29卷2期

• Link 原著 Original Article
• 台灣民眾對不同來源電磁場感知的利益、風險與管制信任The Perception of Benefit, Risk, and Regulatory Trust of Various Sources of Electromagnetic Fields in Taiwan
• 林宜平、林彥君、詹長權、鄭尊仁
  Yi-Ping Lin, Yen-Chun Lin, Chang-Chuan Chan, Tsun-Jen Cheng
• 電磁場 ； 利益 ； 健康風險 ； 管制信任 ； 感知
  Electromagnetic Field ; Benefit ; Health Risk ; Regulatory Trust ; Perception
• 目標：探討台灣民眾對基地台、高壓電線、變電箱、手機、微波爐與無線網路所感知的利益、健康風險與對管制的信任程度。方法：本研究於2008年10月，委託中央研究院調查訪問中心，以電話抽樣完成2,035例18歲以上民眾的橫斷性調查訪問。結果：台灣民眾對不同來源電磁場的利益、風險與管制信任互有相關，但是手機使用頻率只與對手機和基地台的利益感知有關。一般線性模式的分析發現，影響民眾對高壓電線與基地台高風險感知的變項，除了女性與高教育程度之外，還包括低利益、低信任，以及同意電磁場會導致癌症。結論：本研究建議政府相關單位加強民眾對電磁場的管制信任，並增加補助電磁場健康風險研究，以降低民眾疑慮。
  Objectives: To explore the perceived benefits, risks and regulatory trust with regard to electromagnetic fields (EMF) from various sources (including mobile phone base stations, power lines, transformers, mobile phones, microwave ovens, and wireless internet) in Taiwanese people. Methods: A cross-sectional telephone survey was conducted by the Center for Survey Research, Academia Sinica in October, 2008, with a randomized sample of 2,035 adults aged 18 and older. Results: The benefits, risks and regulatory trust perceptions of various sources of EMF were all correlated. The frequency of mobile phone usage, however, was correlated only with the perceived benefit of mobile phones and base stations. General linear model analysis indicated that female, higher education, low benefit, low trust, and agreement that EMF is carcinogenic were the major factors determining the perception of risk from power lines and base stations. Conclusions: We suggest the regulatory agencies in Taiwan increase the general population's trust for EMF regulation. Further, the government should sponsor further EMF health risk studies in order to reduce public concerns.
• 87 - 96
• 10.6288/TJPH2010-29-02-01

• Link 原著 Original Article
• 台灣地區1986-2007年意外中毒死亡趨勢分析Trends in Mortality Due to Unintentional Poisoning by Gender, Age and Cause in Taiwan: 1986-2007
• 洪宇箴、白璐、林金定、高森永、簡戊鑑
  Yu-Chen Hung, Lu Pai, Jin-Ding Lin, Sen-Yeong Kao, Wu-Chien Chien
• 意外中毒 ； 死亡率 ； 死因統計 ； 長期趨勢
  Unintentional poisoning ; Mortality rate ; Vital statistics ; Trend
• 目標：瞭解台灣地區意外中毒在性別、年齡與原因的長期趨勢。方法：本研究以1986-2007年衛生署公佈的「衛生統計」資料，分別計算22年意外中毒死亡在「性別」、「年齡別」與「原因別」死亡率的趨勢變化，並使用2000年世界標準人口調整年齡結構。結果：台灣22年共有12,916人死於意外中毒，整體死亡率呈下降趨勢，降幅73.6%。以性別區分，男性死亡率高於女性，且平均死亡率為女性的2.07倍；在年齡部分，死亡率隨年齡增加而上升，而各年齡層死亡率逐年下降。有關中毒的原因，農藥中毒（佔38.3%）及藥物中毒（佔33.7%）為台灣地區民眾的主要死因，死亡率均呈下降趨勢，前者22年下降幅度最大，降幅96.1%；後者於2000年後取代農藥中毒成為第一死因，自2000年至2007年上升71%；一氧化碳中毒排名第三（佔9.42%），22年來，死亡率上升27%，但未達統計顯著意義，並於2002年成為第二死因。結論：近年來，藥物意外中毒再度上升，並成為第一死因，應加強藥品管制與用藥安全宣導；另外，一氧化碳中毒應從避免家用瓦斯、汽車廢氣及職場暴露意外中毒三方面採取防制措施。
  Objectives: To examine the trends in mortality due to unintentional poisoning in Taiwan by gender, age, and cause between 1986 and 2007. Methods: We analyzed routine mortality data from the official publications of vital statistics from 1986 to 2007 in order to determine trends by gender, age and cause of death adjusted by Year 2000 Standard Population. Linear regression was used to determine the trends. Results: A total of 12,916 people in Taiwan died as a result of unintentional poisoning between 1986 and 2007. There was a downward trend in the total mortality rate, a decline of 73.6%. The mortality rate due to unintentional poisoning for males was higher than that for females (rate ratio: 2.07). The mortality rate increased by age, but the mortality rates within all age groups declined. Pesticides (38.3%) and drugs (33.7%) were the two dominant poisoning agents, yet the mortality rates for both declined. The former had the largest decrease (96.1%), so that, as a result, drugs have become the leading cause of death since 2000, rising 71% of the total from 2000 to 2007. The mortality rate from carbon monoxide, the third leading poisoning agent (9.42%), increased 27%; however, the change was not significant over the 22-year period, although it has been the second leading agent since 2002. Conclusions: Although the mortality rate due to unintentional poisoning has declined, we should still develop prevention programs to reduce mortality due to drug or carbon monoxide poisoning.
• 97 - 107
• 10.6288/TJPH2010-29-02-02

• Link 原著 Original Article
• 失智症老人使用典型／非典型抗精神病藥物及其相關因素Conventional and Atypical Antipsychotic Drug Use in Older Patients with Dementia
• 吳思霈、吳肖琪
  Szu-Pei Wu, Shiao-Chi Wu
• 失智症 ； 抗精神病藥物 ； 用藥率 ； 相關因素
  dementia ; conventional and atypical antipsychotics ; prescription rate ; correlate factors
• 目標：美國食品藥品管制局2008年6月公告使用「典型」及「非典型」抗精神病藥物治療失智症的行為及精神症狀，可能增加死亡風險，但臨床上經常使用該類藥物來治療失智症的行為精神症狀，本研究目的為瞭解國內失智症老人使用抗精神病藥物之情形及影響使用典型／非典型藥物之相關因素。方法：以2005年全民健康保險資料庫中65歲以上失智症病人且使用抗精神病藥物者為對象，瞭解其使用典型或非典型藥物之情形。考慮同一醫師看診之病患有聚集性，因此使用廣義估計模式(GEE)控制同一醫師看診病患之相關性，以邏輯斯迴歸分析影響使用典型或非典型抗精神病藥物之相關因素。結果：我國失智症老人中有33.95%使用抗精神病藥物，有17.49%使用典型藥物；16.46%使用非典型藥物；失智症老人於私立醫院、非醫學中心、非精神科、年長醫師就診者使用「典型」抗精神病藥物的機率顯著較高。結論：國內失智症老人使用典型與非典型抗精神病藥物的比例相近，異於美國以使用非典型藥物為主，醫療機構及醫師特質是影響失智症老人使用抗精神病藥物之重要因素，建議國內藉由醫療網計畫、專科醫學會或醫師公會協助加強醫師繼續教育訓練，讓醫師能重視抗精神病藥物處方之用藥知識，以降低用藥比例。
  Objectives: Although the FDA has notified healthcare professionals that both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychoses, antipsychotic medications are still widely used to manage behavioral and psychological symptoms in dementia despite concerns about their safety. Therefore, the aim of this study was to investigate the prescription of and factors associated with the prescription of these agents for elderly patients with dementia in Taiwan. Methods: Data about patients older than 65 and diagnosed with dementia in 2005 were collected from the databases of National Health Insurance. The prescription rates for atypical and conventional antipsychotic drugs in ongoing and newly diagnosed dementia patients in 2005 were calculated. The factors associated with conventional or atypical antipsychotic prescriptions were analyzed by a generalized estimating equation (GEE) adjusted for the cluster effect and by logistic regression. Results: 14,637 of 83,701 (16.46%) and 13,777 of 83,701 (17.49%) dementia patients were prescribed for conventional and atypical antipsychotics, respectively. Physicians from public hospitals, not from medical centers, not psychiatrists and elder physicians prescribed typical antipsychotics significantly. Conclusions: The use rate of conventional and atypical antipsychotics for patients with Dementia are equal in Taiwan, different from the U.S. The main factors of patients used conventional or atypical are hospitals and physicians’ characteristics. Educational effort to physicians to decrease the use of conventional and atypical antipsychotics is worth.
• 108 - 117
• 10.6288/TJPH2010-29-02-03

• Link 原著 Original Article
• 醫師的遵循行為可促進病患的存活嗎？以台灣非小細胞肺癌病患為例Can Physician Adherence to Treatment Guidelines Improve Patient Survival? A population-based Analysis of non-small Cell Lung Cancer (NSCLC) in Taiwan
• 陳錫杰、 蘇慧芳、李中一、賴美淑、謝碧晴
  His-Chieh Chen, Hui-Fang Su, Chung-Yi Li, Mei-Shu Lai, Pi-Ching Hsieh
• 非小細胞肺癌 ； 一年存活 ； 遵循治療指引 ； 台灣癌症診療資料庫
  non-small cell lung cancer NSCLC ; one year survival ; guideline adherence ; Taiwan Cancer Data Base
• 目標：探討在控制病患特性、醫院及醫師特性後，非小細胞肺癌病患接受遵循指引治療，對一年存活情形之影響。方法：此回溯性世代追蹤研究，資料源自2004年台灣癌症診療資料庫、2002到2004年健保資料庫，及2004到2005年死因登記檔。Kaplan-Meier繪製存活曲線，Cox涉險模型進行風險校正，分析病患接受遵循指引治療對存活情形的影響。結果：57%的病患為第四期，66.6%接受遵循指引治療。不同期別，遵循指引者皆比未遵循者有較好的一年存活率(51.1% vs. 22.1%)。校正後，遵循指引治療者在診斷後一年內死亡的風險比未遵循者低(HR=0.44; 95% CI=0.41-0.48)。期別與遵循指引與否有顯著的交互作用。期別早期且遵循指引者，診斷後一年內死亡的風險，比期別晚期者為低。結論：醫師能遵循治療指引提供照護，能顯著提升病患一年的存活情形，特別是期別較為早期者，其診斷後一年內死亡的風險較低。故早期診斷非小細胞肺癌並促進治療指引共識之建立及落實執行是控制疾病的有效策略。
  To explore the relationship between adherence to treatment guidelines and one-year survival of all stages of non-small cell lung cancer (NSCLC) patients after adjustment for the characteristics of patients, hospitals and physicians. Methods: Population-based data were retrieved from the Taiwan Cancer Data Base (TCDB) in 2004, National Health Insurance Research Database (NHIRD) in 2002-2004 and Taiwan's Death Registries in 2004-2005. This was a retrospective cohort study and Kaplan-Meier analysis was used to construct survival curves. A multivariate Cox proportional hazard model was employed to estimate the hazard ratio (HR). Results: Fifty-seven percent of NSCLC patients were at cancer stage IV. Overall, 66.6% of NSCLC patients in the study cohort were compliant with treatment guidelines. The patients who received treatments in adherence to guidelines had a higher one-year survival rate than those who did not adhere (51.1% vs. 22.1%), even in various stages of cancer. Multivariate analysis showed that the patients who received treatments in adherence to guidelines had a lower risk of one-year mortality (HR=0.44; 95% CI=0.41-0.48). A significant interaction effect between cancer stage and guideline adherence was found. The early-stage cancer patients who adhered to guidelines had a lower risk of one-year mortality then those diagnosed with late-stage cancer. Conclusions: Physician adherence to treatment guidelines is associated with one-year survival of NSCLC patients regardless of the stage of the cancer. Such a favorable effect is particularly noteworthy for patients diagnosed at an early-stage. Early diagnosis and promotion of the adoption of guidelines for treatment are effective strategies for NSCLC control.
• 118 - 130
• 10.6288/TJPH2010-29-02-04

• Link 原著 Original Article
• 失眠與工作壓力：深度訪談使用安眠藥物的女性護理人員Insomnia and Work Stress: In-depth Interviews with hypnotic-taking Female Nursing Staff
• 郭淑珍、陳怡君
  Shu-Chen Kuo, Yi-Chun Chen
• 失眠 ； 工作壓力 ； 安眠藥物 ； 護理人員
  insomnia ; work stress ; hypnotics ; nursing staff
• 目標：本研究藉由使用安眠藥物護理人員之敘說，探索引起失眠的工作壓力之社會脈絡。方法：研究對象由從事5年護士工作的朋友介紹，並徵得受訪者同意，以質性深度訪談訪問25位失眠並有使用過安眠藥物的女性護理人員。結果：受訪者的失眠困擾，主要是工作壓力引起，造成失眠的工作情境包括有：耗費心神的輪班、擾人的認知勞動、不受重視的情緒勞動等。除了工作壓力，有5位受訪者也提及家庭照護壓力會影響其睡眠。當失眠干擾到工作時，受訪者會使用安眠藥物；對於安眠藥物各種作用，受訪者會透過多元管道來瞭解，並組合適合自己狀況的藥物使用方式。結論：受訪者工作壓力的主要癥結，是來自醫療院所的人力配置。為了達到成本控制，醫院管理政策偏向績效與利潤導向，因而對人力資源採彈性、緊縮運用，使得護理人員工作壓力過大而引發睡眠困擾。護理人員是適用勞動基準法，許多醫院卻未確實執行，相關政府單位應落實勞動檢查，才能改善護理人員工作的勞動條件。由於有5位受訪者受到性別社會角色、責任的期待，家庭照護壓力亦對其睡眠造成影響，顯示護理人員睡眠模式是受到社會脈絡和文化型塑。另外，受訪者使用安眠藥物是為了維持正常工作，亦即藥物的使用不只是醫學專業理性的考量，也是回應護理人員所處社會脈絡的困境。
  Objectives: This study explored the social context of work stress in the narratives of hypnotic-taking nurses about their experiences with insomnia. Methods: Introduced by a friend who works as a nurse, the researcher interviewed 25 female nursing staff with insomnia and hypnotic medication, with their consent. Results: Participants cited stress in work as the primary causal agent in their development of insomnia. The major working conditions causing insomnia included exhausting shift work, distressing cognitive labor and neglected emotion labor. Apart from stress at work, 5 participants mentioned stress in domestic care as another factor affecting their sleep. Interviewees took hypnotics irregularly when insomnia disturbed their performance at work. They learned about hypnotic medication through multiple channels and took dosage according to their needs. Conclusions: The shortage of nursing workforce, resulting from cost control and profit orientation in hospital management, was the key stress factor at work for the interviewees. Intensive work made the nursing staff unable to get enough rest and induced sleep disorders. Although the Labor Standards Act is supposed to be applied to nursing staff, most hospitals do not fully comply with it. The government should enforce inspection of labor conditions so that the working conditions of nursing staff can be improved. The sleep behaviors of 5 interviewees were affected by their social roles, gender expectations, and stressful domestic care. This study showed that sleep patterns of nursing staff are shaped by social context and culture. Furthermore, the interviewees took hypnotics to maintain their daily performance at work. Hypnotic medication was not only a consideration based on profession opinion but also a response to the social context.
• 131 - 144
• 10.6288/TJPH2010-29-02-05

• Link 原著 Original Article
• 學校層次菸害防制政策與個人層次特質對於學童吸菸行為之多層次分析：以屏東縣的國小為例School-level Policy for Tobacco Control and individual-level Characteristics in Relation to Cigarette Smoking among Children: A Multilevel Study of Elementary Schools in Pingtung County
• 黃正銘、嚴雅音、陳富莉、許志成、李建宏、林雅瑩、黃曉靈
  Cheng-Ming Huang, Yea-Yin Yen, Fu-Li Chen, Chih-Cheng Hsu, Chien-Hung Lee, Ya-Ying Lin, Hsiao-Ling Huang
• 學童 ； 吸菸行為 ； 多層次分析 ； 校園菸害防制政策
  School children ; smoking behavior ; multilevel ; tobacco-control policy
• 目標：使用多層次分析探討學校菸害防制政策與個人層次特質因素對於學童吸菸行為之相關性。方法：採多步驟集束抽樣選取屏東縣26間國小，以學校為單位，於2008年調查國小三至六年級學童之吸菸行為及其相關影響因素、並同時收集學校層次結構性與菸害防制政策特質因素。共收集有效學生樣本數2350、家長樣本數3726與教職員樣本數52位。結果：學校層次特質及學童本身特質，可解釋學童吸菸行為變異量分別為85%與48%。多層次迴歸模式發現學校層次因素，含山地地區學校(AOR=2.40, 95%CI:1.00-5.79)、有教職員吸菸的學校(AOR=2.57, 95%CI:1.59-4.17)及未推廣戒菸輔導或活動的學校(AOR=2.88, 95%CI:1.39-5.94)對於學童個人吸菸行為具有顯著影響。同時自覺他人吸菸頻率、朋友與家人在面前吸菸頻率、喝酒與嚼食檳榔之行為等個人層次變項，亦為顯著影響因素。結論：學校層次特質與國小學童吸菸行為顯著相關，建議教育與衛生機構能重視這些高風險學校及落實校園菸害防制政策與推廣活動，避免國小學童吸菸行為之發生。
  Objectives: The aim of this study was to use a multilevel analysis to assess the school-level tobacco control policy and individual-level characteristics of students in relation to cigarette smoking among elementary schoolchildren. Methods: We conducted a multilevel study to assess two-level effects on smoking among 2,350 grade 3-6 students in 26 randomly selected elementary schools in southern Taiwan. The individual-and school-level characteristics regarding smoking were estimated using multi-level logistic regression. Results: School-and individual-level effects, accounting for 85% and 48% respectively of variance in the odds of being a smoker, indicated that the school cluster was very important. The risk of smoking was significantly associated with those schools located in a mountainous region [adjusted odds ratio (AOR=2.40, 95%CI: 1.00-5.79)], schools where staff smoked (OR=2.57, 95%CI: 1.59-4.17) and schools without anti-tobacco activities or curricula implementation (AOR=2.88, 95%CI: 1.39-5.94). Individual-level characteristics having a significant relationship with student smoking behavior were student's perceptions of smoking, having best friends or family always smoking in front of them, ever-drinking and-chewing betelnut behavior. Conclusions: The findings suggest that tobacco control policies and preventive programs should be strongly considered for implementation in those elementary schools where students are at the greatest risk for cigarette smoking.
• 145 - 157
• 10.6288/TJPH2010-29-02-06

• Link 原著 Original Article
• 作者回覆：學校層次菸害防制政策與個人層次特質對於學童吸菸行為之多層次分析：以屏東縣的國小為例Response: School-level Policy for Tobacco Control and individual-level Characteristics in Relation to Cigarette Smoking among Children: A Multilevel Study of Elementary Schools in Pingtung County
• 黃正銘、嚴雅音、陳富莉、許志成、李建宏、林雅瑩、黃曉靈
  Cheng-Ming Huang, Yea-Yin Yen, Fu-Li Chen, Chih-Cheng Hsu, Chien-Hung Lee, Ya-Ying Lin, Hsiao-Ling Huang
• 無
  none
• 無
  none
• 158 - 158
• 10.6288/TJPH2010-29-02-08

• Link 原著 Original Article
• 評論：學校層次菸害防制政策與個人層次特質對於學童吸菸行為之多層次分析：以屏東縣的國小為例Commentary: School-level Policy for Tobacco Control and individual-level Characteristics in Relation to Cigarette Smoking among Children: A Multilevel Study of Elementary Schools in Pingtung County
• 莊（女英）智
  莊（女英）智
• 無
  none
• 無
  none
• 158 - 158
• 10.6288/TJPH2010-29-02-07

• Link 原著 Original Article
• 私立幼托機構人員腸病毒通報意圖及其相關因素研究A Study on Factors Related to Behavioral Intention for Enterovirus Notification by Private Kindergarten Staff
• 林國甯、許銘能、胡益進、李思賢
  Kuo-Ning Lin, Ming-Neng Shiu, Yin-Jin Hu, Tony Szu-Hsien Lee
• 私立幼托機構人員 ； 腸病毒通報 ； 計畫行為理論
  private kindergarten staff ; enterovirus notification ; Theory of Planned Behavior
• 目標：本研究調查台北縣與苗栗縣私立幼托機構人員之執行腸病毒通報行為意圖，及探討影響意圖之相關因素。方法：本研究採用計畫行為理論進行橫斷性研究調查，以台北縣及苗栗縣之私立幼托機構之老師與行政人員為研究對象進行立意抽樣，施行結構問卷調查。除計算計畫行為理論每一子信念之相關項目之人數與平均值外，並對通報意圖不同者在各信念之單因子施行多變項變異數分析；使用多變項邏輯式迴歸分析辨認通報意圖之影響因子；另進行通報意圖相關因素之複迴歸分析。結果：共計回收調查問卷501份，幼托機構人員有通報意圖者86.2%。有通報經驗者33.7%。研究對象通報的行為信念、結果評價的交乘積和與態度呈正相關(r=.610)；規範信念、依從動機的交乘積和與主觀規範呈正相關(r=.818)；控制信念、發生強度的交乘積和與知覺行為控制呈正相關(r=.375)。邏輯式迴歸發現就讀系所為非幼保專科者，其通報意圖較幼保專科者高(OR=1.99, 95% CI=1.01~3.91)。以態度及主觀規範預測通報意圖解釋力為25.3%，加入知覺行為控制後解釋力上升至34.5%。結論：私立幼托機構人員多數願依從政府單位訂定之腸病毒防治政策執行相關防治作為，建議政府單位辦理宣導活動可結合其他與家長或媒體互動之活動並行，且可對幼托機構人員說明，如依政府規定進行腸病毒通報，承諾將不會披露園所名稱予媒體記者報導，以提升通報意圖。
  Objectives: The study investigated the behavioral intention for enterovirus notification (abb: NI; notification intention) and related factors by private kindergarten staff in Taipei and Miaoli counties. Methods: A cross-sectional survey based on the Theory of Planned Behavior (TpB) was conducted with a structured questionnaire in order to interview a convenience sample of private kindergarten staff in Taipei and Miaoli counties. The frequency and mean score of each item related to the corresponding TpB sub-component were calculated. MANOVA was used to compare the frequency of those individuals with and without NI. A multiple logistic regression technique was used to identify factors related to NI, and multiple regression models were established to explain NI with TpB component variables. Results: Of the 501 respondents who finished the interview, 86.2% showed positive NI, and 33.7% reported experience in notification. The respondents' attitudes were positively correlated with the sum of the products of behavioral belief multiplied by outcome evaluation (r=.610), their subjective norm was correlated with normative belief multiplied by motivation to comply (r=.818), and their perceived behavioral control was correlated with control belief multiplied by power (r=.375). Moreover, those respondents who had graduated from o departments other than nursery had twice (OR=1.99, 95% CI: 1.01~3.91) the NI of those who had graduated from nursery departments in a multiple logistic regression model. The results of multiple regression analysis indicated that attitude and subjective norm accounted for 25.3% of the total variation of NI, to which the addition of perceived behavioral control could increase the explanation by 9.2% to a total of 34.5%. Conclusions: Most private kindergarten staff are willing to comply with government policies for the prevention of enterovirus infection. In order to promote NI, the government should campaign for prevention in cooperative and interactive activities with parents and media, and promise not to disclose to the press the names of those kindergartens making a notification.
• 159 - 168
• 10.6288/TJPH2010-29-02-09

• Link 原著 Original Article
• 台灣南部地區重鬱症與雙極症之表現型特徵與社交關係的家族聚集現象Clinical Features and Familial Aggregation of Social Relationships in Major Depressive and Bipolar Disorders in Southern Taiwan
• 賴穎婕、呂明坤、楊延光、 林進嘉、譚宏斌、陳為堅、陸汝斌、郭柏秀
  Yin-Chieh Lai, Ming-Kun Lu, Yen-Kuang Yang, Jin-Jia Lin, Hung-Pin Tan, Wei-Jen Chen, Ru-Bagd Lu, Po-Hsiu Kuo
• 重鬱症 ； 雙極症 ； 家族聚集 ； 家族研究
  Major Depressive Disorder ; Bipolar disorder ; Familial Aggregation ; Family Study
• 目標：探討台灣南部地區重鬱症與雙極症之人口學特徵與症狀分佈情形，及社交關係的家族聚集現象。方法：透過家族研究設計收取290位個案（127位雙極症第一型，43.8%；84位雙極症第二型，29.0%；79位重鬱症患者，27.2%）及399位家屬。透過組合性國際診斷會談問卷(CIDI)收集人口學變項及臨床表徵資料。重鬱症與雙鬱症患者在社交關係的家族聚集由混和模式(mixed models)、組內相關係數(intraclass correlation coefficient)評估。結果：重鬱症中女性為男性兩倍，雙極症中男比女約一比一。重鬱症患者結婚率較雙極症高。兩種患者中九成社經地位較低。雙極症的發病年齡較重鬱症早且發作次數頻繁。兩種患者的功能損傷越嚴重則越少與朋友聯絡，且對於親屬與朋友的社交依賴存在家族聚集現象。結論：重鬱症與雙極症存在不同的臨床特性且在社交關係有家族聚集現象。
  Objectives: To investigate the demographic features and the distribution of symptoms for major depressive disorder (MDD), bipolar disorder type I (BPI), and bipolar disorder type II (BPII) families in Southern Taiwan, and to evaluate the familial aggregation of social relationships for the three diagnoses. Methods: A total of 290 probands (127, 43.8% BPI; 84, 29.0% BPII; and 79, 27.2% MDD) and 399 relatives participated in this study. Participants were interviewed by well-trained interviewers using the Composite International Diagnostic Interview (CIDI) in order to collect data about diagnosis, demographic and clinical features. Familial aggregation of social relationships were evaluated by the use of mixed models and intraclass correlation coefficients. Results: The female to male ratio was two to one in MDD and one to one in BPD. A higher proportion of MDD patients were married than were BPD patients. About ninety percent of all mood disorder patients had low socioeconomic status. Patients with BPD had an earlier age of onset and more depressive/manic episodes than did MDD patients. Probands with more severe impairments tended to have fewer contacts with friends. A familial aggregation of social dependence was observed in our sample. Conclusions: MDD and BPD patients have different clinical characteristics and familial aggregation of social relationships.
• 169 - 182
• 10.6288/TJPH2010-29-02-10

• Link 原著 Original Article
• 配備廢氣再循環系統(EGR)車輛之道路實測氮氧化物(NO(下標 x))排放分析NO(subscript x) Emission Rates of an EGR-equipped Vehicle on the Road
• 溫蓓章、莊志偉、楊智凱
  Pei-Chang Wen, Chih-Wei Chuang, Chih-Kai Yang
• 廢氣再循環系統 ； 車輛行駛之氮氧化物排放率 ； 道路測試
  Exhaust Gas Recirculation EGR system ; Nitrogen oxides NO(subscript x) emission rate of moving vehicle ; on road test
• 目標：車輛配備廢氣再循環系統(Exhaust Gas Recirculation, EGR)是有效降低車輛使用NO(下標 x)排放量的方案之一；不過，卻缺乏研究探討EGR系統於道路行駛之成效。本研究即探討配備EGR車輛之道路實測NO(下標 x)排放，並將與推估車輛移動排放NO(下標 x)總量模式使用的排放係數相互比較。方法：本研究運用車載量測設備(On-Board Emission Measurement)，搭載於配備EGR系統之汽油車輛上，進行高速公路與市區道路之實際行駛測試，量測並紀錄逐秒NO(下標 x)排放率；再進行法規審驗之實驗室測試並紀錄下可比對的數據。結果：前述測試條件下，配備EGR車輛實測之NO(下標 x)排放係數均低於1 g/km，顯著低於國內車輛排放推估模式所採用的排放係數70%以上；許多狀況下實測值尚不及模式排放係數10%；而且，車速大於70 km/hr高速區間排放係數隨速度變化的趨勢實際應為降低，而非模式係數升高。結論：推估模式所使用之NO(下標 x)排放係數，無法呈現搭載EGR車輛的NO(下標 x)排放特性。本研究建議應儘速建立配備EGR車輛的NO(下標 x)排放係數，並掌握其在車輛總數中的占比，才能較為適切的推估車輛排放NO(下標 x)總量。
  Objectives: The Exhaust Gas Recirculation (EGR) system is one solution for reducing vehicle Nitrogen oxide (NO(subscript x)) emissions; however, there is no research on the effectiveness of the EGR system, particularly with regard to gasoline-engine vehicles. This study aimed to fill in this gap. Methods: This study utilized a gasoline-engine test car equipped with the EGR system and an on-board emission measurement device which recorded second-by-second NO(subscript x) emission rates during road tests conducted on freeways and urban arterials. Comparable data was recorded from chassis tests performed in the laboratory. Results: NO(subscript x) emission rates measured from the test car, in all conditions, were less than 1 g/km. This was significantly lower than the parameters set by the EPA model, MOBILE-Taiwan. Moreover, the measured NO(subscript x) emission rates decreased while vehicular speeds increased over 70 km/hr. This was in contrast with the increasing trend of the parameters from the EPA Model. Conclusions: The results of this study showed that the NO(subscript x) emission rates of the EGR-equipped vehicle were not well represented by the model parameters. In light of the evidence, this study calls attention to the need for investigation of NO(subscript x) emission rates of EGR-equipped vehicles in order to better estimate vehicle NO(subscript x) emission as the popularity of EGR-equipped vehicles in the new car fleet is significant.
• 183 - 190
• 10.6288/TJPH2010-29-02-11