6卷3期

• Link 綜論 Review Article
• 我國職業病防治的現況、困難及展望Occupational Disease Prevention in Taiwan: Present Status and Future Perspectives
• 王榮德
  Jung-Der Wang
• 無
  none
• 過去20年中，由於台灣地區急速工業化，引入了許多可能導致職業病的因素。我們團隊與許多單位台作，共同在四年內證實下列職業病：彩色印刷打樣工人因正已烷引起的多發性神經病變，巴拉刈製造工人因聯?啶結晶與離心作業所引起的皮膚癌，軸承製造工人因煤油引起的皮膚病，黏扣帶製造工人因二異氨酸甲苯引起的職業性氣喘，印刷工人因四氣化碳引起的肝炎，錳鐵鎖煉廠工人區艋引起的巴金森氏病。面對這些挑戰，我們應加緊培養人才及傳播知識。按本國法規來估計，我們至少需要138名職業醫學專科醫師，516名工業衛生師及3866名職業衛生護士；我們也需要品質良好的實驗室及儀器設備，來作環境採樣測定，以及建立職業與環境危害的基本資料，供政府制定防治先後次序之參考。本文並討論到防治策略應以預防?本，目前找到疾病後再除去病因的作法，是亡羊補牢之計；並對政府各單位提出許多建議，期盼全國人民一致努力，作好廠內廠外一貫的防治工作。
  Occupational disease prevention has become one of the major issues of Taiwan because of the rapid industrialization in the last 20 years. In collaborating with others, we have discovered following occupational diseases in the past 4 years: n-hexane induced polyneuropathy among press proofers, skin cancer among paraguat manufactures, kerosene dermatoses among ball bearing workers, toluene diisocyanate induced asthma among velcro tape manufacturers, carbon tetrachloride poisoning among printing workers, and manganese-related Parkinsonism among ferromanganese smelters. Facing the challenge of ever-increasing occupational hazards, we must promote both the knowledge and manpower of occupational health immediately. The demand of full time occupational physicians, industrial hygienists and occupationa1 health nurses were estimated to be at least 138, 516 and 3866 respectively. There is also an increasing demand of qualified laboratories for the identification and measurements of environmental contaminants. Various actions have been proposed for different departments of the governmental agencies to conquer present difficulties.
• 1 - 14
• 10.6288/JNPHARC1986-06-03-01

• Link 綜論 Review Article
• 開發中國家的公共衛生問題：以台灣作爲個案從社會、政治、經濟層面加以探討The Public Health Problems in the Development Country: Taiwan as a Case Study
• 陳永興
  Yong-Shing Chen
• 無
  none
• 公共衛生的目標是什麼呢？如果我們贊同公共衛生的目標是要改善眾人的健康、促進整個社會裹頭集體大眾的健康狀況，那麼公共衛生就必然要和社會、政治、經濟各方面的因素發生關係。因?公共衛生不只是疾病和醫療照顯的問題而已，公共衛生事實上和人口、生產量、酈民所得、教育程度、工作、住宅、糧食、欽水、環境再染、生活方式、醫療制度、社會福利等等夠素都有密切的關係。我們可以說要了解或改善公共衛生的問題，必須從社會、政治、經濟方面有關的因素加以研究，所以本文嘗試從這樣的觀點來探討開發中國家的公共衛生問題，尤其是以台灣作?個案來給予分析。 所有的開發中國家都必須接受極大的挑戰去面對複雜的公共衛生問題，因?在很快速的不同開發階段，都有不斷出現的社會、政治、經濟困難等著要解決。而且每個國家有他的特殊性，有時相同的社會裹頭在不同的地區、時間、族群也可能出現不同的特殊問題。譬如在開發中國家來說，台灣的“經濟奇蹟”是非常有名的，然而在經濟發展過程中，大量的人口增加和快速的工業化、都市化，也同時伴隨著公共衛生問題的出現。事實上台灣在過去四十年的開發過程中，公共衛生問題的變化和累積也到了相當嚴重，值得我們加以注意的程度。本文分析台灣目前所面臨挑戰的公共衛生問題時，分成以下六大項目：(1)人口問題(2)環境問題(3)疾病防治問題(4)食品、藥物和毒性物質處理問題(5)精神衛生問題(6)健康服務問題。 本文的主要觀點是以“公共衛生和人權”貫穿問題的本質。結論中提到聯台國世界衛生組織的呼籲：“公元二○○○年時希望全人類都得到健康”，事實上開發中國家要達到這樣的理想還必須做很大的努力去接受面臨的挑戰。公共衛生問題的改善就是人權問題的改善，也是社會、政治、經濟問題的改善。
  In the developing countries, Taiwan is famous for its ”economic miracle”. During the developing process of high population growth and fast industrial development, there is also dilemma between economic progress and public health problems. Since public health problems are basically engendered from the socio-political-economic roots of the social structure, this paper analyzes the underlying background of socio-political-economic situation of Taiwan for approaching its public health problems. There is a very great challenge for the developing countries to face their complicated public health problems engendered at different developing stages in a relatively short period. In fact, the socio-political-economic change in Taiwan in the past 40 years has been so big and fast that some public health problems are now very critical which need our attention today. And current challenge of public health problems in Taiwan is discussed in this paper from the below categories: (1) population problems, (2) enviromental problems, (3) disease prevention problems, (4) food, drug, and toxic substance problems, (5) mental health problems, (6) health service problems. This paper gives the concepts of ”Human Right and Public Health” as its conclusion. From the concepts, we know that there are still many challenges and struggles in the developing countries for the dream of ”health for all”. And we also know that all the problems of public health are also problems of human right as well as problems of socio-political-economic reform.
• 15 - 28
• 10.6288/JNPHARC1986-06-03-02

• Link 原著 Original Article
• 限鈉行爲介入對尿中含鈉量之影響研究The Influence of Sodium-Restriction Intervention on Urinary Sodium
• 李蘭
  Lee-Lan Yen
• 行改變 ； 高血壓 ； 限鈉 ； 尿鈉
  Behavior modification ; Hypertension ; Sodium restriction ; Urinary sodium
• 一個以學校?基礎的實驗研究之完成，乃在探討飲食介入對尿中含鈉量改變的影響。選出具有原發性高血壓家族史的學生並隨機分派至實驗或控制組。 介入計畫係根據行?改變理論和方蠢，?實驗組學生及其有高血釐之父母所設計，每週一次?時120分鐘，共計巡次約教學時間。學生前測時的高血壓知識程度、後測時自認能做到限鈉行?的信心程度、以及父母的健康自覺度，在決定他們的尿中含鈉量上扮演很重要的角色。本文並對未來研究提出重要的建議。
  A schoolased experimental Study was carried out to examine the influence of a dietary intervention on changing urinary sodium, Students sith a positive family history of essential hypertension were selected and tandomly assigned to the treatment or control group. An intervention protocol, Which was based on behavioral modification theories and methods, was designed in four Weekly 120-minute educational sessions for both students and their hypertensive parents of the intervention group. Student's knowledge of hypertension at pretest and self-efficacy in sodium restriction at post test, and parent's health perception play an important role in determining their urinary Sodium. The suggestions for future research are important.
• 29 - 42
• 10.6288/JNPHARC1986-06-03-03

• Link 原著 Original Article
• 大專聯考壓力症候群的探討Study on University Entrance Examination Stress Syndrome
• 張珏
  Chueh Chang
• 無
  Examination Stress ; Physical Syndorome
• 本研究係針對Selye的壓力模式，探討處在大專聯考壓力源下的高中學生2,127人（其中男生1,044人，女生1,083人），與不需參加聯考的師專學生483人（男生223人，女生260人），在其自述性身心症狀上的差異性。結果顯示，經由相對危險差的95%信賴區間來驗證與在Mantel-Haenszel X^2檢驗的比較，的確在有聯考壓力組中，表現出較多的症狀，同時在壓力組中，有隨年級增加而症狀增多的趨勢。
  For purpose of testing the stress model from Selye, 46 self-reported symptoms have been administered to 2127 senior high school students (who are going to take the University Entrance Examination (UEE) as the stress study group), and 483 junior college students (who are not take the UEE as the comparison group). Based on analysis of 95% confidence interval of odds ratio; as well as Mantel-Haenszel X^2 test, results show that those students who are under UEE stressor do report more symptoms, as compare to the comparison group. In addition, those symptoms in UEE stress group, tend to incresae by grades with a linear trend.
• 43 - 55
• 10.6288/JNPHARC1986-06-03-04

• Link 原著 Original Article
• 台北市十一家急救責任醫院急診室之使用適當性評估Appropriateness of the Emergency Department Utilization at Eleven Major Hospitals in Taipei City
• 姜錦燁、王榮德
  Chin-Yeh Chiang, Jung-Der Wang
• 急診標準 ； 評估 ； 急診
  emergency criteria ; evaluation ; true emergency
• 從台北市十一家急救責任醫院，於民國七十一年間分層隨機抽取7,314名急診病人的急診病歷資料，分析其急診條件以評估台北市緊急醫療照護系統被民眾不適當使用的程度。研究者根據目前十一家醫院現用的急診標準，訂出一套評估指標進行評估。結果合乎此套評估指標（稱之??急診）的百分率?69.4%。其它各性質的真急診百分率比較結果?：公立醫院高於私立醫院，男性高於女性，10~29歲和70歲以上較其它年齡組?高，大夜斑高於白斑和晚班，周間高於假日。呼吸系疾病和醫院的員工與眷屬的?急診百分率較低。?急診百分率在四季和不同的居住地並沒有多大差異。建議請專家學者組成委員會，根據現有急診標準並參考本研究所用之各種指標，共同訂出一套急診標準推介各醫院使用，並定期評估急診資源使用的適當性，以增進急診資源之使用。
  The purpose of the study was to determine the appropriateness of the emergency service utilization in Taipei. We abstracted 7, 314 medical records from the emergency departments of eleven major hospitals and evaluated the percentage of true emergency' according to a combined criteria of eleven major hospitals and modified by the authors. The results showed that 69.4% of emergency visits were truly emergent. Public hospitals were more likely to have higher percentages of true emergency than those of private hospitals. The percentages of true emergency for upper respiratory tract infections, gastrointestinal infections, and hypertension were 48.0%, 45.5%, and 37.7%, respectively, which were the major sources of nonemergent visits. Families of hospital employees' and children during age of 0 and 4, were more likely to use the emergency services inappropriately. There was no significant difference on the utilization of emergency service if stratified by the categories of season and residence place. We recommend that a uniformed criteria for emergency visits sh9uld be set up through an expert committee on this field in order that hospitals can put on practice and future evaluation can be done periodically.
• 56 - 73
• 10.6288/JNPHARC1986-06-03-05

• Link 原著 Original Article
• 台灣省立台北醫院急診病人的特性Characteristics of Emergency Patients at Taiwan Provincial Taipei Hospital
• 李孟智、 張永福、 呂碧鴻
  Meng-Chin Lee, Yeong-Fu Chang, Bee-Horng Lue
• 無
  none
• ?瞭解社區醫院急診患者的背景、急診疾病的性質，及社區民眾利用急診的情形，本研究以台灣省立台北醫院?例，自民國74年2月至乃年1月共365天中，立意隨機抽出30天，調閱該30天所有的病歷，進行分析。重要的結果如下： 1患者的背景：患者中男性與女性分別佔58.9%及41.1%，年齡層分布以0~9歲(24.8%)最多，住址分布以新莊市(69.0%)最多，付費身份以自費(62.2%)最多。2.急診疾病的性質：以外傷(29.0%)，呼吸系統疾病(26.7%)，及消化系統疾病(9.7%)居前三位；而科別分布織內科(38.8%)最多，其次是外科(32.3%)及小兒科(23.7%)。外科疾病以車禍(39.7%)最多，其次是工業傷害(22.4%)。工業傷害則以手部之撕裂傷及碎裂傷最常見。該院急診病人的轉診率?1.8%而轉診的疾病中以頸部外傷(44.5%)最多，轉診的原因多因設備不足(61.1%)。 3.民眾利用急診的情形：社區民眾對急診之利用度高，但急診中屬非急診者佔17.1%。非急診者的疾病以上呼吸道感染(48.1%)最多，並且來診的時間多在小夜班(45.6%)。 由本研究顯示該社區醫院的急診疾病以外傷最多，其中又以工業傷害?其特點，有待進一步探討及改進。又急診求醫中，有不少是屬非急診，影響急診室的正常運作，宜制定合理的急診標準，以強化急診的功能。
  To analyze the characteristics of emergency patients at the Taiwan provincial Taipei Hospital, 1115 cases were systemically drawn and reviewed from all the emergency visits during 1985-1986. The main results are as follow: 1. 58.9% of the patients were male, and 41.1% female. Patients aged under 10 years occupied the largest percentage (24.8%). 69.0% of the patients lived at Shinchuang City. As to source of payment, 62.2% of the patients were self-pay. 2. Three leading causes of emergency visits were trauma (29.0%). respiratory .system diseases (26.7%), and digestive system (9.7%). In term of specialty, Internal Medicine (38.6%) and Surgery (32.3%) comprised the majority of the cases. 22.4% of the cases. of trauma were due to industrial accident, an unique emergency in this community. Regarding the referral, 1.8% of all patients were referred mostly because of shortage of facility, and 44.5% of the referred patients were the cases of head injury. 3. Of all the patients, 17.0% were not-emergent and should not have visited the emergency department. 48.1% of non-emergency visits were upper respiratory tract infection.
• 74 - 82
• 10.6288/JNPHARC1986-06-03-06

• Link 原著 Original Article
• 研究生的自我認識結果分析An Analysis of the Results of Participating in Self-Recognition Activity among Graduate Students
• 李蘭、白恩惠、晏涵文
  Lee-Lan Yen, En-Huei Pai, Han-Wen Yen
• 自我認識 ； 人格特質
  Self-recognition ; personality
• 一個以兩所國立大學修讀「衛生教育」課程之研究生為對象，利用「感覺和偏好」量表測出人格特質的二十個層面的活動。結果顯示少數人格特質確有因學校、性別、和年齡之不同而有差異。學生方面，可用自我認識的結果瞭解人類行?的複雜性；教師方面，因對學生有更多的瞭解可有助於教學。
  Using a ”Perception and Preference” Scale to measure 20 levels of personality, an activity for enhancing students' self-recognition and self-analysis was conducted. The graduate students who took the course of ”Health Education” were selected as target population. Results indicate that few personality characteristics are different between schools, and between sexes/ages. On the part of students, results concerning self-recongition are bases for under-standing the complexity of human behaviors. On the part of instructors, more under-standing toward students facilitates teaching.
• 83 - 90
• 10.6288/JNPHARC1986-06-03-07

• Link 原著 Original Article
• 台北市中醫診所及中藥房求診孕婦常見症狀及常用處方調查Prescription Pattern of Chinese Her B Drugs among Herd Drug Stores and Chinese Herb Doctors in Taipei
• 許昭純、王榮德、沈志陽、陳淑娟
  CC Syu, J-D Wang, CY Shen, SC Chen
• 無
  none
• 本研究希望了解1.孕婦常見求診、抓藥原因。2.常見用之於孕婦的處方型態及內容。3.比較中醫診所和中藥房有關孕婦處方之異同。因此，研究對象以台北市衛生局七十四年中醫診所和中藥房名冊，去除部分與研究主題無關者，共得八百四十二家，分別郵寄問卷三次，並以電話輔助追?三次，以促進問卷的回收。結果在回收率23%情形下，初步發現中藥房或中醫診所孕婦常見抓藥原因相當一致，均?惡阻、胞阻、子腫、胎漏、子嗽及子喘等。平常使用以生藥材?主，常用複方以安胎飲（較十三味少了菟絲子）居多；同一複方其基本處方相當一致，只是中醫開方常因各人體質而有加減上的變異。這對將來中藥複方的評估，提供了一個似乎可行之路。
  Today, many women are still taking herb drugs during pregnancy in our country. The practice raises the concern of possible adverse effects to the fetus. The object of this study is to determine the common symptoms for which women take Chinese herb drugs and the consistency of contents of these drugs. We have conduct a mailed questionnaire survey of all, Chinese herb prsctitioners and drug stores in Taipei, and have succesfully obtain 30% and 20% valid answers from the former and the latter respectively. Th result shows that the most common symptoms during pregnancy for seeking Chinese herb drugs are nausea and vomiting, edema, vaginal spotting and cough. The most common Chinese herb prescription during pregnancy is An-Tai-Yin(???), which is the same as the socalled ”Tang-Kuei Thirteen herb combination : (???) except that the latter does not include Too-Sih-Tsu (???). We conclude that using epidemiologic method to evaluate adverse effect of Chinese herb drugs to fetus may be possible because of the consistency of these prescriptions.
• 91 - 104
• 10.6288/JNPHARC1986-06-03-08

• Link 其他 Others
• 76年中華民國公共衛生學會年度大會開幕致詞The Political Economy of Public Health
• Ivan L. Bennett
  Ivan L. Bennett
• 無
  none
• 無
  none
• 105 - 113
• 10.6288/JNPHARC1986-06-03-09

• Link 其他 Others
• 公共衛生的政治經濟學觀公共衛生的政治經濟學觀
• 賓綱德
  賓綱德
• 無
  none
• 無
  none
• 114 - 117
• 10.6288/JNPHARC1986-06-03-10