8卷4期

• Link 綜論 Review Article
• 現階段台灣毒性物質管理政策之可能缺失及改進之道Potential Problems and Solutions of Current Policy of Toxic Substance Control in Taiwan
• 王榮德、簡慧貞
  Jung-Der Wang, Huei-Jen Chien
• 無
  toxic substance control ; legislation
• 本國之毒性物質，在過去缺乏統一事權之法律與管轄機關，導致曾發生許多毒物引起的疾病。政府最近頒訂毒性物質管理法（以下簡稱〔毒管法〕)，並將環保機關提升為署，顯示其加強毒管之決心。本報告即是針對毒管政策，特別是毒管法及細則，加以分析。 本研究發現目前之毒管法採用公告列管，對新出現的毒物不能防患未然；且由於缺乏毒物在環境中流布之資料、充足的判讀毒物毒理之人才，以及進行毒理研究與毒物疾病流行研究之人才與技術，對於公告之先後次序勢必發生爭論與決策上之困難。此外毒管法與其他相關之法規間，如勞工安全衛生法、農業管理法等，尚缺乏一致的毒物資料表；以致毒物的流布無從掌握，而可能引起人體中毒與環境污染。我們建議立即採取下列措施，以減少流弊且達成毒管目標：1.加速公告速度，並在3~5年內修法以管制新的化學物。2.成立財團法人性質之「環境毒物研究中心」，提供毒管所需之高級人才、知識與技術；並建立資訊中心，以收集及整理各種毒管所需之資料庫。3.利用毒管技術諮詢委員會與協商會等組織，訂立毒物公告之次序。4.在毒管法施行細則中明訂毒物之安全資料表格式與內容，並推廣至尚未被列管的化學物。5.積極培訓公私立機構之毒管人才，並建議教育部在各大學優先增設毒管技術相關之系所，或至少加開這類課程。此外，在細則中宜增加適當現定以保障毒管人員之品質。6.加強政府機開間之協調，以逐步建立毒管法之權威及執行方式。7.寬籌經費以達成以上工作。此外，並應逐步建立毒管政策之各種結構、程序及結果指標，以監測其成效
  Toxic substance control in Taiwan once fell under the jurisdication of six different government agencies, with at least 17 laws or regulations promulgated for the purpose. Because of the fragmentation of these regulations and responsibilities, diseases caused by toxic substances have been rampant and increasing over the last decade. In an effort to reverse this trend, the Environmental Protection Agency was set up and Toxic Substance Control Act (TOSCA) was enacted recently. This review predicts the potential problems of this new policy and provides ways to prevent or correct possible adverse effects. The findings (potential problems) included that (1) the scope of the current TOSCA is too limited because it will include only 300 substances on its registry in the next 5 years and it does not provide for regulation of new chemicals; (2) With lack of sufficient information about environmental distribution and toxicologic effects, chemicals cannot gain priority on the registry; (3) material safety data sheet was not provided and standardized; (4) all the regulations and agencies responsible for toxic substance control were not integrated. We propose the following solutions: (1). An increase in the speed of addition of chemicals to the registry, and modification of the law to regulate new chemicals over the next 3-5 years. (2). Establishment of a toxic chemical research center, which can provide the necessary information and support the technology for toxic substance control. The center should be a non-profit organization rather than falling completely under the current governmental system, in order to allow flexibility and to preserve qualified personnel. (3). Establishment of priorities for regulated chemicals by organization of a technical council and a coordination council for toxic substance control. The former would consist of representatives of consumers, manufacturers, and officers from related governmental agencies, while the latter would consist mainly of physicians and toxicologists. (4). Generation of a standardized material safety data sheet to be used for all chemicals and for all regulations. (5). Promotion of education, training, and continued education for toxic substance control personnel in factories and related agencies. (6). Enhancement of intra-governmental communication and integration of toxic substance control. (7). Provision of an adequate budget for the work.
• 205 - 219
• 10.6288/JNPHARC1988-08-04-01

• Link 綜論 Review Article
• 從護理觀點建立病人分類系統：文獻探討The Development of Patient Classification System from Nurses' View Point-Literature Review
• 蘇喜
  Syi Su
• 無
  patient classification ; self-sufficiency ; direct care index
• 傳統上護理人力資源的決定與分配，一直根據固定的人員?位比率，而此比率早已被認為無法適時地反應出機構間與每個病人間的變數（病人的護理需求因個人的情況之不同而有所不同）。以護理需求為依據的病人分類系統，乃專為解決護理人力分配而發展的有效工具。本文就此工具的重要性、信度及效度的考量、建立時的步驟及限制一一加以討論。
  Traditionally the determination and allocation of nursing personnel resources relies heavily on globally recommended fixed staff-to-patient ratios, which have been considered to be insensitive to variations both among hospitals and among individual patients. Patient classification method, a manpower planning tool uniquely developed for nursing, is more likely to determine appropriate nursing personnel requirements. This article discusses the importance, reliability, validity and development of the patient classification system as well as its limitations.
• 220 - 229
• 10.6288/JNPHARC1988-08-04-02

• Link 原著 Original Article
• 嬰兒奶粉促銷活動與母親對嬰兒奶粉之選擇的探討Infant Formula Promotion and How Mothers Choose Infnt Formulae
• 屈蓮、白璐
  Lian Chiu, Lu Pai
• 無
  Infant Formula ; promotional Activities ; Formula Companies
• 眾多的研究報告指出，奶粉廠商的促銷活動是造成母乳哺餵低落的主要原因之一，於是世界衛生組織為了約束有關嬰兒奶粉的促銷活動，而制定了「國際母乳代用品規章」。我國不屬於世界衛生組織，嬰兒奶粉的促銷活動也較活躍，但對於促銷活動的事實狀況及其影響性，均尚未有可資參考的文獻報告。 因此本研究訪問了國內現有的奶粉廠商、台北市擁有婦產科之醫院診所、及超級市場與平價商店，希望了解促銷活動之現況。並以自擬結構式問卷，訪問台北市木柵區於76年6、7、8三個月出生之未滿六個月正常嬰兒的母親，及75年底至76年12月以前結婚之新婚夫婦中第一胎懷孕的母親、以便了解母親如何選擇嬰兒奶粉。 訪問結果顯示，奶粉廠商使用的促銷方法可歸類為六大項：(1)免費供應醫療院所奶粉樣本；(2)發送（陳列）宣傳刊物；(3)大眾媒體的宣傳；(4)減價優待；(5)附送贈品；(6)直接與母親接觸。中、日廠商的促銷方法較歐美廠商具多樣性，且頻繁度較高，而歐美品牌的價格較中、日高。問卷調查結果發現，母親傾向於購買來自歐美、高價位、中促銷的嬰兒奶粉。顯然促銷活動對母親選擇嬰兒奶粉具有部份影響力，但高促銷並不一定造成高銷售量，這由母親對各促銷方法的相信程度及購買意願之情形亦可窺之。
  Many studies indicate that the commerical promotion of infant formula is one of the factors causing the decline in breast-feeding. In order to limit these promotional activities, the World Health Organization established the ”International Code of Marketing of Breast-Milk Substitutes” in 1981. Since the Republic of China is not a member of the World Health Organization, the promotion of infant formula is quite active in this country. The purpose of this study was to determine the effect of promotion on mothers' choices in infant formula. We visited formula companies, obstetric and gynecologic clinics, supermarkets and other stores in Taipei to investigate promotion activities. In addition we interviewed 81 first-time-pregnant women and 200 mothers of bottle-feeding infants who were under six months of age to understand betters their decirions to choice infant formula. It was found that infant formula promotion activities include providing formula samples to clinics, supplying pamphlets and posters, advertising by mass media, selling products at discounted prices, distributing gifts to buyers, and contacting mothers by marketing personne. Companies from the Republic of China and Japan were included in more extensive promotional activities than those from the U.S. and European countries. However, the prices of formulas made in American and European countries were among the highest. Mothers tended to buy formulas made in Western countries, and of higher prices, and medium promotion. Obviously promotion can partially affect mothers' choices; haweves, strang promotion does not necessarily induce strong demand for the product
• 230 - 247
• 10.6288/JNPHARC1988-08-04-03

• Link 原著 Original Article
• 影響大學生高血壓的生理心理社會因素Biopsychosocial Risk Factors of High Blood Pressure among College Students
• 梁繼權、李明濱、陳慶餘
  Kai-Kuen Leung, Ming-Been Lee, Ching-Yu Chen
• 無
  high blood pressure ; parental hypertension ; obesity ; emotional reactivity ; psychosocial stress
• 無
  A total of 51 students with high blood pressure were compared with 59 controls. Factors examined were parental histories of hypertension, degree of obesity, cigarette smoking, exercise patterns, emotional reactivity, and number and self-perceived severity of stressful experiences. The results indicated that high blood pressure was strongly correlated with parental histories of hypertension and degree of obesity (p<0.005 and p<0.001 respectively), but not with cigarette smoking, exercise patterns, emotional reactivity, and stressful experiences.
• 248 - 254
• 10.6288/JNPHARC1988-08-04-04

• Link 原著 Original Article
• 台灣地區社區高血壓防治實驗計畫：I．流行病學特徵與治療順從性Six-community Hypertension Intervention Trial in Taiwan: Epidemiological Characteristics and Treatment Compliance
• 陳建仁、曾文賓、潘碧珍、林淑華、莊雅倩、譚素貞、 鄭淑姿、江弘基
  Chien-Jen Chen, Wen-Ping Tseng, Bi-Jen Pan, Shu-Hwa Lin, Ya-Chien Chuang, Shue-Jane Tan, Sock-Chee Tay, Hung-Cu Chiang
• 無
  hypertension ; prevalence ; risk factors ; treatment compliance
• 本研究之目的在於瞭解台灣地區居民之高血壓流行病學特徵及危險因子，評估高血壓患者之治療順從性，以及探討社區高血壓防治工作之可行性。本研究自台北市、高雄市和台灣省分別選取了南港區、楠梓區、大園?、大樹?、竹南?和斗南?作?研究地區，以隨機抽樣選取了4056名男性和3899名女性居民?研究對象。根據世界衛生組織推薦之標準方法，由特別調訓之衛生所醫師及護士，進行高血壓調查和治療之工作。同時在六個衛生所成立高血壓特別門診，進行免費之階段治療。研究結果發現，台灣地區居民之性別、年齡別平均收縮壓與舒張壓，與世界各國並無明顯差異。高血壓盛行率隨著年齡增加而增加，女性自30歲以下的1.0%增加至70歲以上的37.4%，男性則自15%增加至34.2%；在五十歲以下的年齡層男性高於女性，五十歲以上則女性高於男性。複迴歸分析顯示鄉鎮居民之盛行率高於市區居民，而且肥胖度、喝酒頻率、喝茶頻率、鹹食攝取頻率及父母高血壓史與高血壓呈現正向的劑量效應關係，而活動量則與高血壓呈負相關。心臟血管疾病與糖尿病?往史也與高血壓有密切相關。防治實驗也顯示轉介至高血壓特別門診的患者，其治療順從性高達80.6%；而轉介至其他門診的患者，其順從性只達50.6%。高血壓患者中斷治療的主要原因是「不再感覺到有不舒服」以及「沒有時間看病」。
  In order to examine epidemiological characteristics and risk factors of hypertension, to assess the treatment compliance of hypertensives, and to evaluate the feasibility of community-based hypertension control programs in Taiwan, a Six-Community Hypertension. Intervention Project (SCHIP) was conducted, involving the survey and follow-up of 7,955 men and women. Experienced public health physicians and nurses were employed to conduct cardiovascular surveys and laboratory examinations according to standard protocols, and special hypertension clinics were established for the step-care of hypertensives.
• 255 - 269
• 10.6288/JNPHARC1988-08-04-05

• Link 原著 Original Article
• 化學相關工廠使用個人防護設備的現況調查Use of Personal Protective Equipment in Chemical-Related Industries in Taiwan
• 林嘉明、 簫淑珍、施文儀、許文三
  Jia-Ming Lin, Shwu-Jen Shiau, Wen-Yi Shy, Wen-San Shi
• 無
  personal protective equipment ; chemical industry ; respiratory protective devices
• 個人防護設備的使用為預防職業危害的方法之一，可是容易因不當之應用致失去其保護工作者健康之用意。本調查以問卷及實他巡檢，在我國中部夜台中、彰化、南投、雲林等四縣，訪視104家化學相關工廠，發現712%的工廠認為其工作環境需要使用個人防護具，而97.2%的雇主提供，但只有17.5%的工廠由雇主指派代表負責維護及管理防護具；實地巡檢之結果，發現1744項潛在曝露，514項有對應的防治措施，使用個人防護具者佔38.5%，其中61.6%為呼吸防護具，唯呼吸防護具之有效性的出現率偏低。因此認為大部份的工廠在沒有嚴謹的計畫下使用個人防護具，尤其是呼吸系防護具之使用可能造成不當應用的後果，需要推行活動輔導廠商。
  Personal protective equipment (PPE), one method for protecting workers from occupational hazards, may be ineffective and lead to immediate exposure to hazards if it is not supported by a proper program. Thus, a survey was conducted in central Taiwan in order to determine whether PPE was being properly utilized in chemical-related industries. Among 104 factories, 71.2% responded that there was at least one workplace where PPE was required in their factories. In these factories, most employers (97.3%) took the responsibility of supplying PPE, but only 17.6% of the employers had designated persons to be responsible for the use and maintenance of PPE. In addition, the walk-through survey discovered 1744 potential hazards. Precautions had been taken against only 514 of these hazards, 38.5% of these precautions involved PPE; 61.6% of the PPE were respiratory protective devices. However, the use of respiratory protective devices was inappropriate in most cases. A campaign is required to correct this situation.
• 270 - 277
• 10.6288/JNPHARC1988-08-04-06