11卷1期

• Link 原著 Original Article
• 家庭疾病照顧與婦女角色之研究A Study on Family Health Care and Women's Role
• 季瑋珠、張珏、胡幼慧、李蘭、楊志良
  Wei-Chu Chie, Cheuh Chang, Yow-Hwey Hu, Lee-Lan Yen, Chih-Liang Yaung
• 無
  family ; health cari ; women's role ; Parents of Mental Retarded ; Eugenic ; Family Planning
• 為了解家庭疾病照顧的型態，尋找疾病照顧分工的影響因素，特別探討婦女在家庭疾病照顧中所扮演的角色，本研究在台灣北部地區使用依照人口比率之機率集束抽樣法，抽出50個地段，每地段再抽出40戶，以問卷訪視進行調查，總共完成1590戶（完成率79.5%)，包含5857個個人資料，其中有862個家庭成員在訪視指定期間曾經患病，佔全部5857人的14.7%。資料分析係針對此862人，先以卡方檢定，再以逐步對數複迴歸法(stepwise nultipll logistir regression)，分析各種社區、家庭，及個人的特徵，如何影響其所得到疾病照顧的分工。為使結果明確易懂，並配合我國注重家庭的文化特色，特將疾病照顧的分工分成自我照顧、性別分工，及輩份分工三個角度來看。本研究的主要發現為，在家庭層次95%以上的疾病照顧由同住家人完成，在個人層次，控制其他有顯著影響的變項後，與擴大家庭相比，離散期前核心家庭有較多由病人向我照顧的情形。勝算比為1.42，且無論離散期前或期後的核心家庭，均比擴大家庭，有較多由家中上一代照顧者，勝算比分別為3.42及4.34；孩童與青年相比，較多由上一代，且係由妻子母親照顧，（前者勝算比19.68，彼者20.17），老人受到他人照顧的程度則遠不及孩童。妻子、母親雖然在孩童照顧中扮演主要照顧者的角色。但當其本身需要照顧時，本研究並未發現其有被忽視而更須向我照顧的情形。最後，本研究從理論及測量上計論了這些結果，並對醫療保健政策提出建議。
  A proportional probability sampling with clusters was done to obtain 50 clusters, 1590 households and 862 cases with self-reported illness. A Structured questionnaire interview with home visit was performed. The influences of the characteristics of the community, the family and the patients themselves were analysed with Chi-square test and stepwise multiple logistic regression. The main results were: At the family level, cver 95% of the health care works were performed by the family members living together. At the individual level, after controlling all other variables, the influence of urbanization was not significant, patients in nuclear families before the stage of launching tended to take care of themselves, (adds ratio 1.42), those in nuclear families both before and aftex the stage of launching tended to be cared by the upper generation (odds ratio 3.42 and 434); children tended to be cared by the upper generation, actially, mothors (odds iatio 19.68 and 20,17), whill the elderly did not get the sane level of care as childion. Mother-wives did play an important role in family health care, however, when they onle necded others' care them needs were not found to be neglected or postponed. The issues in theoretical basis, concept and measurement, as well as the policy implication were also discussed.
• 1-12
• 10.6288/JNPHARC1992-11-01-01

• Link 原著 Original Article
• 花蓮縣山地鄕原住民健康問題盛行率之初步調查Preliminary Study of Health Problems in Hua-Lien Aboriginal Villages
• 陳慶餘、沈友仁
  Ching-Yu Chen, Yu-Zen Shen
• 無
  Epidemiologic Study ; Aborgine
• 山地醫療是台大醫院輔導花蓮醫療綱計畫的重點工作。本研究以家戶為單位，採系統抽樣問卷調查方法，針對山地原住民常見健康問題，如飲酒習慣、農藥中毒、意外傷害、絛蟲感染以及各種慢性疾病，研究其盛行率並分析各種健康問題與年齡、性別、族別、收入、教育程度、婚姻狀況、宗教信仰和職業的關係，以確認伴同健康問題的人口學特性，做為進一步防治規畫的參考。
  The study aims to investigate several common health problems known of the inhabitants in the three aboriginal villages of Hua-Lien county. Chronic diseaes were also included. One third of total household was sampled. There were 1,834 adults in 1,572 households. The survey was conducted from April 1989 to Jamuary 1990 by district nurses using a semi- structured questionnaire. The crude complete rate was 69.4%. Data was gathered from 1,113 adult aborgines. Results were summarized as follows: (1) The prevalence rate of alcohol overuse was 16.4%; alcoholism, 7.3%;agricultural drug poisoning, 3.9%; accident, 17.1%; tape worm infection, 27.3%; and pulmonary tuberculosis, 5.0%. (2) Peptic ulcer diseases was the leading chronic disease with a prevlence rate of 21.1%. It was followed by arthritis, 11.7% and hypertension, 7.6%. (3) Those health problems with their personal social profile as age, sex, tribe, income, education, marrital status, religion and occupation were examined. Each health’ problem with its demographic characteristics was identified. (4) The tendency of increasing alcohol drinking problem was associated with the occurrence of accident, agricultural drug poisoning, tape worm infection, pulmonary tuber-culosis, osteoarthritis and hypertension.
• 13-19
• 10.6288/JNPHARC1992-11-01-02

• Link 原著 Original Article
• 臺灣地區醫療財源籌措的問題與對策Health Care Financing in Taiwan: Issues and Directions
• 江東亮
  Tung-Liang Chiang
• 無
  Health Insurance ; Health Policy
• 目前，臺灣地區尚有55%的人口沒有健康保險。為了進一步保障人人有公平就醫的機會，政府已經決定在1994年完成實施全民健康保險。但是，在低保險費率政策與醫療費用節節上升之下，所有現行健康保險都已面臨嚴重財務他絀的危機。低保險費率政策主要源於過度強調社會保險的福利層面、與政治利益及降低生?成本的考量；而醫療費用的節節上升則與物價上漲、醫療需求的增加、醫學進步、事後論量計酬制度，以及醫療資源的配置不當等息息相關。為了健全全民健康保險制度，本文建議未來使康保險不但應單獨設置會計制度，按精算結果釐訂保險費率，而且應實施部分負擔，管制高科技醫療給付，採取總額預算制度，以及配合醫療行政改善醫療資源總體配置效率。本文最後呼籲應建立社會連帶責任的共識，期能在醫療資源有限的時代，化衝突為建設力量。
  At this moment approximately 55% of the total population in Taiwan are uninsured. In order to futher protect the right of citizen to health care the Government has decided to fully implement the National Health Insurance (NHI) program by 1994. However, as a result of their low premium policy and the rapid rising of health care costs all existing health insurance programs are facing serious financial deficits. The low premium policy was mainly due to an overemphasis upon the welfare dimension of social insurance, concerns for political interest and for the cost of production. The rising of health care costs was attributed to price inflation, the increase of demand for health care, the medical advancement, retrospective fee-for- service payment system, the inefficent macro-allocation of health care resources, and so on. To assure the soundness of the NHI program, I suggest that health insurance programs should not only establish their independent accounting system and adopt actuarial premium rates, but also implement cost sharing, regulate the benefit of advanced medical technology, adopt a global budgeting system, and integrate with the public administration of medical affairs to improve the efficiency of allocating health care resources. Finally, in an era of limited resources I should call for building a consensus of social solidarity so that the interest conflict be resolved into constructive power.
• 20 - 31
• 10.6288/JNPHARC1992-11-01-03

• Link 原著 Original Article
• 台北市學童對疾病與健康觀念的初探School-Aged Children's Concepts of Health and Illness
• 張珏、 陳芬苓
  Chueh Chang, Fan-Lin Chen
• 無
  Child ; Concept ; Illness ; development ; Parents of Mental Retarded ; Eugenic ; Family Planning
• 本研究的目的在探?兒童對疾病及健康的觀念。研究對象是台北市某國小3-6年級男女學童354名，採取開放式的問卷進行施測。根據認知發展理論，不同年齡的兒童對疾病和健康的概念也有所不同，由具體、知覺性、生理的概念，到抽象，非知覺性、心理的概念，會呈現階段性的差異。 研究的結果可歸納成下列幾點：（一）不同年級的兒童，對疾病與健康的概念也有所差異。（二）兒童對於疾病的概念多偏向以生理層面(87.2%)來解釋，只有少部份到心理層面(6.0%)，並沒有學童提到人際關係良好等社會層面的因素也和疾病的發生有關。（三）在生病處理方式上，多數提到是藉由外力的方式來處理(91.8)，五、六年級有10.3%的學童提到以自我控制的方式來處理，如：多休息，多喝開水等。（四）在健康的定義上，生理層面的定義居多占69.8%，心理層面的占16.0%，並未提到社會層面的定義。（五）有88.3%的兒童認為促進健康的方法是要有良好的行為。（六）年級愈高對生病原因和健康定義的敘述項目愈多。此外，性別在各變項上並無顯著差異。 根據結果，我們建議：(1)從事與兒童保健相關的工作人員，應了解不同階段之兒童，在疾病和健康觀念上的差異。(2)兒童健康教育的教材對疾病的原因和過程，要儘量具體，並詳加解釋而不是只有描述。(3)父母親若能對子女生病的原因做具體的解說，則將有助於子女預防下一次疾病的發生。(4)應加強兒童在生理、心理、社會三個層面之整體性的健康觀念。
  This study presents the development of children's concepts of health and illness based on Piaget's stage theory. Open-ended questions regarding the reasons for and the construction of health and illness were presented to 354 third to sixth grade students in a Taipei elementary school. Additional questions explored students' understandings of disease management and health promotion. Results indicate 1/Different concepts are formed over the different grade levels. 2/Most students see the origin of disease in physiological processes (87.2%). Only 6% mentioned psychological reasons and none of the students saw social factors as potential causes of illness. 3/A full 91.8% of students stated their reliance on external controls; however, 10.3% of fifth and sixth grade students saw self control as a means to manage sickness. 4/As to the factors promoting health, 69.8% of students referred to physiological processes, 16% mentioned psychological factors-but none saw social factors being involved in the construction of health. 5/Eighty-eight percent of students reported that doing good can promote health. 6/The older the student, the more elaborate the accounts offered for states of health and illness. 7/ There were no sex differences in the development of health and illness concepts. We present 4 implications for consideration: 1/ Health workers should understand the development of children's conceptions of illness. 2/ Teaching methods in health education should be concrete and provide more examples. 3/ Parents should be more specific in their descriptions of disease to the end of increasing children's understanding and ability to prevent disease while minimizing potential guilt feelings. 4/ Greater efforts should be made in the future to promote the bio-psychosocial view of illness and health.
• 32 - 43
• 10.6288/JNPHARC1992-11-01-04

• Link 原著 Original Article
• 減肥製劑中含安非他命類藥物之調查Report on the Survey of Adulteration of Amphetamine-Like Drugs in the Anorexiant Preparations
• 簡俊生、林春惠、孫慈悌
  Chun-Sheng Chien, Chung-Hwei Lin, Tsi-Tee Suen
• 無
  Diethylpropion ; Phentermine Methamphetamine ; Phenylpropanolamine
• 在1990年8、9月間，衛生署藥物食品檢驗局受理由中華民國消費者文教基金會檢送消費者提供各處中醫診所、減肥中心等99件減肥藥物檢體，檢驗是否含有安非他命類藥物。檢驗結果輸出有安非他命類藥物者33件(33.3%)，其中以含Diethylpropion者19件最多，依次是Phentermine 11件，Methamphetamine 2件及Phenylpropanolamine 1件，進一步分析顯示，在99件檢體中，有52件檢體來向24家中醫診所（藥房），佔最大部份(52.5%)；其中13件檢體(25%)，取自12家中醫診所(50%)，經檢驗出含有安非他命類藥物，對於隨意輕信媒體廣告，欲減肥之紳士、仕女實應格外小心。
  The adulteration of traditional chinese medicine preparation with chemical substance which was banned by the health authority for the reason of public safety has been a serious problem in Taiwan. The public in general are unaware of the seriousness of this problem. In the past, amphetamines, amphetamine-like drugs including amphetamine and its related substances such as diethylpropion, phendimetrazine, etc, were used to treat narcolepsy and hyperkinetic child. Our recent observation indicated that the appetite suppresive effect of this banned substance and its derivatives was utilized to treat obesity. The danger of potential drug abuse and severe side effect of these chemicals were well documented. From 99 samples of anorexiant preparations, we have found that 33 samples were adulterated by the amphetamine-like drugs. 52 out of the 99 samples came from 24 traditional chinese medicinal practitioners or chinese herbal drug stores. In addition, 13 samples (25%) which were found containing amphetamines were collected from 12 traditional chinese medicinal practitioners or chinese herbal drug stores. Among those 33 amphetamine-like drug adulterated samples, 19 samples contain diethylpropion which is the most widely used one. The result from this study indicated that the adulteration of these chemical substances among the traditional chinese medical practice has reached an alarming state. It requires Strict enforcement to curtail such illegal and dangerous activities.
• 44 - 48
• 10.6288/JNPHARC1992-11-01-05

• Link 原著 Original Article
• 台灣地區男女醫師專業生涯之比較－醫學社會面的探討Career Contingencies of Men and Women Physicians in Taiwan: A Study of Sociology of Medicine
• 劉慧俐、藍忠孚、藍釆風
  Hui-Li Liu, Chung-Fu Lan, Phylis-Lan Lin
• 無
  Women Physician ; Career ; Discrimination
• 為了了解女性何以選擇傳統上男性為主的職業－醫師為其職業，及其在專業上所遭遇的困難而進行本研究。透過問卷調查，共訪到159位女醫師及206位男醫師，結果發現：(1)女醫師較男醫師來自更優越的家庭背景。她們習醫動機及習醫重要參考人物多受家庭專業社會化影響。在選擇習醫的諸因素中女醫師受社會價值影響小。(2)在醫學院或醫療工作上半數左右的男女醫師皆認為女醫師受到性別歧視的壓力，但女醫師比男醫師少認為向己選錯了職業。與男醫師相同，「工作時間的過長或不定時」、「沒有進修時間」是專業上碰到的主要困擾。
  This research aims to explore the circumstances under which women selected one of the traditional male occupations in Taiwan, i.e. physician as their career and consider evidence documents difficulty against women in medicine. 159 female physicians and 206 male physicians responded to a structured questionnaire. The result revealed that: (1) The background of family's SES of the female physicians were more prestigious than the male physicians. The female physicians' family professional socialization influenced their career choice. The social value might play the minor role in making their career decision. (2) Abont half of female physiciarls perceived discrimination against themselves while they were in medical school and in practice. Compared to their male counterpart, the female physicians would usually not chose wrong occupation. Whether female or male physicians, work too long and no time to learn were the main difficulties in career.
• 49 - 59
• 10.6288/JNPHARC1992-11-01-06

• Link 原著 Original Article
• 初創期群醫中心門診使用率之分析An Analysis of Health Services Utilization in a New Group Practice Center-San Chill GPC
• 顧進昌、賴美淑、謝世民、林敬綜、謝維銓
  Jinn-Chang Guh, Mei-Shu Lai, Shih-Min Hsieh, Jing-Tzong Lin, Wei-Chuan Hsieh
• 無
  Group Practice Center ; Utilization Rate ; Accumulative Utilization Rate ; Farmer's Health Insurance
• 為了解社區民?對新開辦群醫中心門診醫療服務利用的情形，本研究以台北縣三芝鄉群體醫療執業中心為例，收集群醫中心自民國78年7月20日開辦以後至民國78年12月31日的門診資料，逐月分析門診使用率，並探討相關因素與使用率的關係。 結果平均每月來診病人52.1%(482/926)為女性，47.9%(444/9260為男性；37.3%(345/926)為自費病人，62.7%(581/926)為非自費病人。全社區平均月使用率為5.58%，其中女性使用率(6.33%)高於男性使用率(4.95%)，累積使用率呈穩定增加到12月底為18.04%(2991/16576)年齡方面，平均月使用率最高者為老年人口(14.98%)，其次為中年人口(8.66%)，再其次為幼年人口(4.55%)，最低為青壯年人口(3.04%)。以村別分析，則愈遠離群醫中心之地區平均月使用率愈低，其中埔頭(8.06%)，埔坪(7.41%)兩村最高，店子(0.85%)、興華(0.77%)兩村最低。保險人口（農保為例）8月份年齡標?化使用率為8.37%（直接法）與7.85%（間接法），均較全社區8月份使用率(5.38%)為高。研究結果顯示高危險群使用率高，而健康保險與交通距離均為影響使用率的重要因素，對使用率偏低的村落，有加強家訪衛教的必要。
  In order to explore the health services utilization of a newly developed group practice center (GPC) in the rural area, medical records of San-Chih GPC, Taipei County, were collected and analysed since opened date July 20, 1989 to December 31, 1989. Monthly utiligation rate and factors relating to utilization rate were investigated. The results showed that 52.1% (481/926) of average monthly GPC users was female, 47.9% (444/926) was male; 37.3% (345/926) was self-payment users, 62.7% (581/926) was partial or total reimbursement users. The average monthly utilization rate of the whole community was 5.58%, female's utilization rate (6.33%) was higher than male's (4.95%). The accumulative utilization rate increased steadily to 18.04% (2991/1650) by the end of December, 1989. As regards age, higher utilization rate were found in the elderly and chilldren group (?14Y/O); average monthly utilization rate by age were: 14.98% (?65Y/O), 8.66% (40-MY/O), 4.55% (?14Y/O), 3.04% (15-39Y/O). Utilizationn rate was inversely related to the distance that from the village center to GPC, 8.06% and 7.41% were found in two nearest villages, 0.85% and 0.77% were found in the most far areas. Age-standardized utilization rate of the people who had farmer's health insurance were 8.31% (direct method) and 7.85% (indirect method) respectively, those two were higher than the utilization rate of the whole community in August (5.38%). This study revealed the high risk age group had higher utilization rate; health insurance and accessible distance were important factors related to utilization of the GPC. Public health services like home visit and health education should be provided to the low utilization area.
• 60 - 69
• 10.6288/JNPHARC1992-11-01-07

• Link 原著 Original Article
• 自殺之潛在生命損失及其對社會之影響The Years of Potential Life Lost of Suicide and Its Social Impact
• 曹昭懿、王榮德
  Jau-Yih Tsauo, Jung-Der Wang
• 無
  Suicide ; YPLL Years of Potential Life Lost
• 以死亡率來估計一個社會的健康狀況，乃將不同年齡之死亡者，視為帶來社會同樣的損失，而潛在生命損失則考慮在不同年齡死亡時，社會所損失之人年數，可較準確的估算某死因所帶給社會的衛擊。向殺死亡者通常是年輕人，正值生產年齡，其死亡對社會所造成之不良影響通常比死亡率所表現出來的數字更大。本文乃利用行政院衛生署之生命統計資料及行政院主計處之薪資與生產力年報中國民平均薪資所得，計算因惡性腫瘤、腦血管病變及自殺三種原因致者，所帶來之潛在生命損失與薪資損失。由於前二死因之死亡人數遠超出自殺死亡人數，其所得之潛在生命損失與潛在早死年數損失均大於自殺死亡所致者。然而三死因所致之潛在工作年數損失則相差減小甚多。以之計算薪資損失，在民國78年時，惡性腫瘤、腦血管病變及自殺死亡所造成之薪資所得損失，在男性各為264.9、90.5及54.1億元；在女性則各為113.2、32.8及23.1億元。以上尚未計算由於自殺所造成社會、家庭變化之損失，如果再加上自殺未遂所耗費之人力、財力，則自殺所造成之損失更加龐大。吾人實應多用心於自殺之防治，以減少社會之損失，並提高社會之生產力。
  Mortality rates have been a major index of health status in a community for decades. They describe the number and rates of death due to different causes in a population, but were unable to represent the total social impact resulting from this mortality. YPLL (years of potential life lost), in contrast, is presented as an index that focuses more on the social and economic consequences of mortality. Victims of suicide arc usually young and productive. The social impact from suicide is greater than what represented from mortality rate. The objectives of this paper are to measure the YPLL's from the death of suicide and to compare with those from malignancy and cerebrovascular attacks (CVA). Besides, we have estimated the loss of income from these three causes of death. The YPLL and PYPLL (pre mature years of potential life lost) from malignancy and CVA are much greater than that from suicide because of the greater mortality rates. However, the difference among the WYPLL (work years of potential life lost) of these three causes is smaller. The loss of income in 1989 from malignancy, CVA and suicide are NT$ 26.5, 9.1 and 5.4 billions respectively for males; and NT$ 113, 3.3 and 2.3 billions respectively for females. If counting the cost of the psychological influence of the family and society, the impact from suicide will become even greater. We conclude that the prevention of suicide is an important task in our society, and need to put more resources on.
• 70 - 77
• 10.6288/JNPHARC1992-11-01-08