated with radical cystectomy (ICD-9-CM code 57.7) were selected from the database of ”Inpatient Expenditures by Admissions” provided by the Bureau of National Health Insurance (BNHI). To obtain physician and hospital information, we linked the inpatient records of the research samples with the databases of ”registry for medical personnel” and ”registry for contracted medical institutions.” Outcome indicators were in-hospital mortality, complication rate, and prolonged length-of-stay (over 30 days). Multilevel logistic regression was used to adjust factors for different nested levels of patients and physicians. Results: The in-hospital mortality rate, overall complication rate, and prolonged length-of-stay in our study were 2.01%, 12.34%, 22.49%, respectively. After controlling for other factors, physicians with higher cystectomy volumes had significantly better outcomes, including lower in-hospital mortality, lower complication rate, and shorter lengths-of-stay, than physicians with lower procedure volumes. Hospital volumes had no significant relationship with outcomes indicators. Conclusions: Better outcomes in bladder cancer patients with cystectomy occurred when surgeons had high procedure volumes. Surgeon volumes had a greater effect on outcomes than hospital volumes.
• 184 - 193
• 10.6288/TJPH2009-28-03-03

• Link 原著 Original Article
• 醫師之住院醫療利用是否較具成本效果？Do Hospitalized Physicians Consume Medical Resources More cost-effectively?
• 高毓翔、楊長興
  Yu-Hsiang Kao, Chiang-Hsing Yang
• 醫師 ； 住院 ； 知情消費者 ； 全民健保資料庫
  physician ; hospitalized ; informed consumer ; National Health Insurance Research Database NHIRD
• 目標：探討身為知情消費者的醫師在住院時所使用醫療資源與治療成效相較於非醫師之醫療專業人員及一般民眾是否較具成本效果。方法：研究資料為1999年至2003年健保資料庫相關基本資料檔與門、住診檔案。採多重研究－對照之設計。對照組選取條件為：以醫師資料為主，經匹配性別與年齡後，分別對醫療專業人員與一般民眾進行1比1及1比10抽樣。最後利用複迴歸與邏輯斯迴歸檢視醫師、醫療專業人員與一般民眾在住院時醫療利用與治療成效上的差異。結果：經統計模式校正後，醫師在住院醫療資源利用(住院費用與高科技醫療利用率)顯著低於醫療專業人員與一般民眾；而治療成效（出院後14天內同疾病再入院）卻較佳。結論：在高時間機會成本的影響下，醫師較可能縮短其住院天數。此外，醫師具專業醫療知識，會尋求較具效率但未必昂貴的照護模式。結合此兩種因素可能導致醫師住院之成本較低。同時，由醫師的生活方式與習慣較為健康，加上可能的健康工人效應影響，亦會導致住院照護成效較佳。綜合上述所論，醫師之住院醫療利用具有較佳之成本效果。
  Objectives: To assess whether hospitalized physicians, as informed consumers, use medical resources more cost-effectively? Methods: The data were drawn from National Health Insurance Research Database (NHIRD), for the period of 1999-2003. A case-control design was employed, and the study included three groups of subjects (physicians, non-physician health professionals, and the general population) matched for age and gender. Multivariate linear and logistic regression analysis was conducted to compare the utilization of medical resources and outcomes of treatment among these three groups. Results: Compared to non-physician health professionals and the general population, hospitalized physicians tended to consume significantly lower cost resources (have fewer high-tech procedures) and thereby incur less medical expense. Compared to the general population, hospitalized physicians derived significantly more benefit from their care (had lower readmission rates). Conclusions: Thus, the cost of hospitalizing physicians may be lower because the higher opportunity cost of time is related to shorter LOS and because physicians have more medical knowledge and are therefore more likely to seek more efficient but not necessarily more expensive inpatient care. Moreover, healthier behaviors and lifestyles together with a healthy worker effect are likely to contribute to the greater effectiveness of care of hospitalized doctors.
• 194 - 204
• 10.6288/TJPH2009-28-03-04

• Link 原著 Original Article
• 健保IC卡對醫師診療之助益及其相關因素Helpfulness of Insurance IC card to Physicians' Diagnosis and the Associated Factors
• 蔡文正、游秋華、黃光華、謝淑惠、陳慧珊、廖家慧、吳守寶、詹勳政、龔佩珍
  Wen-Chen Tsai, Chiu-Hua Yu, Kuang-Hua Huang, Shwn-Huey Shieh, Hui-Shan Chen, Chia-Hui Liao, Shou-Bao Wu, Hsun-Cheng Chan, Pei-Tseng Kung
• 健保IC卡 ； 助益性 ； 滿意度
  Insurance IC Card ; Helpfulness ; Satisfaction
• 目標：健保IC卡政策全面實施至今，少有全面性探討醫師對此政策之看法，因此本研究將全面探討醫師對於IC卡之整體評價。方法：以全國各醫療院所之中醫、西醫、牙醫為研究對象，以分層比例進行隨機抽樣，郵寄結構式問卷進行問卷調查，回收有效問卷分別為中醫227份，西醫712份，牙醫285份。同時以逐步迴歸分析探討影響醫師認為IC卡對診療助益性之因素。結果：醫師讀取健保IC卡頻率最高項目為「重大傷病」，登錄內容適切性則以「記載過敏藥物」最高，IC卡助益性認知主要為「記載過敏藥物等就醫安全更有保障」。醫師於看診後將病患資訊寫入IC卡意願平均為3.36分（1-5分），降低寫入及讀取主因皆為「延誤看診時間」（52.93%及58.11%），滿意度平均則為2.96分(1-5分)，認為IC卡對診療助益平均為62.34分（1-100分）。影響醫師自覺IC卡助益性之因素為：參考IC卡資料頻率、寫入IC卡之意願、對IC卡認知、是否參考IC卡資訊避免重複開藥、平均每週看診總人數及機構層級別。結論：整體而言除了基層西醫外，大多數醫師對目前IC卡實施表示中度滿意，對於寫入及讀取IC卡表示願意配合，但是認為花費時間，普遍認為IC卡對看診是有助益性。
  Objectives: The National Health Insurance IC card has been used for more than 5 years, but there are no studies of physicians' viewpoints about it. This study explored the overall assessment of IC card implementation by physicians. Methods: The study subjects included western medicine physicians, Chinese medicine physicians, and dentists. A stratified random sampling method was used as we mailed questionnaires to physicians according to the ratio of levels of hospitals and the ratio of western medicine physicians, Chinese medicine physicians, and dentists in Taiwan. A total of 712, 227, and 285 useable questionnaires were received from western medicine physicians, Chinese medicine physicians, and dentists, respectively. Multiple regression analysis was conducted to explore the relative factors that influenced physicians' perceptions about IC cards with regard to patient care. Results: The IC card's content item with the highest frequency of being read by physicians is ”patient's catastrophic illness”. The item with most useful content is ”allergy medicine records”. This was the most helpful item from the physicians' point of view because ”the allergic medicines listed will enhance the safety of medical treatment”. The average score of ”willingness to upload patient's information into IC cards” is 3.36 (range 1-5). The major reason for unwillingness to upload and read IC card information is ”delaying the consultation time” (52.93% and 58.11%). The average satisfaction score with the IC card is 2.96 (range 1-5). The average score for the helpfulness of the IC card to a physician's care is 62.34 (range 1-100). The factors that influenced the physicians' perceptions of the helpfulness of IC cards in patient care are ”frequency of consulting the data on the IC card”, ”willingness to upload data into the IC card”, ”perception of the IC card”, ”consulting IC card data to avoid duplicate prescriptions”, ”number of patients' visits per week”, and ”level of the medical care organization”. Conclusions: Except for western medicine physicians practicing in clinics, most of the physicians had mid-level satisfaction with the implementation of the IC cards. Physicians were willing to upload and to read the data into/from IC cards but felt that it was time consuming. Generally, physicians thought that the IC card was helpful in patient care.
• 205 - 217
• 10.6288/TJPH2009-28-03-05

• Link 原著 Original Article
• 台灣版糖尿病生活品質測量工具Diabetes-39的發展與驗證Development and Validation of a Chinese Version of the diabetes-39 to Measure Diabetes Quality of Life in Taiwan
• 黃情川、黃一展、吳明彥、 陳姿君、吳菁珍、 林文德
  Chyng-Chuang Hwang, I-Chan Huang, Ming-Yen Wu, Tzu-Chun Chen, Jing-Jhen Wu, Wen-Der Lin
• 糖尿病 ； 生活品質 ； Diabetes-39台灣版 ； 心理計量
  Diabetes Mellitus ; Quality of life ; D-39 Chinese version ; psychometric property
• 目標：進行糖尿病生活品質測量工具D-39中文版的翻譯及驗證。方法：橫斷式研究法。對象為署立台南醫院糖尿病門診病患280人。資料收集為病人問卷與病歷摘要。病歷摘要收集臨床變項用以驗證D-39，包括實驗室診斷（醣化血色素、飯前與飯後2小時血糖）與糖尿病併發症（視網膜病變、腎臟病變、神經病變、足部病變、心血管疾病、及腦血管疾病）。心理計量分析包括信度與效度。結果：翻譯結果顯示，中文版D-39在語意上與英文版相似，且能被病人接受。心理計量分析發現，D-39中文版的測量結構與英文版相吻合。D-39與SF-36（效標）同質性面向之相關性較異質性面向強。D-39對於飯後2小時血糖及肌酸酐等指標，及心血管疾病、腦血管疾病、與足部病變等併發症，分別呈現有意義的預知組別效度（效果量＞0.2）。D-39對於神經病變、腦血管疾病、視網膜病變、足部病變、心血管疾病、與腎臟病變的綜合鑑別效度達到可接受的標準（C-統計值＞0.7）。結論：本研究翻譯並驗證了中文版D-39，其結果將有助於糖尿病人健康結果之評估。
  Objectives: The Diabetes-39 (D-39) is a well-validated and widely used diabetes quality of life (QOL) instrument. The purpose of this study was to translate the D-39 into Chinese and test its psychometric properties. Methods: Data were collected from 280 patients treated in diabetes clinics of the Tainan Hospital, Taiwan Department of Health, through QOL survey and medical record review. Information collected from medical records, used to validate the D-39, included laboratory indicators (hemoglobin A1c (HbA1c), fasting plasma glucose, 2-hour postprandial plasma glucose (2-h PPG), creatinine (Cr), and glomerular filtration rate) and diabetes complications (retinopathy, nephropathy, neuropathy, diabetic foot complications, cardiovascular complications, and cerebrovascular complications). We conducted forward/back translations and a focus group session to develop the Chinese version of the instrument. For psychometric evaluation, we analyzed construct validity, convergent/discriminant validity (using the SF-36 as the standard), known-group validity, and overall discriminant validity of the D-39. Results: The D-39 Chinese version demonstrated equivalent semantics to the original D-39. Pearson's correlations were weak with subscales measuring heterogeneous constructs between the D-39 and SF-36, but high among subscales measuring homogenous constructs, suggesting good convergent/discriminant validity. The D-39 discriminated better for 2-h PPG, Cr, cardiovascular, cerebrovascular, and diabetic foot complications (effect size >0.2), suggesting good knowngroup validity. C-indexes suggested greater discrimination (>0.7) by the D-39 compared to the SF-36 across all complications, indicating good overall discriminate validity. Conclusions: Our successfully translated D-39 demonstrated good psychometric properties. The D-39 Chinese version is an acceptable instrument for assessing treatment effectiveness and monitoring patient outcomes in Taiwan.
• 218 - 231
• 10.6288/TJPH2009-28-03-06

• Link 實務 Public Health Practice
• 化學性因子職業暴露資料庫之設計與實作Design and Implementation of an Occupational Chemical Exposure Database
• 姚永澔、吳俊德、林嘉明
  Yung-How Yao, Jyun-De Wu, Jia-Ming Lin
• 化學性職業暴露 ； 暴露評估 ； 暴露實態 ； 職業暴露評估資料庫
  chemical occupational exposure ; exposure assessment ; exposure profile ; occupational exposure assessment database
• 目標：為改善職業暴露評估，建置可適用於本國中小型事業勞工化學性職業暴露的資料庫，以呈現事業單位中工作者的暴露實態，並可累積資料作為行政管理與學術研究之用。方法：透過資料要項的設計、架構規劃、電腦系統選擇與程式寫作、功能設計、程式測試修正及資料庫實作等步驟建置勞工化學性因子職業暴露資料庫。結果：資料庫採IBM PC與Microsoft Windows搭配的電腦系統作為運作環境以節省成本；具備十二大類資料要項；以員工本體為核心以連結各項暴露因素；具呈現暴露實態的特別功能；實際使用所呈現的主要的問題是操作面的，而不是功能性的問題，這個問題可藉由操作訓練予以解決。結論：建置完成的資料庫，能引導事業單位蒐集完整的暴露資料，有效的掌握員工職業暴露實態；了解單位內主要危害所在，作為調整管理策略與經費的參考依據。若此資料庫成為累積彙整全國事業單位暴露資料的平台，可作為國家勞工職業暴露危害管理決策及研究的有用工具。
  Objectives: This study established a database for the assessment of chemical exposure among employees of small and medium-sized enterprises in Taiwan. With it, the exposure profile of workers can be properly documented and historical data can be used for administrative management and academic research. Methods: This employee occupational chemical exposure database was completed stepwise through data elements design, framework planning, computer system selection and program writing, function design, program testing and revision, and database implementation. Results: The database ran on IBM PC and Microsoft Windows in order to reduce cost. Twelve elements were included in the database. The context of all data elements was designed so that an exposure profile could be identified for each employee. Problems using the database are operational, not functional, and can be solved by operational training. Conclusions: The database directs each enterprise to systematically record complete exposure data and keep itself informed of each employee's exposure profile. The users may prioritize their controls and budgeting based on the exposure profile. For government, nationwide data would improve the management of occupational exposure and set research priorities.
• 232 - 247
• 10.6288/TJPH2009-28-03-07

• Link 實務 Public Health Practice
• 台灣個人防護裝備類防疫物資供應商現況之調查研究A survey Study of Personal Protective Equipments Suppliers in Taiwan
• 蘇雄義、林桓、張芳慈、石尊元
  Shong-Iee Ivan Su, Huan Lin, Fang-Tsu Chang, Tsun-Yuan Shih
• 防疫政策 ； SARS ； 個人防護裝備 ； 供應商 ； 風險分析
  Pandemic prevention policy ; SARS ; personal protective equipment ; suppliers ; risk analysis
• 目標：本研究是台灣首次針對個人防護裝備類防疫物資之供應端供應現況進行大規模調查，其調查對象含防護衣、N95和外科口罩之主要製造商與經銷商。此項調查結果將有助於政府與使用端有效規劃個人防護裝備儲備政策，增強國家防治疫災的規劃及應變能力。方法：透過供應商問卷調查及電話追蹤訪談，於2008年1至8月間深入調查10家製造商和37 家經銷商。結果：國內個人防護裝備供應端主要由「台灣設廠之製造商」、「海外設廠，台灣僅為分公司或經銷點之製造商」與「本身無工廠，純粹為經銷商或代理商」所組成。製造商多於中國大陸、東南亞、北亞和美洲等地設廠，該類廠商工廠與主要庫存都存放於台灣境外，故一旦疫情於亞洲區域進行蔓延，國內需求單位較不容易及時採買到足夠的個人防護裝備需求量。結論：台灣的防護衣自製能力低，對外依存度高，仍需儲備較高的國家安全庫存。不同於防護衣，N95 或同等級口罩以及外科口罩的台灣產能頗高，是以建議可予以調降現行高水位之安全庫存政策。
  This research was the first time of a large scale survey on PPE (personal protection equipment) suppliers in Taiwan. Major suppliers of protective clothes, N95 and same level of masks, and surgical masks were surveyed on their supply conditions. The survey study intends to help Taiwan government and major user institutions to effectively set up right pandemic prevention policy regarding to the preparation of PPE materials and the strengthening of the ability for national pandemic prevention and contingency planning. Methods: A comprehensive questionnaire survey of 10 major manufacturers and 37 distributors was conducted using the semi-open questionnaire followed by telephone interview from January to August of 2008. Results: PPE supply side was composed by suppliers with Taiwan factory, suppliers with overseas factory, and distributors/agents. Suppliers with factory usually built factories outside of Taiwan, mainly in Mainland China, Southeast Asia, North Asia, or America. There were very few stocks kept in Taiwan. If any pandemic disease strikes an Asian country and spread out in Asia, there is a high risk of PPE shortage. Conclusions: Taiwan has low manufacturing capacity for personal protective clothes and relies mainly on overseas production and stocks. A higher national safety stock level is required. However, to avoid the disposal of overdue stocks, a collaborative and customized program with major protective clothes suppliers is needed for the turnover of safety stocks. For N95 and surgical masks, Taiwan is much better positioned with self-manufacturing capability. It is suggested to lower current national safety stock level for these two types of PPE.
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• 10.6288/TJPH2009-28-03-08