12卷1期

• Link 原著 Original Article
• 烏腳病盛行地區居民之早期砷暴露和皮膚癌之病例對照研究Early Arsenic Exposure and Cancer-A Community-Based Case-Control Study in an Endemic Area of Blackfoot Disease
• 陳淑媛、余幸司、陳國熏、郭宗禮、陳建仁
  Shu-Yuan Chen, Hsin-Su Yu, Gwo-Shing Cheng, Tsung-Li Kuo, Chien-Jen Chen
• 砷 ； 皮膚癌 ； 病例對照研究
  Arsenic ; Skin Cancer ; Case-Control Study
• 台灣西部沿岸有較高的皮膚砷癌盛行率，其中以烏腳病地區最高。本研究的目的在於瞭解飲水改善後，烏腳病盛行地區的皮膚砷中毒症盛行率；探討砷暴露指標和皮膚砷中毒症的關係；並評估調整其他危險因子後，累積神暴露量對皮膚瘤的影響。本研究選擇烏腳病盛行率最高的嘉義縣布袋?好美、復興、新民三里的30歲以土居民?研究族群，進行以社區?基礎的病例對照研究。總共有914名當地居民在1989年1至2月接受健康檢查和問卷訪視。結果發現皮膚色素沈著過多症、角化症和皮膚瘤的盛行率（及患者平均年齡）分別是13.1%（57.7歲），4.9%（58.0歲）和5.9%（61.1歲）。年齡調整後之皮膚癌盛行率皆隨飲用深井水年數或飲水累積砷暴露量的增加而上升。飲用深井水年數?＜10，10-19，20-29和30年以上者，其年齡－性別調整後皮膚癌盛行率，分別是3.5%，3.9%，4.8%和9.8%；而累積暴露量?0，1-9，10-29，30年ppm以上者，該調整盛行率分別是0%，1.1%，7.0%和11.1%。經調整和皮膚癌有顯著統計相關的危險因子，包括年齡、性別、工作日曬史、家族烏腳病或皮膚癌既往史、血清麩丙酮轉氨基?濃度、食用曬乾番薯簽年數、以及鹽田工作史後，飲水累積砷暴露量仍與皮膚癌盛行率呈現劑量效應關係。
  Chronic arsenicism of the skin has been- documented to be extraordinarily high on the southwestern coast of Taiwan, especially in the endemic area of blackfoot diease (BFD). The specific aim of this study is to estimate the prevalence of chronic arsenicism among residentsin the BFD-endemic area after the discontinuation of drinking artesian well water. Arsenic exposure and skin lesions including hyperpigmentation, hyperkeratosis and cancer were studied. Residents aged 30 years old or more in the BFD-hyperendemic villages were recruited as study subjects for this community-based case-control study. A total of 914 residents in Homei, Fuhsin and Hsinming villages were examined by dermatologists during the period from January to February, 1989. The prevalence (mean age of the affected) of hyperpigmentation, hyperkeratosis and non- melanoma skin cancers were 13.1% (57.7 years), 4.9% (58.0 years) and 5.9% (6.1 years), respectively. There was a dose-response relationship between cumulative arsenic exposure and the age-sex-adjusted prevalence of skin lesions. The age-sex-adjusted prevalence of skin cancers for those who had consumed artesian well water for <10, 10-19, 20-29 and 30+ years were 3.5%, 3.9%, 48% and 9.8%, respectively. The prevalence was 0%, 1.1%, 7.0% and 11.1%, respectively, for those who had a cumulative arsenic exposure level of 0, 1-9, 10-29, 30+ ppm-years. This dose-response relationship remained significant after adjusting for other risk factors significantly associated with the development of chronic arsenicism of the skin including age, sex, a familial history of BFD and skin cancer, an elevated alanine transaminase level, frequent consumption of dried sweet potato (used as an indicator of undernourishment), as well as a history of working in salt fields.
• 1-9
• 10.6288/JNPHARC1993-12-01-01

• Link 原著 Original Article
• 自述性身體健康測量結構之年齡差異Age Differences in the Structure of Self-Reported Physical Health
• 吳淑瓊、江東亮、梁浙西
  Shwu-Chong Wu, Tung-Liang Chiang, Jersey Liang
• 健康測量 ； 年齡差異 ； 結構公式模式
  Health indicators ; measurement ; structural equation modeling ; age differences
• 本研究的目的係檢定身體健康測量結構在年輕（20-39歲）、中年（40-59歲）、及老年（60歲以上）等三個不同年齡組中之異同。參考過去文獻，本研究提出一個三向度（自述疾病、身體功能、自評健康）的身體測量結構模式，並利用台大公共衛生研究所1985年問卷調查所得1，194名成人的自述性健康資料，及結構公式模式(structural equation modeling)技術驗証此健康測量結構模式之適和度，結果發現不論用Lisrel 7及EQS/EM version 3.0套裝軟體之ML或AGLS估計法，此結構模式在三個年齡組中均分別具適合性。?進一步瞭解此模式在三年齡組間之異同，再以Simultaneous factor analysis和Lagrange multiplier test檢驗組間差異，結果發現各年齡組測量模式十分相似，主要差異是存在於年輕組和老年組間，老年組中自述疾病對身體功能之影響，顯著大於年輕組者。
  This study attempts to assess the age differences in the factorial structure of a three-dimensional model of self-reported physical health among the young (2039), middle (40-59), and old (60 and over) age groups. Data for this research came from a survey (n=1, 194) conducted in 1985 by the Institute of Public Health at the National Taiwan University. The model was empirically evaluated for the various age groups by structural equation modeling using both the ML estimation in LISREL 7 and the AGLS estimation in EQSIEM version 3.0. Simultaneous factor analysis and the Lagrange Multiplier Test were applied to examine the structural differences between the three age groups. The measurement structure was found to be quite similar across the three age groups. The major difference was found between the young and the old age groups. The causal impact of self-reported conditions on functional status was significantly greater in the old age group.
• 10-25
• 10.6288/JNPHARC1993-12-01-02

• Link 原著 Original Article
• 臺灣工業界對乙二醇醚溶劑的認知Recognition of the Hazards and Uses of Glycol Ethers in Taiwan
• 陳叡瑜、林佳谷
  Ruey-Yu Chen, Chia-Ku Lin
• 乙二醇醚 ； 丙二醇醚 ； 烷氧醋酸
  Ethylene glycol ethers ; propylene glycol ethers ; alkoxyacetic acid
• 醇醚類是一種屬於中高沸點的兩性溶劑，在化工界裡用途廣泛。1980年代，歐美化工界展開一場E系列醇醚與P系列醇醚的大戰，在毒性化學物質管制法(TSCA)的主導下，代謝產物?烷氧醋酸(alkoxy acetic acid)，具有生殖毒性及致畸胎作用的E系列醇瞇，漸失嬌寵，而代謝成較與毒性丙二醇(Propylene glycol)的P系列醇醚則頗獲青睬。延至1988年，美國OSHA及歐洲諸國先後對E系列醇醚加強管制，部分E系列醇瞇的生產大廠相繼有停產某些產品與販賣的措施。值此世界潮流，我們十分關切國內業界的使用情形及其對於E系列醇瞇溶劑生殖毒性的認知與態度，遂進行本研究。 在研究期間，我們拜訪了歐、美、日各大國生產E系列醇醚與P系列醇醚的在台分公司代理商和經銷商；接著以親自訪問或郵寄問卷方式，訪問各類使用E系列醇醚與P系列醇瞇的工廠；同時透過國貿局進口貨品查詢等過程，對於國內工業界在乙二醇醚類溶劑的使用與認知方面獲得初步瞭解。目前，國內的乙二醇醚類溶劑完全仰賴進口，我們估計，國內一年的消耗乙二醇醚類溶劑數量如下：2-ME 2,500-3,000噸；2-EE 1, 200-1, 800噸；2-EEA 5,000-8,000噸；2-BE 8,000-10，00噸。工業界對於低分子量乙二醇醚類溶劑具生殖危害毒性與皮膚吸收危險性的認知相當缺乏，瞭解者僅止於上游供應者及少數大型工廠。面對工業界知的斷層，深覺物質安全資料表(MSDS)制度的建立和法規標準的修訂乃當務之急，而職業衛生教育則是斧底抽薪，徹底解決國人漠視毒性物質危害的唯一管道。
  Glycol ethers (including glycol ether esters) are a group of solvents with medium-high boiling points and low evaporation rates, possessing the solvent characteristics of alcohol/ ethers (or ether/ester) functions. They have been widely used in coatings and in various industries for more than half a century. Recently, the lower molecular weight E-series glycol ethers have been found to have reproductive and teratogenic toxicity. Based on the potential toxicity of E-series glycol ethers, ACGIH adopted new TLVs in 1984; Japan, Germany, and Sweden, also lowered their exposure standards in 1990, 1986 and 1991, respectively. As a result, most manufacturers of E-series glycol ethers have also taken action to stop the production or sell of these potentially hazardous products. In response to the impact of this worldwide transition transition from the E-to P-series, this study focuses on the types and quantities of these solvents being used in Taiwan, and the knowledge of users about the potential toxic effects. In this study, we found that large quantities of E-series glycol ethers are imported and used in Taiwan. Our estimates are: 2-ME, 2,500-3,000 tons; 2-EE, 1,200-1,800 tons; 2EEA, 5, 000-8, 000 tons; and 2-BE, 8, 00010, 000 tons annually. About 70% to 80 % are used in the coating industry. Lack of recognition of the potential toxic effects and the possibility of skin absorption are common among users. In con elusion, increased occupational health education, modification of current legislation and the providing of substitutes are urgently needed.
• 40 - 56
• 10.6288/JNPHARC1993-12-01-04

• Link 原著 Original Article
• 精神分裂病患家庭及一般家庭其家庭功能及教養態度之差異Differences in Family Function and Childbearing Attitudes between Schizophrenic Families and Normal Families
• 蕭淑貞
  Shu-Jen Shiau
• 精神分裂病患者 ； 家庭功能 ； 教養態度 ； 個案對照研究法
  Schizophrenic patient ; family function ; parenting attitude ; case control study
• 由臨床及研究可以了解精神病患者的家庭功能運作情形，常呈現出功能失調，因而影響其子女的成長。本研究之主要目的在於探討精神分裂病患之家庭功能及教養態度與一般家庭有何不同。 本研究採個案對照研究法，以精神分裂病患者並育有十五歲以下子女之家庭?研究對象，並找出兒童年齡、性別、父母社經地位背景相近的家庭?對照組。病患組與對照組各?30對。經由病患組與對照組填寫“家庭功能評估量表”及“教養態度評估量表”，所收集之資料由敘述性統計法及無母數之推論性統計法處理之。 研究結果顯示，男病患對家庭功能的評價比其配偶或女病患高，對子女教養態度方面，男病患比其配偶較採取獨立性、少溝通及不刻意訓練之態度。女病患比男病患採較多與子女溝通之態度。對照組之家庭功能比病者組的高。對照組的先生比男性病患對子女較刻意訓練、較多溝通、較不獨立及子女較依附，對照組的太太比女病患更刻意訓練、對小孩較嚴格。因此男性病患之小孩需練習自己照顧自己。但女性病患子女之成長更需關切，因?男性病患的太太顯得比女性病患的先生較能負擔起教養之責任。 本研究結果可增進了解精神病者家庭及一般家庭的家庭及教養情形。因此在醫院病房、門診或居家訪問時，醫療專業人員能關懷地評估此家庭之功能及教養態度，以促進家庭心理衛生及兒童之發展。
  Family function and the development of off spring in families of schizophrenic patients are influenced by the patient's symptoms and poor copying abilities. The purpose of this study was to explore the differences in family function and childbearing attitudes of schizophrenic families and normal families. The case control research design was adopted for this study. Thirty schizophrenic subjects were recruited by convenient sampling from a psychiatric outpatient department. Only patients with children under 15 years old were included. Thirty normal subjects were matched for age and sex of children and family social economic status. Two questionnaires were used: (1) The Family Function Scale, and (2) Childbearing Attitudes. Data were analyzed by descriptive and inference statistics using the SPSSIPC program. The results showed that male patients perceived the family function to be better than their spouses did; male patients expressed more independence and free attitudes toward childbearing than female patients did. Female patients showed more communication ability than male patients did. Family function was better in normal families than in schizophrenic families. Normal fathers demonstrated more discipline, communication ability, attachment and less independent childbearing attitudes than male patients did. The attitude of normal mothers toward discipline was greater than female patients. It seems that the offspring of male patients has to learn to take care of themselves. There is greater concern for the development of the offspring of female patients, because spouses of male patients take on more of the childrearing responsibilities than spouses of female patients. The major contributions of this study are the enhancement of our knowledge of the family function and childrearing attitudes of psychotic and normal families. Clinical health professionals need to assess the family function and childrearing attitudes of patients in order to improve the family mental health and child development status.
• 57 - 69
• 10.6288/JNPHARC1993-12-01-05

• Link 原著 Original Article
• 有關智障者性教育問題之意見調查Attitudes Toward and Acceptance of Sex Education for Mentally Retarded People
• 張珏、葉安華
  Chueh Chang, An-Hwa Yeh
• 心智殘障 ； 青少年對成年人 ； 性教育
  Mentally retarded ; adolescents vs adults ; sex education
• 本研究的目的在了解與智陣者有關的家長、教育、衛生與社會工作者對智陣者性教育的看法及性行?的觀察。研究地區?台北市，採問卷訪視方法。研究對象?12-30歲居住在台北市的智障者之父母們，共二百三十七人；此外，台北市國中、國小益智和啟智班老師、普通班老師，及衛生與社會福利單位工作人員共兩百人。 研究結果如下： 1．家長與專業工作者，對於智障者性教育施行的態度，均隨著智障程度的不同而有不同，智障程度愈重，支持其性教育的人數就愈少。不過整體而吉，不論輕、中、重度的智障者，認?其性教育有必要性的專業工作者的比例均高於智障者家長。 2．大部分的受訪者認?智障者的性教育，其家長應負起最多的責任(90%)，特教老師居次，再次之?醫療工作人員 3．多數受訪者認?智陣者比一般人較易受到性欺侮。 4．有40.7%男性智障者與12.5%女性智障者被觀察有自慰行?。 5．對於智障者的自慰行?，有近五分之二的家長會採用「試著向他解釋」的方式，有四分之一的家長會儘量阻止，但專業工作者較會採行「請教醫師、老師等有關專家」的方式。 6．家長在觀察其女兒月經來處理方法時，輕度智障者有69.4%可自理，只有2%無法自理，而重度者可以自理只有4.2%。 7．月經處理的方式可能會因智障程度不同而有所不同。 8．在性教育的內容方面，就輕度者而官，「認識自己的身體器官及生理結構」，「兩性相處，婚姻關係」及「如何保護自己，安全防衛知識」?家長與專業工作者所選擇的前三項。至於中、重度方面，雖然多數家長認?無教育之必要，而專業工作者回答的比例又很低，但仍以「認識自己的身體器官及生理結構」此答案所佔的比例最高。
  The purpose of this survey was to understand the attitudes of parents, educators, health workers and social workers toward sex education for and related sexual behaviors in mentally retarded individuals. Data were collected from 237 parents with mentally retarded children ranging in age from 12 to 30 in Taipei. Also 100 health and social workers and 100 primary and junior high school teachers from the same area were surveyed. The results were as followed: 1. The attitudes of parents and professionals toward sex education varied with the degree of retardation; the more severe the retardation, the lower the level of support. Across all levels of retardation, professionals were generally more supportive than parents. 2. Most respondents felt that parents should have the primary responsibility to educate children with mental retardation on the topic of sex. Professionals were secondary. 3. Most respondents presumed that children with retardation were more vulnerable to sexual harassment than normal children. 4. About forty percent (40.7%) of the males and 12.5% of the females with mental retardation have been observed to masturbate. 5. Given the prospect of masturbation, a quarter of the parents indicated they would attempt to stop the behavior, while half of the parents said they would ”try to explain the situation to the child”. Professionals, however, urged parents to first consult medical or related experts. 6. During menstrual cycles, 69.4% of the females with mild mental retardation could independently care for themselves, only 2% could not. The percentages were switched for females with severe mental retardation. 7. Methods of care during menstrual cycles differ according to the level of retardation. 8. For children with mild retardation, subjects emphasized the importance of ”understanding the physical structures of the body”, ”relationships with the opposite sex”, and ”safety, prevention, and protection.” Most parents felt no need to provide sex education for children with moderate or severe retardation.
• 70 - 83
• 10.6288/JNPHARC1993-12-01-06

• Link 原著 Original Article
• 台灣地區居民意外災害及惡性腫瘤、腦血管疾病之累積死亡率與潛在生命損失之長期趨勢(1971-1990)Trends of Cumulative Mortality Rate and Years of Potential Life Lost on Accidents, Malignant Neoplasms and Cerebrovascular Attacks in Taiwan (1971-1990)
• 丁先玲、王榮德、許文林
  Shian-Ling Ding, Jung-Der Wang, Wen-Lin Hsu
• 意外災害 ； 惡性腫瘤 ； 腦血管疾病CVA ； 潛在生命損失值YPLL ； 潛在工作年數損失值WYPLL
  Accident ; malignant neoplasm ; CVA ; YPLL years of potential life lost ; WYPLL work years of potential life lost
• 近些年來，台灣地區經濟成長迅速，醫療保健和國民生活水準提高，使得民眾的主要死因也逐年有所變動。本文分析1971~1990年間台灣地區民眾罹患惡性腫瘤、腦血管疾病及意外災害的年齡標準化死亡率、男女累積死亡率（0~74歲）、潛在生命損失值(years of potential life lost; YPLL)和潛在工作年數損失值(work years of potential life lost; WYPLL)，探討國人該三大死因的死亡率型態及趨勢。結果發現國人罹患惡性腫瘤和意外災害的累積死亡率（0~74歲）在近20年間有微輻上揚趨勢，而腦血管疾病則呈現逐年明顯下降的現象。潛在生命損失值和潛在工作年數損失值是評估各種死因對社會衝擊的另一種方式，它假定每個人活一年均有同等重要性，則年輕人死亡對社會生產力的損失，似乎較老年人更?顯著。本文以1990年台灣居民各年齡層平均餘命，推算出該年全民因急性腫瘤、腦血管病變及意外災害的潛在生命損失值，則男性的該三大死因分別?230.2、121.6及389.0千人年；在女性則各?152.5、91.0及146.1千人年。同時，意外災害在該年共造成台灣男性居民259.4千人年的潛在工作年數損失，遠超過急性腫瘤84.8千人年或腦血管疾病31.7千人年數倍之多。因此，政府?保陣國人生命安全，除了應再繼續加強急性腫瘤和腦血管等慢性疾病的醫療保健之外，有關意外災害的各種防治工作更應加強。
  During the past three decades, the prosperous economic growth of the Taiwan area has caused improvements in the living standard and general health condtions of the people. As a result, malignant neoplasms, cerebrovascular attacks (CVAs), and accidents have become the three leading causes of death in Taiwan since 1966. Based on the vital statistical data of Taiwan, this study calculated the standardized mortality rate and the cumulative mortality rate (0-74 years old' CMR(subscript0-74)) in order to examine the mortality trends for these three major causes of death from 1971 to 1990. The results show that the CMR(subscript 0-74's) of malignant neoplasms and accidents have had a mild but consistent increase during the last 20 years, while those for CVAs show a consistent decrease after 1985. In addition, we also calculated the years of potential life lost (YPLL) and the work years of potential life lost (WYPLL) to estimate the social and economic impacts from these causes of death. We found that the YPLL of cancer, CVAs and accidents are 230,200, 121,600 and 389,000 for males; and 152,500, 91,000 and 146,100 for females, respectively. In terms of WYPLL, however, accidencs accounted for 259,400 work years lost compared with 84,800 years for cancer and 31,700 years for CVAs in males; the WYPLL ror accidents, cancer and CVAS were 86,500, 57,000, and 16,400 person years, respectively. We conclude that accidents constitute the leading cause of death for those of productive ages and deprive society of more years (and working years) of potential life than cancer or CVAs. In the future, the prevention of accidents deserves greater action and research.
• 84 - 91
• 10.6288/JNPHARC1993-12-01-07

• Link 原著 Original Article
• 新店市居民商業人身保險投保現況及意願Demand for Private Insurance among Residents in the Sing-Den Area, Taipei, Taiwan, R.O.C
• 林芸芸
  Yun-Yun Lin
• 商業人身保險 ； 全民健康保險
  Commercial personal insurance ; national health insurance NHI
• 本研究目的在探討新店市居民投保商業人身保險的現況，及未來全民健康保險實施後，加保商業人身保險的意願，並分析其相關特性。以新店市20至65歲的居民?研究對象。依聚落及系統抽樣法，抽出3701人。於民國78年11月間進行問卷訪視，共得有效樣本1700位，回收率?46%。結果顯示：27.7%的民眾目前有商業人身保險，且其中78.9%?人壽險、15.6%意外傷害險、9.4%防癌險、4.8%子女教育年金險、2.2%婦女壽險。具商業人身保險者的特性：以年齡較輕、每月因定收入較多、有社會保險、症狀數較多者居多。 8.6%目前無商業人身保險的民眾，考慮於全民健康保險實施後加保的意願依序?：意外傷害險34.4%、人壽險31.1%、子女教育年金險27.1%、防癌險11.5%、婦女壽險9.4%。民眾目前具有、或欲加保商業人身保險的理由依序?：1．認?可以儲蓄2．認?健康保險項目太少3．認?健康保險給付的費用太少。欲加保商業人身保險者，聽過全民健康保險的百分比(93.5%)，顯著高於不加保者(75.4%)。且認?目前勞保保費每月平約460元不合理的百分比(21%)，顯著高於不加保者(13%)；但其認?合理的保費，則和不欲加保者無顯著差異，每月平均255.4元。且以教育程度較高（高中以上較高中以下）、罹病數較多者，較欲加保商業人身保險。分析其商業人身保險投保意願結構顯示：30.2%「人壽險型」、27.1%「意外險型」、22.9%「子女教育年金險型」、19.8%「防癌、婦女壽險型」。且「子女教育年金險型」、「防癌婦女壽險型」較「人壽險型」的健康自覺差；又「子女教育年金險型」較「人壽險型」多已具社會保險。 目前商業人身保險在台灣的健康保險市場拓展的空間仍極有限，新店民眾傾向以商業人身保險互補社會保險。無跡象顯示：全民健康保險的實施將對商業人身保險市場產生威脅。
  This study was aimed at better understanding the current and future participation rates in private insurance, and analyzing the relevant factors which might cause one to purchase private insurance once National Health Insurance (NHI) is implemented. A total of 3701 residents in the Sing-Den area, all between 20 and 65 years old, were interviewed by questionnaire in November of 1989. The questionnaire response rate was 46%. Among the residents, 27.7 % had private insurance. Of these, 78.9% had life insurance, 15.6% had accident insurance, 9.4% had cancer insurance, 4.8 % had insurance for their children's education, and 2.2 % had insurance for women. Their reasons for purchasing commercial personal insurance were: 38.4% for savings, 20.3% because too few items were included in their insurance coverage, and 11.6% because of low reimbursement by NHI. Those who had commercial personal insurance tended to be younger, insured by social insurance, had more symptoms and had higher fixed incomes. Of the uninsured residents 8.6% were expecting to take out private insurance. Of these, 34.4% expected to purchase accident insurance, 31.1% life insurance, 27.1% insurance for their children's education, 11.5 % cancer insurance, and 9.4 % insurance for women. Those who intended to take out commercial personal insurance had a greater degree of knowledge about NHI, and considered the current Labor Force Insurance premium to be unreasonable. Characteristicly, they were more educated, and had more diseases. The distribution of the latent structure model constructed form the willingness to participate in the different types of commercial personal insurance was as follows: 30.2%, life insurance; 27.1%, accident insurance; 22.9%, insurance for children's education; and 19.8%, cancer insurance and insurance for women. Those choosing the last two types of insurance were perceived to be less healthy than those choosing only life insurance.
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• 10.6288/JNPHARC1993-12-01-08