26卷3期

• Link 原著 Original Article
• 本國籍和外國籍產婦生產方式之差異及探討Differences in Obstetric Delivery Modes between Native and foreign-born Women in Taiwan
• 黃元德、黃瓊瑩、馬作鏹、郝宏恕
  Yuan-Der Huang, Chiung-Yin Huang, Tso-Chiang Ma, Horng-Shuh Hao
• 外籍產婦 ； 剖腹產 ； 剖腹產率
  Foreign-born mothers ; Cesarean delivery ; Cesarean section rate
• 目標：現今我國產科照護之主要議題為外籍產婦的不斷增加及過高的剖腹產率。剖腹產率過高可能潛存醫療資源浪費，而偏低則暗示著醫療照護不足。本研究係調查分析不同國籍產婦在周產期之相關背景及其生產方式的差異情形，以作為產科醫師及衛生醫療主管機關的參考。方法：以準結構式問卷及病歷資料分析，抽樣對象為一生產數多且配合研究之中部某區域教學醫院及某大型婦產科專科診所，對所有不同國籍產婦共1465位進行調查。以卡方檢定、變異數分析及羅吉斯迴歸分析，探討其背景資料之差異與不同族群婦女選用生產方式之影響因素。結果：本國籍、大陸籍與東南亞籍婦女之剖腹產率各為33.6%、26.3%及17.9%，呈現明顯差異。本國籍產婦之年齡、體重、剖腹產次數均較外籍產婦為高，而社經背景也較好。後續分析顯示本國籍產婦之年齡、體重等生理因素則是造成剖腹率偏高的主因，而國籍別則非影響不同國籍婦女剖腹產率差異的主要因素。結論：我國產婦及醫師在決定採用剖腹產時受國籍別等非醫療因素干擾不大。因此，研擬降低剖腹產率偏高的有效策略應自醫療因素著手。
  Objectives: In Taiwan, the increase of foreign-born mothers and the high prevalence of Cesarean rate are major issues in obstetric medical care. A high Cesarean rate may imply the waste of medical resources, while a low Cesarean rate may indicate the lack of medical care. The aim of the research is to describe and explain the differences between native and foreign-born mothers. Methods: Using semi-structured questionnaires and medical chart review, information was collected from 1465 mothers from one negional hospital and one clinicin central Taiwan for livebirths in 2005. We used Chi-square test, analysis of variance, and logistic regression to determine the factors that affect the choice of delivery mode. Results: Newborns arrived by Cesarean delivery in 397 of 1182 (33.6%) of Taiwanese mothers, 20 of 76 (26.3%) of mainland China mothers, and 37 of 207 (17.9%) of Southeast Asia mothers. Taiwanese mothers had statistically significantly higher age, maternal body weight, and socioeconomic status than other mothers. Further analysis revealed that nationality is not the direct influential factor, instead physiological factors such as age and maternal body weight are more significant. Conclusion: When mothers and obstetricians make medical decisions, non-medical factors such as ethnicity may not directly influence the selection of delivery mode. Accordingly, clinical and physiological factors should be included in the design of effective strategies for reducing cesarean rate in Taiwan.
• 169 - 176
• 10.6288/TJPH2007-26-03-01

• Link 原著 Original Article
• 台灣地區之退伍軍人症Legionellosis in Taiwan
• 蘇勳璧、鄭麗容、周振英、張登欽
  Hsun-Pi Su, Lei-Ron Tseng, Chen-Ying Chou, Tung-Ching Chung
• 退伍軍人症 ； 嗜肺性退伍軍人菌
  Legionellosis ; Legionella pneumophila
• 目標：本文收集2000年至2005年共8590位被通報疑似退伍軍人症患者之檢體進行確認，並整理分析其結果，以勾繪出台灣退伍軍人菌之現況。方法：收集疑似肺炎之患者檢體，依照美國CDC指引，分析患者血清、尿液和痰液檢體。血清檢體進行間接免疫螢光抗體試驗，尿液檢體檢測嗜肺性退伍軍人菌第一型抗原，痰液檢體進行微生物培養及鑑定。結果：8590位患者中，有428位疑似肺炎患者被証實為感染退伍軍人症，其陽性率為5.0%。性別比例方面，男性有305位(71.3%)，女性有123位(28.7%)。年齡分布方面，大於65歲以上的有230位(53.7%)，佔最多數，而14歲以下為0。季節分布方面，一年四季發病率都一樣高。地理分布方面，每10萬人口發生率(Incidence rate)以在花蓮縣最高為(5.46)，其次為台東縣(0.89)、台北縣(0.35)、高雄市(0.33)和苗栗縣(0.30)。但以送檢率相對調整後，每10萬人口調整發生率p值無顯著差異。結論：在台灣退伍軍人症的確定病例陽性率從2000年至2005年平均約5.0%。因此菌培養不易，本實驗室經改進培養方法，將陽性培養率0%提高至15.8%。其中以Legionella pneumophila佔87.9%，又以Legionella pneumophila serogroup 1佔63.6%為最主要菌種，此結果與其它國家相似。
  Objective: Our purpose was to determine the distribution of legionellosis (LG) in Taiwan. Methods: Specimens from 8,590 LG-suspected patients were collected and analyzed during the period 2000–2005. Following Centers for Disease Control (USA) guidelines, serum, urine, and sputum specimens were assessed by the indirect immunofluorescence antibody test, Legionella pneumophila type 1 antigen test, and Legionella isolation, respectively. Results: LG was diagnosed in 428 pneumonia patients (305 [71.3%] male and 123 [28.7%] female), and the LG positive rate among pneumonia patients in Taiwan was calculated to be 5.0% (428/8,590). Most LG patients 230 (53.7%) were age =65, while none were =14. No seasonal differences in LG incidence rate were detected. Incidence rates (per 100,000 patients) were highest in Hualien county (5.45), followed by Taiton county (0.89), Taipei county (0.35), Kauosiun city (0.33), and Mialee county (0.30). Conclusions: The LG incidence rate among pneumonia patients in Taiwan was 5.0% from the year 2000 to 2005. Owing to modification of the isolation technique in this study, the isolation rate for Legionella increased from 0% during 2000-2001 to 15.8% in 2005. Furthermore, Legionella pneumophila (87.9%) was the most frequently isolated species in Taiwan, and Type 1 (63.6%) was its most prevalent serogroup. This result is similar to results from other countries.
• 177 - 183
• 10.6288/TJPH2007-26-03-02

• Link 原著 Original Article
• 緊急醫療救護系統資源配置及績效評估之模擬研究－以台南市為例Simulation and Evaluation of Emergency Medical Services Systems Resource Allocation and Performance
• 黃國平、吳青翰
  Kevin P. Hwang, Ching-Han Wu
• 緊急醫療救護系統 ； 系統模擬 ； 反應時間 ； 利用率
  Emergency Medical Service System ; System Simulation ; response time ; utilization ratio
• 目標：針對緊急醫療救護系統之資源配置問題，研擬救護車數量與區位配置方案，以改善目前系統之績效。方法：收集台南市93年1月至10月計13,871筆資料，分析並建立模擬模式。依各時段的案件空間分佈，利用空間分析的K-Means法，調整救護車之配置方式後，對各方案進行模擬分析，以評估其反應時間及救護車利用率的表現。結果：經模擬分析，整體反應時間以方案1（14車）表現最佳；而反應時間合乎標準的方案中，利用率以方案2（13車）最高；經綜合評估兩項指標，本研究認為方案6（依時段調整車數）為較佳之方案。結論：反應時間良寙與利用率大小，存有交互損益的關係，必須在兩者間取得平衡；本研究證實依案件之數量及空間分佈，機動調整救護車數量及駐點，除可改善緊急醫療救護系統反應時間的表現外，亦可提升利用率。
  Objectives: The research attempts to assess alternatives of the number and locations of ambulances in order to improve emergency medical services systems performance. Methods: From January to October 2004 ambulances responded to 13,871 calls in Tainan City, Taiwan. According to the spatial distribution of calls of every shift, we used K-means, point pattern spatial analysis, to redeploy the ambulances. A simulation model based on the empirical data was developed to analyze response times and utilization ratios to evaluate the performance of each alternative. Results: Based on the simulation analysis, alternative #1 (14 ambulances) performs best on overall response time, while alternative #2 has the highest utilization ratio among those alternatives whose response times are acceptable. In comprehensive evaluation of the two indicators, alternative #6 (number of ambulances that varies with shifts) is superior. Conclusions: There is a trade-off relation between response time and utilization ratio. Our research shows that redeploying ambulances according to arrival frequency and spatial distribution of calls can improve not only the performance of their response time but also their utilization ratio.
• 184 - 195
• 10.6288/TJPH2007-26-03-03

• Link 原著 Original Article
• 全民健保對健康差距之影響－以平均餘命為測量Changes in Health Disparity after Introduction of National Health Insurance: Measurement on Life Expectancy
• 吳宛蕙、楊長興
  Wan-Hui Wu, Chiang-Hsing Yang
• 全民健保 ； 平均餘命 ； 健康差距 ； 都市化 ； 時間數列
  National Health Insurance ; life expectancy ; health disparity ; urbanization ; Box and Tiao's event intervention analysis
• 目標：探討全民健保是否有助於改善男性、女性最高與最低都市化，以及最高與中等都市化程度民眾平均餘命之差距。方法：以1987至2003年為研究期間，使用內政部之人口資料檔及衛生署之死因資料檔，計算出各都市化程度民眾的平均餘命後，採用Box及Tiao的時間數列介入分析，比較全民健保介入民眾平均餘命差距之影響評估。結果：全民健保實施後，並沒有顯著降低最高、最低都市化位階民眾平均餘命的差距，但是男性最高、中等都市化位階65歲平均餘命差距，以及女性最高、中等都市化位階0歲、5歲、65歲平均餘命差距皆有顯著性的縮小。結論：全民健保的實施對於民眾的健康有正向的改善，城鄉間女性健康差距較男性小，同時對於最高、中等都市化位階平均餘命差距改善程度優於最高、最低都市化位階平均餘命差距，特別是老年人的部份，但是最高、最低都市化位階民眾平均餘命的差距並沒有顯著性的縮小，因此未來應持續推動最低都市化位階地區民眾婦女保健、產前照護、環境改善及教育提升，使偏遠地區民眾得以獲得適當照顧，進而提升偏遠地區民眾平均餘命，以縮短城鄉間平均餘命的差距。
  Objectives: To examine whether National Health Insurance has narrowed the gap of life expectancy between levels of urbanization. Methods: For the period from 1987 to 2003, population data were was obtained from the Taiwan-Fuchien Demographic Fact Book, and cause of death information was obtained from the Department of Health. Life expectancy for residents was transformed to mortality series, and the event intervention analysis by Box and Tiao was employed to compare the disparities in life expectancy among the resident groups. Results: After the implementation of national health insurance in Taiwan, the gap in life expectancy between residents living in areas of the highest and those living in the lowest levels of urbanization was not statistically significantly reduced. For men at age 65, between areas of the highest and the middle levels of urbanization, the lifespan gap was significantly reduced. For females at birth, age 5, and 65, the gap between areas of the highest and middle levels of urbanization was also significantly reduced. Conclusions: Implementation of national health insurance was associated with reduction of health disparities for both genders, although seeming to be more apparent for females than males. The improvement of the gap in life expectancy between residents living in the areas of the highest and middle levels of urbanization was larger than that between the areas of the highest and lowest levels of urbanization, especially for senior citizens. In order to ensure health equity for all citizens, more resources need to be allocated for women's health care, prenatal care, and environmental protection and education in remote areas.
• 196 - 207
• 10.6288/TJPH2007-26-03-04

• Link 原著 Original Article
• 住院中與出院後病人滿意度差異比較－系絡觀點Comparison of Satisfaction of Hospitalized and Discharged Patients
• 陳建立、梁素琴
  Chien-Li Chen, Su-Chin Liang
• 病人滿意度 ； 系絡觀點 ； 因素恆等性 ； 效果量
  patient satisfaction ; contextual perspective ; factorial invariance ; effect size
• 無
  Objectives: The purpose of this study was to find out the measurement invariance of satisfaction factor structure of hospitalized and discharged patients and to compare the differences of satisfaction assessment between them. Methods: THIS questionnaire was used to measure patient satisfaction before and after discharge in the same interval. We selected 1128 hospitalized patients for exploratory factor analysis to get the satisfaction factor. Confirmatory factor analysis was performed among 685 hospitalized random patients and 641 discharged patients, using multi-group structural equation modeling to test the factorial invariance of satisfaction. We compared effect size between hospitalized and discharged patients' satisfaction. Results: Five factor structures were found in the hospitalized patient satisfaction, which explained 72.8% of the total cumulative variance. Factor loading of the two groups was between 0.78 and 0.92 with factorial invariance. Hospitalized patient satisfaction was higher than discharged patient satisfaction (p<0.001, Cohen's d). Effect size had a medium different level between 0.46 and 0.71. Conclusions: Physical environment and social context affect hospitalized patient satisfaction. Satisfaction perception between hospitalized and discharged patients was significantly different. Construct validity and biases should be assessed in measuring service satisfaction.
• 208 - 217
• 10.6288/TJPH2007-26-03-05

• Link 原著 Original Article
• 台灣地區成年人之休閒運動行為與健康行為、健康狀況、健康相關生活品質之關係探討Leisure-time Physical Activity and Its Association with Health Behaviors, Health Status and health-related Quality of Life among Taiwanese Adults
• 林佑真、溫啟邦、衛沛文
  Yu-Chen Lin, Chi-Pang Wen, Jackson Pui-Man Wai
• 運動 ； 成人 ； 台灣國民健康訪問調查 ； 健康有關的生活品質
  Leisure-time physical activity ; Adults ; National Health Interview Survey Taiwan ; Health-related quality of life
• 無
  Objectives: This study describes the patterns of leisure-time physical activity (LTPA) and assesses its association with health behaviors, health status and health-related quality of life. Methods: Data came from the 2001 National Health Interview Survey of Taiwan. A total of 7978 males and 8154 females completed the exercise questionnaire. ”Regularly exerciser” was defined as one who exercised =5 times a week and accumulating =150 minutes in moderate intensity or =3 times a week for =20 minutes per time in vigorous intensity. Results: About 21% of respondents reported as regular exercisers, while 50% reported no exercise during their leisure time. Walking was the most popular activity reported. In a multivariate logistic model, age, education status, fruit and vegetable consumption, chronic disease status, and difficulty in activities of daily living (ADL) were statistically significant correlates of exercise behavior. Analyses of the SF-36 dimensions showed that adults who exercised regularly also had significantly better scores than those who did not exercise (p<0.001) in self-perceived physical function, role limitations due to physical problems, pain, general health, vitality, and mental health. Conclusions: Eight out of ten adults in Taiwan do not meet the CDC/ACSM recommendation for LTPA. Prevalence in LTPA was lowest among those 25-44 years of age, with less than middle school education, with restricted ADL, smoking or obese males, and underweight females.
• 218 - 228
• 10.6288/TJPH2007-26-03-06

• Link 原著 Original Article
• 國民中學健康教學者的工作狀態與健康相關生活品質之關係探討Relation between Working Status and health-related Quality of Life among Health Educators in Junior High Schools
• 劉潔心、晏涵文、邱詩揚、廖梨伶、廖靜宜、洪惠靖
  Chieh-Hsing Liu, Han-Wen Yen, Shy-Yang Chiou, Li-Ling Liao, Jing-Yi Liao, Hui-Jing Hung
• 國民中學 ； 健康教學者 ； 工作需求－控制－社會支持模式 ； 工作壓力 ； 健康生活品質
  junior high school ; health educator ; Job Demand-Control-Social support Model ; job stress ; health-related quality of life
• 無
  Objective: This study aims to develop a Questionnaire on Working Status and Health Condition of Health Educators in Junior High Schools based on the Job Demand-Control-Social support model. A secondary objective is to understand the relation between working status and health. Method: A total of 765 health educators, from 65 health promoting schools appointed by the Taiwan Ministry of Education in 2005, participated (response rate of 71%). Results: Respondents rated job control (MEAN score=3.70, SD=0.37) as the highest item of work status and job demand (MEAN=2.76, SD=0.51) as the lowest. The overall perception of healthrelated quality of life was rated as ”partially satisfied”. Job demand was negatively associated with health-related quality of life (r=-.326, p<0.01), while job control and social support were positively associated with health-related quality of life (r=.248, p<0.01). Job demand, job control, and job support were statistically significant correlates of health-related quality of life and accounted for 15.2% (p<0.05) of variance. Conclusion: Promoting the health-related quality of life of health educators in junior high schools may be achieved by decreasing the perception of job demands, strengthening social support between colleagues, distributing suitable work loads, and providing skills for time management. Additional contributors may include providing on-job training and new information based on the needs of educators, arousing the awareness of multiple work tasks, and enabling educators to pay more attention to their own health.
• 229 - 240
• 10.6288/TJPH2007-26-03-07

• Link 實務 Public Health Practice
• 從SARS經驗建構重大疫情媒體溝通之標準作業流程Standardized Operation Process for Communication with Mass Media during Disease Outbreaks: Based on Experiences from SARS
• 吳宜蓁
  Yi-Chen Wu
• SARS ； 風險溝通 ； 標準作業流程
  SARS ; risk communication ; Standard operation process
• 目標：從檢視2003年台灣SARS疫情的媒體溝通機制與報導失誤問題，建構一套未來發生重大疫情的媒體溝通標準作業流程(SOP)，作為政府與媒體皆可遵循的疫情新聞處理準則。方法：首先從二手資料及初步訪談中建立本研究的SOP初步架構，再進行深度訪談法與焦點座談法搜集修正意見。從2004年1月到4月訪談實地參與SARS防疫工作的衛生署官員、醫藥記者或主管及專家學者共19人。結果：根據資料所建構出的重大疫情媒體溝通SOP，包括應變指揮中心、機構發言人、新聞警戒線、媒體監看與新聞更正等重點。新聞警戒線視疫區封鎖情況，分為「媒體拍攝區」、「中央廚房式」及「全面禁止進入」等三層次之採訪準則。新聞更正則可透過與媒體記者與編採部門主管的直接溝通，或引用相關罰則來處理。結論：一、面對疫情危機，政府宜立即建立緊急應變機制及發言人機制；二、媒體應確實遵守三層次之採訪準則；三、對於錯誤報導，政府應直接與記者及其主管連繫要求立即更正。
  Objectives: The aim of this study was to create a standardized operation process for Taiwan government communication with mass media during disease outbreaks. After assessing the government-media communication during the 2003 outbreak of Severe Acute Respiratory Syndrome, we built a model with standard information flows. Methods: Our model was developed from a review of the literature and was then modified on the basis of in-depth individual interviews and focus group interviews from January to April 2004. Results: Our proposed standardized operating process consists of three parts: the unified command center and spokesperson; guidance for three-level interviews; and surveillance and corrections of media coverage. Conclusions: First, when facing serious disease outbreaks, government should employ several spokespersons who speak consistently. Second, media reporters should follow the ”three zone rules”-media reporting zone, central kitchen zone (media representative permitted only), and media prohibition zone-to cover the outbreak. Third, in case of inaccurate news coverage, the government should contact the appropriate reporters or chief editors to request immediate correction.
• 241 - 249
• 10.6288/TJPH2007-26-03-08