11卷2期

• Link 原著 Original Article
• 某釉藥工廠鉛暴露源之偵測診斷Identification of Lead Exposure Sources of a Ceramic Enamel Production Factory in Taiwan
• 詹長權、黃勝凱、莊弘毅、王榮德
  Chang-Chuan Chan, Sheng-Kai Huang, Hung-Yi Chuang, Jung-Der Wang
• 無
  Lead ; Ceramic enamel
• 本文的研究目的主要是對某家釉藥工廠的鉛暴露來源做科學性的偵測診斷以做為危害控制的主要依據，並提供有關單位做為危害鑑定的參考。本研究是以封閉式濾紙匣採樣法對某釉藥公司做作業環境中粉塵以鉛濃度暴露評估，由定點採樣結果發現配料台及一號窯爐乾燥箱為高暴露區，其粉塵濃度分別為3.07，6.15；而鉛濃度分別為1.153，0.246 (mg/立方公尺)。個人採樣結果顯示窯爐組工人有最高的鉛暴露（平均濃度為0.087 mg/立方公尺）。且由個人採樣結果及窯爐組員工工時分配情形得知員工鉛暴露量與其接近一號窯爐乾燥箱之時間長短有相關(R^2=0.96)，此結果可更加證明配料台及一號窯爐乾燥箱為高暴露區。另外，由個人及定點採樣之空氣中飴濃度仍超通國家標準，顯示此釉藥廠之作業場所仍然存在潛在的鉛危害。窯爐組工人在定點及個人採樣結果均與其血中鉛(41±9 ug/dl)較高一玫。本中心也建議工廠改進配料台的通風控制系統及變更乾燥過程，而避免使用由窯爐排出含有高程度鉛燻煙的廢氣。根據此項研究結果顯示，一套完整的環境採樣策略可以正確地評估作業場所的危害暴露狀況，鑑定?染源及提出可行的控制方案。
  The purpose of this study is to identify sources of lead exposure in one ceramic enamel production factory in Taiwan. A comprehensive ambient air monitoring program in the workplace was designed to determine worker's exposure to lead and particulates. Both personal and area samples were collected on mixed cellulose ester filters at 1.9l/min for 8 hours. Lead was analyzed by graphite furnace atomic absorption spectrometer. The results of area sampling indicated that particulates and lead concentrations were higher at the mixer and the dryer of No. 1 boiler than other places. The particulate concentrations at the mixer and the dryer were 3.07 mg/m^3 and 6.15 mg/ m^3 respectively. The lead concentrations at the mixer and the dryer were 1.153 mg/ m^3 and 0.246 mg/ m^3 respectively. The results of personal sampling indicated boiler workers had the highest lead exposure (mean=0.087 mg/m^3). A simple correlation analysis showed that the longer they worked at the dryer of No. 1, the higher their lead exposures (r=0.96). Both area and personal sampling results corresponded well with a higher blood lead (41±9 ug/dL) among boiler workers. Recommendations were made to the factory to improve the ventilation control of mixing operation and modify its drying process to avoid using the waste gas from the furnace, which usually contains a high level of lead fume to dry the products. This study demonstrates that a well planned air monitoring program can accurately evaluate worker's exposures, identify emission sources and suggest feasible control strategies.
• 81 - 88
• 10.6288/JNPHARC1992-11-02-01

• Link 原著 Original Article
• 民國74-79年各種職災累積死亡率與潛在生命年數損失之分析Death Due To Occupational Accidents and Cost to Society: An Analysis of Cumulative Mortality Rates and Years of Potential Life Loss
• 劉益宏、王榮德
  Yi-Hung Liu, Jung-Der Wang
• 無
  Cumulative mortality rates ; occupational accidents ; year of potential life loss
• 無
  The mortality rates of occupational accidents in Taiwan were usually 5-10 times those of Singapore and Japan during the past five years. The objective of this study was to explore the determinants of occupational fatalities and the loss of society incurred by these incidents. We collected and analyzed all mortality records (n=9457) of occupational accidents during January 1985-April 1991 from the Labor Insurance Bureau of Taiwan. The result showed that the average age of victims was 39.1±12.6. The average age of male workers was higher than that of female workers (40.8 vs 38.6 P<0.001). Among different industrial divisions, the average age of mining and quarrying workers was the highest (48.5±8.9), while that of commercial workers was the lowest (34.5±12.3). The five leading causes of occupational fatalities were traffic accident, drowning, falling from height, stumbling, and electrical shock, each consisting of 48.0%, 8.1%, 7.6%, 4.2%, and 3.8% of all occupational fatalities. Annually, the years of potential life loss (YPLL) incurred by occupational fatalities were near 66, 000 person-years, and the working years of potential life loss (WYPLL) were as high as 44,000 person-years. The estimated total amount of salary loss was about 13 billion New Taiwan Dollars in 1990. The risk of occupational fatalities of male workers was 6-8 times higher than that of female workers. The lifetime (1565 years) cumulative mortality rates of male and female workers were 0.025 and 0.0004 respectively. The three most dangerous industrial divisions of male workers were mining and quarrying, farming and fishing, and construction industries, because their average cumulative mortality rates were 0.115, 0.076 and 0.035 respectively. Those of female workers were utility services, mining and quarrying, and manufacturing industries, because their lifetime cumulative mortality rates were 0.011, 0:009 and 0.006 respectively. During the last 6 years, the death rates of occupational accidents in Taiwan have shown a mild decline. However, the overall figure of mortality rates due to occupational accidents is still high if compared with more industrialized countries and need more effort to reduce it.
• 89 - 101
• 10.6288/JNPHARC1992-11-02-02

• Link 原著 Original Article
• 營養師人力特性之分析Characteristics of Dietetic Manpower
• 章樂綺
  Leh-Chii Chwang
• 無
  Dietitan ; manpower
• 我國營養師在民國77年底首度經國家考試及格而正式誕生，為醫療體系新的生力軍，現有六個縣市成立公會，共有會員198人。本研究以其會員名單為對象，經由郵寄問卷調查營養師之人力特性，包括人口學資料、教育背景及執業性質等，以期提供營養師養成教育及人力規劃冬參考。結果顯示：營養師以女性為主(94.4%)，年齡在26-40歲間者佔87.6%，大學及以上學歷者達82.6%，大部份在醫院工作(71.5%)，從事行政管理及臨床普養業務。
  The first national examination held in 1988 gave the birth of the dietetic profession in Taiwan. Currently, there are 6 local dietitians' associations in Taiwan, with a total of 198 members. Through a questionnaire survey, this study examined dietitians' characteristics of demographics, education, place of employment and area of practice. The results indicate that dietitians are predominantly female (94.4%), in the 26-40 age groups(87.6%).The majority of dietitians are graduates of baccalaureate and graduate programs. They are mostly employed by hospitals (71.5%) and their main areas of practice are management and clinical nutrition.
• 102 - 106
• 10.6288/JNPHARC1992-11-02-03

• Link 原著 Original Article
• 某專科學校學生對B型肝炎之知識、態度與預防性健康行為之研究A Study on Students' Knowledge, Attitude and Preventive Health Behavior Toward Type B Hepatitis in a Junior College
• 郭憲文、袁素娟、郭憲華、王理
  Hsien-Wen Kuo, Su-Jiuan Yuan, Hsien-Hwan Kuo, Li Wang
• 無
  type B hepatitis ; Knowledge ; attitude ; health behavior
• 本研究係以某醫專學生為調查對象，以過去4年間（一年級至四年級）B型肝炎檢查結果，分為三組（易感染者，已有B型肝炎抗體者及B型肝炎帶原者），三者有相同比例之年級及性別，再經結構式問卷調查，實得有效問卷第一組100位同學，第二組73位同學，第三組168仁同學，比較三組組別間對B型肝炎認知，態度及所採取之預防性使康行為有何差異及探討影響採取預防性健康行為之相關因素，並瞭解在學四年間學生罹患B型肝炎之盛行率(prevalence rate of type B hepatitis)及四年間累積B型肝炎帶原者之發生率(cumulative incidence rate of type B hepatitis)。 研究結果顯示：該醫專同學B型肝炎知識來源主要是課本及教師，在認知上以護理科最高，牙技科最低，可能和修習B型肝炎課程有關。不同組別在B型肝炎預防性使庫行為上亦有所差異，其中，以第一組易感者對B型肝炎認知較差，故宜建議針對尚未感染者施以正確之教育，以切斷其可能感染之機會。B型肝炎帶原者竟有72.%認為不需追蹤檢查，顯示這些同學漠視B型肝炎對人體之危害性。在B型肝炎檢查中，四年間累積發生率為1.3%。因此，建議有關衛生主管單位與學校共同研擬B型肝炎防治計劃，除每年應做B型肝炎檢查外，應對易感染者加強其衛生教育及預防性使康行為，以達到有效切斷可能感染來源及維護個人使康之目的。
  The results showed that (1) the students' knowledge about type B hepatitis 8medical personnel; (2) for the knowledge of type B hepatitis, the department of nursing was the best, while the department of dentistry was the poorest and that was due to courses they took in school; (3) the factors which affected their attitude toward type B hepatitis were knowledge about type B hepatitis and sex and course; the more knowledge, the better attitude and health behaviors and female students more than male students; (4) the prevalence rates of type B hepatitis the first graders and the fourth graders were 15.8% and 13.9%, respectively, and cumulative incidence rate was 1.3% during a period of 4 years. Suggestions of how prevent type B hepatitis among junior college students were provided in the text. The objective of this study was to investigate the knowledge, attitude and preventive health behaviors toward type B hepatitis and to measure the prevalence rate and cumulative incidence rate during a period of 4 years among college students. According to previous data, 100 students were enrolled as susceptible groups, while carrier (n=168), students found with antibody of type B hepatitis in the fourth year (n=73) were chosen as two infective groups. All students were interviewed with a constructed questionnaire of which content validity and reliability were tested before the interview.
• 107 - 123
• 10.6288/JNPHARC1992-11-02-04

• Link 原著 Original Article
• 台灣南部地區某山地鄕C型肝炎病毒血清流行病學研究Seroepidemiology of Hepatitis C Virus among Residents of an Aboriginal Township in Southern Taiwan
• 黃凱琳、游山林、王秋華、朱健次、楊照雄、陳建仁
  Kai-Lin Hwang, San-Lin You, Chiu-Hwa Wang, Chien-Ts Chu, Czau-Siung Yang, Chien-Len Chen
• 無
  HCV ; HTLV-I ; Epidemiology ; Aborigional township
• 台灣地區一般人口的C型肝炎病毒(HCV)抗體陽性率約在1%左右。由於第一型人類T細胞白血病病毒(HTLV-Ⅰ)和HCV同屬體液傳染病毒，本研究乃以HTLV-Ⅰ感染率偏高的高雄縣桃源鄉為研究地區，調查當地居氏的HCV抗體陽性率，並辨明是否有家族聚集的現象。總共以隨機抽樣選取119家戶之398名成員為研究對象，利用放射免疫分析法測定血清中之B型肝炎表面抗原(HBsAg)，而以酵素免疫分析法儉驗HCV抗體陽性狀態，並且根據結構式問卷調查人口學特徵，以及輸血、刺青既往史。研究結果發現，當地居民之HCV抗體陽性率高達5.8%(23/398)，而且隨年齡增加而顯著上升，於30-39歲達最高峰(17.0%)，而彼下降。HCV抗體之年齡標準化陽性率，男性(6.5%)略高於女性(4.7%)，已婚者(4.7%)高於未婚者(1.3%)，有輸血既往史者(5.3%)略低於無既往史者(5.5%)，閩南籍(5.5%)與山地籍(6.0%)相近，各變項均與HCV抗體陽性率無顯著相關。HBsAg帶原者的HCV抗體年齡標準化陽性率(7.6%)亦僅略高於非帶原者(5.0%)。雖然有兩戶家庭各有兩名陽性個案，其家屬關係分別為夫妻和公媳，但統計分析顯示無明顯家族聚集現象存在。當地居民HCV抗體陽性率偏高之原因，有待進一步探討。
  The positivity rate of antibody to hepatitis C virus (anti-HCV) was reported as 1% for the general population of Taiwan. Both human leukemia/lymphoma virus type-I (HTLV-I) and HCV are body fluid-transmitted viruses, residents of an aboriginal township with a high prevalence of HTLV-I was studied to examine the positive rate and familial aggregation of anti HCV. A total of 398 subjects in 119 randomly selected housholds were recruited. The hepatitis B surface antigen (HBsAg) carrier status and anti-HCV positivity were examined by radioimmunoassay and enzyme immunoassay, respectively using commercial kits. Sociodemographic characteristics and history of blood transfusion and tattooing were obtained through standardized interviews based on structured guestionnaires. The anti-HCV positive rate of study subjects was as high as 5.8% (23/398). It increased with age and peaked at ages of 3039 years. The age-adjusted anti-HCV positive rate was 6.5% and 4.7%, respectively, among males and females. There was no significant association of age-adjusted anti-HCV positive rate with marital status, history of blood transfusion, and paternal and maternal ancestry. HBsAg carriers had slightly higher age-adjusted anti-HCV positive rate (7.6%) than non-carriers. Although there were two families with two family members infected by HCV, no statistically significant familial aggregation was observed. The reasons for the extraordinarily high anti-HCV positive rate among residents in the township remain to be elucidated.
• 124 - 130
• 10.6288/JNPHARC1992-11-02-05

• Link 原著 Original Article
• 口服中藥成藥對血清腎上腺皮質醇濃度的抑制效應Suppressive Effect of Formulated Herb Drug on Serum Cortisol Level
• 陳育堂、王榮德、張智仁
  Yu-Tang Chen, Jung-Der Wan, Chin-Jen Chang
• 中藥成藥 ； 腎上腺皮質醇
  formulated herb drug ; cortisol
• 無
  The objective of this study is to determinate the effect of formulated herb drugs on serum cortisol level. After eliminating most conditions (including taking various kinds of drugs) known to influence serum cortisol level, we have selected 59 subjects who ever used to taking formulated herb drugs at our clinic of family medicine. 76 subjects who never use herb drug were also recruited for comparison. Serum cortisol levels were measured ill 8 a.m. and 4 p.m. respectively by radioimmunoassay method. The results revealed that the serum cortisol values at S a.m. of the above two groups (control vs . user, mean±S.D.) were: 11.9±4.1µg/dL, 6.3±4.8µg/dL respectively, P<0.0001; and those at 4 p.m. were 6.3±3.0µg/dL, 3.9±2.9µg/dL respectively, P<0.000l. Because we have excluded all other alternative explanations, we conclude that taking formulated herb drugs may reduce the serum cortisol and probably result in adrenal insufficiency. The degree of suppression was greater among people who take formulated herb drugs for arthralgia or/and bone pain than those who take for other reasons. We recommend that history of taking formulated herb drugs should be routinely asked in our regular clinic, especially for patients with symptoms of bone pain and/or arthralgia. Thus, we can early detect adrenal insufficiency and prevent complication. The limitation of our study is that we have no determination of steroid content inside herb drugs, and hope that further research should be directed to resolve this problem.
• 131 - 139
• 10.6288/JNPHARC1992-11-02-06

• Link 原著 Original Article
• 1979及1989兩年台灣地區十大死因之潛在生命損失與累積死亡率之比較Comparison of Potential Life Lost and Cumulative Mortality Rates for 10 Leading Causes of Death in 1979 and 1989 of the Taiwan Area
• 林茂榮、陳美滿、王榮德
  Mau-Roung Lin, Meei-Maan Chen, Jung-Der Wang
• 無
  Cumulative mortality ; years of potential loss ; ten leading causes of death
• 一般生命統計是以死亡率的高低來決定死因的順位，但死亡率並無法直接反應出各死因的生產力損失。故本文以各種潛在生命損失及累積死亡率計算民國六十八年與七十八年生命統計中的十大死因，試圖了解各死因的大致經濟損失及各年齡層的危險死因。各種潛在生命損失的計算皆使原本十大死因的順位有相當的改變，六十八年與七十八年的各種潛在生命損失都以意外災害高居首位。七十八年生產年齡層死在意外災害所造成的經濟損失以總薪資來估計約為新台幣920億元，而其他九個死因在生產年齡層的經濟損失總合約新台幣834億元。另外，六十八年十大死因的累積死亡率，7至59歲之間以意外災害最高，60至69歲之間則以惡性腫瘤為高，69歲以彼腦血管疾病雖為首位。至於七十八年十大死因的累積死亡率，0至59歲以意外災害為最高，59歲以後則以惡性腫瘤與腦血管疾病較高。六十八年與七十八年十二個死因累積死亡率的比較，大部份死因都有降低，其中以腦血管疾病與高血壓疾病降低最多，而惡性腫瘤、意外災害與糖尿病卻上升。此外，兩年中之男女性十大死因累積死亡率的比較，男性皆高於女性，大致在59歲以前以意外災害差距較多，59歲以後則變成腦血管疾病與惡性腫瘤在男女性之差距較大。由結果顯示，意外災害死亡者大部份在生產年齡，因此它帶給社會及家庭經濟衝擊是非常巨大的，而六十八年與七十八年兩年意外災害的比較，顯示它並無減少，因此需要政府與國人更進一步重視研究與預防。
  The objective of this study is to calculate and compare the years of potential life lost (YPLLs) and cumulative mortality rates for 10 leading causes of death of Taiwan in 1979 and 1989. Mortality and population data abstracted from the national health statistis were used to calculate the YPLL, PYPLL (premature years of potential life lost), WYPLL (working years of potential life lost), VYPLL (valued years of potential life lost) and the CMR (cumulative mortality rates). The results showed that mortality from accidents has the highest YPLL's for all different calculations, and it has the highest cumulative mortality rate from age 7 to 59. The total less of wage due to accidents in 1989 was estimated to be NT$92 billion as compared with NT$83.4 billion which was the estimated sum of all other 9 leading causes of death. There was a general decline of cumulative mortality rates for major causes of death other than accidents, cancers and diabetes mellitus. Besides, the CMR of male were general higher than those of females. Before age 59, mortality due to accidents had the highest sex difference in CMR, which cancers and CVA showed the highest sex difference in CMR after age 59. We concluded that the mortality due to accidents had the most significant social impact in terms of economic loss, and there was no improvement during 1979 and 1989. We therefore recommend that more resource and attention need to be drawn on the research and prevention of accidents mortality.
• 140 - 149
• 10.6288/JNPHARC1992-11-02-07

• Link 實務 Public Health Practice
• 衛生所報表簡化過程之探討A Study on Simplification of the Health Information, System of Health Station
• 季瑋珠、李世代、簡大任、符春花
  Wei-Chu Chie, Shyh-Dye Lee, Ta-Jen Chien, Chun-Hua Fu
• 衛生所 ； 報表系統
  Health station ; report system
• 衛生所各項業務報表系統繁雜、重複，致使工作效率降低，人力時間浪費，又無法提供迅速、正確而完整的社區健康資訊，以為決策之參考。本研究搜集各型衛生所現行的各種重要報表，訪問相關機構，由基層至中央，追查其設五的來源、目的、去向及考核呈報系統。經實地考察、分析的結果，發現目前以衛生所為起始點的報表系統，不僅存在上述的問題，尤有進老，因衛生所服務涵蓋率有限，經由此系統蒐集之資料無論如何簡化與改善品質，仍不足以達到診斷社區使康問題及需求，與評價整體服務成效的目的。另一方面，要求各公私立醫療院所均採行此一報表系統之可行性又極低，因此本研究建議大量刪除現有的親表，只保留個案記綠做服務管理之用。社區診斷與服務評價的工作，則應改為一方面由涵蓋醫療及保健之全民使康保險給付記錄獲取資料，一方面由衛生機構會同學術單位，在各地實施定期抽樣調查。
  The complex and redundant health information system of health station results in low efficiency, waste of time and manpower, and limited capability to offer quick, correct, and complete health information of a community. In order to solve these problems, all important health information forms and reports of health stations were collected and studied. The purposes and pathways of these forms and reports were studied carefully. After a period of field observation and analysis, a further problem was found in addition to those problems stated above. The proportions of most services provided by health stations in terms of total services provided (such as provided by provincial hospitals and private hospitals) were so low that the informations collected from these reports could not reflect the health demands of their community or the effects of their services, no matter how much effort was made to simplify them. It was also of least possibility to ask all public and private health care facilities to fill up all those complex report forms as the health stations did. According to this finding, the authors suggested to cancel all reports except case records, and to collect health informations fron health insurance records and periodical surveys.
• 150 - 161
• 10.6288/JNPHARC1992-11-02-08