18卷5期

• Link 公衛論壇 Public Health Forum
• 震災地區應注意環境衛生設施震災地區應注意環境衛生設施
• 宋鴻樟
  Fung-Chang Sung
• 無
  none
• 無
  none
• 299 - 300
• 10.6288/CJPH1999-18-05-01

• Link 公衛論壇 Public Health Forum
• 天然災害與公共衛生天然災害與公共衛生
• 詹長權
  Chang-Chuan James Chan
• 無
  none
• 無
  none
• 301 - 302
• 10.6288/CJPH1999-18-05-02

• Link 原著 Original Article
• 臺北市二國小高年級學生脊柱側彎篩檢研究School Screening for Scoliosis among Fifth and Sixth Graders of Two Elementary Schools in Taipei
• 李碧霞、陳靜敏
  Pi-Hsia Lee, Ching-Min Chen
• 脊柱側彎 ； 脊柱側彎篩檢 ； 脊柱側彎計
  scoliosis ; scoliosis screening ; scoliometer
• 目標：本研究旨在瞭解國內學童脊柱側彎的盛行率與嚴重度，以及找出影響脊柱側彎的相關因素。方法：以臺北市某二所國小85學年度所有在學的五、六年經學生為研究對象，以脊柱側彎計，於85年9月～12月進行檢查，共調查987位學生。結果：脊柱側彎以等於或大於5度的軀幹旋轉度來定義，則國小高年經的盛行率是10.1%，其中男性為10.2%，女性為10.1%；五年經盛行率為9.3%，六年經盛行率為11.1%。脊柱側彎的發生與否，不因學童的性別、年經、背書包時間、書包型式、書包重量等的不同，而有顯著的差異，但在身高／體重比例上有顯著差異，尤以女生最為顯著。以對數迴歸分析，發現女學生脊柱側彎的發生與身高有關，身高愈高罹患脊柱側彎的可能性愈高。脊柱側彎的嚴重度（即軀幹旋轉度）與年級、年齡、身高、體重、身高／體重比例等，並無統計上顯著的關聯。結論：建議針對不同年齡群的學生進行篩檢，並繼續驗證相關危險因子，如：長短腳、書包重量、遺傳、營養等。
  Objective: The purposes of this study were to estimate the prevalence rate and to discover relevant risk factors for scoliosis among elementary school students in Taiwan. Methods: Samples were selected from two elementary schools in Taipei. All fifth and sixth graders registered in both schools in 1996 were screened between September and December using a scoliometer. Totally, 987 subjects were screened. Results: Scoliosis was judged on the basis of the angle of trunk rotation (ATR). Students with spinal rotation equal to or greater than 5° were considered as having scoliosis. The prevalence rate was estimated at 10.1% (boys: 10.2%; girls: 10.1%). The sixth graders had a significantly higher prevalence rate of scoliosis (11.1%) than did the fifth graders (9.3%). Gender, academic year, types and weight of students' satchels, and length of time for students carrying their satchel per day were not significantly associated with scoliosis. The heightweight ratio was found to be a significant factor for scoliosis, especially for girls. However, results of logistic regression analysis indicated that height was the significant predictor for scoliosis only in female students. The taller the female student is, the more likely she will have scoliosis. Severity of scoliosis (ATR) was not associated with academic year, age, height, weight, or height-weight ratio. Conclusions: Results of this study point to the need for screening various age groups of students. Risk factors for scoliosis such as leg-length discrepancy, actual weight of satchel, family medical history, and nutritional status require further investigation.
• 303 - 312
• 10.6288/CJPH1999-18-05-03

• Link 原著 Original Article
• B型及C型肝炎盛行鄉內各村之间的盛行率差異：高雄縣梓官鄉之社區研究HBsAg and Anti-HCV Prevalence among Villages in an Endemic Township: A Community Study in Tzukuan, Kaohsiung
• 陳義隆、盧勝男、吳正禮
  I-Lung Chen, Sheng-Nan Lu, Chen-Lee Wu
• B型肝炎病毒 ； C型肝炎病毒
  Hepatitis B virus HBV ; Hepatitis C virus HCV
• 目標：高雄縣梓官鄉是台灣地區曾被報告的C型肝炎病毒盛行地區之一。本研究旨在做全鄉篩檢，以了解該地區B型肝炎表面抗原(HBsAg)及C型肝炎抗體(anti-HCV)盛行率及各村之間的差異。方法：設籍於梓官鄉45歲以上民眾共計9,628位，以信件及廣播通知來檢查HBsAg及anti-HCV，回應率為30.2%。結果：HBsAg及antiHCV之年齡性別標準化盛行率分別為12.8%及41.6%，其中包括有4.6%為兩者共同感染。HBsAg之盛行率隨年齡增加而減少，反之anti-HCV之盛行率隨年齡增加而增加。性別與盛行率無關。沿海七村的anti-HCV盛行率61.4%，明顯高於內陸八村的29.1%。各村間的anti-HCV盛行率最高為赤崁村67.9%，最低為梓和村23%。結論：本研究建立C型肝炎盛行地區基本流行病學資料，發現同鄉內各村落間之盛行率差異大，可作為推展防治工作的參考。
  Objectives : The authors have earlier reported on Tzukuan, in Kaohsiung County, as an endemic area of the hepatitis C virus (HCV). We further conducted a screening survey in the town-HCV among villages in the township. Methods: A total of 2909 (30.2%) residents aged 45 years or older who lived in Tzukuan responded to our invitation to a screening for HBsAg and anti-HCV. Results: Age-, and sex-standardized prevalence rates of HBsAg and anti-HCV for all participants were 12.8% and 41.6%, respectively, which included 4.6% with dual infection. Prevalence of HBsAg significantly decreased with age, while anti -HCV significantly increased with age. Sex was not related to the prevalence of HBsAg or anti-HCV. The prevalence of anti -HCV was higher in coastal areas (61.4%) than in inland areas (29.1%). Chukang village had the highest prevalence of anti-HCV (67.9%) and Tzuho village had the lowest (23%). Conclusion: This survey reveals apparent variation in anti-HCV prevalence rates among villages in a township. The information we obtained can serve in HCV prevention and control in this area as well as in other endemic areas.
• 313 - 318
• 10.6288/CJPH1999-18-05-04

• Link 原著 Original Article
• 台南市不同生理年齡層安療養機構住民之生理照護需求與功能狀態探討Physiological Care Needs and Functional Status of Residents of Different Ages in long-term Care Facilities in Tainan
• 葉莉莉、溫敏杰、杜淑玲、林寁、戴臆珊
  Lily Yeh, Miin-Jye Wen, Shu-Lin Tu, Tsan Lin, Yi-Shan Dai
• 機構住民 ； 年齡層 ； 生理照護需求 ； 功能狀態
  long-term care ; chronological age ; physiological care needs ; Functional status
• 目的：探討台南市安療養機構中，設籍台南市之四種不同年齡層住民（64歲以下，6574歲，75-84歲，85歲以上），其生理照護需求及功能狀態。方法：研究者設計問卷並使用巴氏量表，取得21家機構389位住民資料，以SAS及SPSS統計套裝軟體進行分析。結果：住民中以75-84歲最多，計437%；女性551%多於男性。各年齡層皆以家中無人手照顧為主要進住原因，除64歲以下者外，皆以進住未立案機構為主。生理照護需求顯示各年齡層皆有約二成的住民身上有留置導管，需求一種以上生理照護的住民，以75-84歲為最多，其次為65-74歲。功能狀態由巴氏量表分數呈現，以無母數統計之Kruskal-Wallis檢定法及Dunn之多重比較進行四組年齡層得分差異檢定，結果顯示75-84歲巴氏量表得分最低，其餘三組間無差異存在。日常生活活動項目中，各年齡層最需協助者為洗澡，最不需協助者為進食。住民中有69%屬低照護需求個案（無生理照護需求且功能狀態可獨立者）。結論：機構住民以75-84歲需求最多生理與功能照護，低照護需求個案進住機構適切性值得探討。
  Objectives: To explore the physiological care needs and functional status of residents of different ages (ages under 64, 65-74, 75-84, and age over 85 years old) in long-term care facilities (LTCF) in Tainan. Methods: A data collection tool combined with Barthel's score was used. A sample of 389 residents was drawn from 21 LTCF. Data were analyzed by SAS & SPSS statistical software packages. Results: Data showed most of the residents (43.7%) were between 75 and 84 years old. The most common reason for living in an LTCF was no available caregiver in the home setting. Physiological care needs showed that about 20% of residents in each group had catheter. Residents in the 75-84 age group had the most physiological care needs. Regard of functional status, the Kruskal-Wallis test and Dunn multiple comparisons showed that the Barthel's score was lowest in residents in the 74-85 age group and was significant different from the other three groups. In the item of activities of daily living, all residents needed the most help in bathing and the least help in eating. Results showed that 6.9% of residents had no functional deficits or care needs, and these low-care need cases seemed inappropriately placed in an LTCF. Conclusions: Residents in the 75-84 years old age group in an LTCF need more physical and functional care than residents in other age groups. Low-care need cases need to be studied further.
• 319 - 326
• 10.6288/CJPH1999-18-05-05

• Link 原著 Original Article
• 影響醫院購置昂貴醫療儀器決策之因素－以台南高雄兩地醫院為例Factors Influencing Hospitals' Acquisition of High Medical Technology in Tainan-Kaohsiung Area
• 李隆生
  Lung-Sheng Lee
• 醫療科技 ； 醫療儀器 ； 醫院經營
  medical technology ; medical devices ; hospital management
• 目標：本研究目的在於探討影響醫院購置昂貴之高科技醫療儀器決策的因素，特別是電腦斷層攝影掃描儀(CT)。方法：根據文獻探討和專家意見設計問卷，母體樣本為台南高雄地區之180家醫院。描述性統計用於了解醫院對於購買高科技醫療儀器的一般態度，對數迴歸分析用以決定所選定之因素對醫院購置CT的影響強度。結果：有55家醫院回覆本問卷，其中37份為有效問卷，符合地區醫院（含）以上的要求。描述性數據顯示93%的醫院同意提升醫療品質為購置CT的主要動機，對數迴歸分析卻說明，醫院病床數為唯一影響醫院購置CT的顯著因素(p=0.013)，另一具中度顯著性的因素為直接的金錢報償(p=0.127)。結論：根據所回覆的有效問卷，配備CT的醫院多為具有較多病床的醫院，此意涵唯有大型醫院有能力購置昂貴的高科技醫療儀器，其目的應為提升醫療品質。
  Objective: This study investigated factors influencing the acquisition decision among hospitals for new high technology medical units, especially CT scanners. Methods: Hospitals (n=180) in Tainan-Kaoshiung area were chosen as the potential sample source. Literature and experts in health care management were consulted for designing questionnaire. Descriptive statistics was used to summarize the general attitudes toward the acquisition of high technology units at hospitals. Multivariate logistic regression analysis was used to determine the strength of association with the acquisition for selected factors. Results: Among 55 respondents, 37 were hospitals meeting survey requirement as regional hospitals or larger hospitals. In the descriptive data, 93% of respondents indicated that the use of CT scanner would elevate the quality of health care at the hospital. However, the logistic regression model showed that the hospital size was the only significant factor (p=0.013) associated with the CT scanner acquisition. Although, expected direct monetary return also had moderate significant association with this type of acquisition. Conclusion: In this group of respondents, hospitals equipped with CT scanner were more likely to have larger number of beds. The results suggest that only large hospitals are capable of purchasing high technology with the intention of improving patient care.
• 327 - 333
• 10.6288/CJPH1999-18-05-06

• Link 原著 Original Article
• 臺灣醫師人力政策當前重要課題之專家意見分析Current Major Issues in Physician Manpower Policy in Taiwan: An Analysis of Experts' Opinions
• 宋文娟、藍忠孚、 陳琇玲、詹錕鋙
  Wen-Chuan Sung, Chung-Fu Lan, Hsiu-Ling Chen, Kun-Wu Tsan
• 醫師人力政策 ； 德菲法 ； 紮根理論研究法
  Physician Manpower Policy ; Delphi Method ; Grounded Theory Method
• 目標：本研究之目的在藉由專家意見對未來醫師人力進行預測並尋求適當的政策改革。方法：應用德菲法與紮根理論研究法對四十四位專家進行二回合問卷調查。結果：(1)全民健保實施對專科結構之影響較醫師人力來得大。(2)未來人力供需及專科結構，其他條件不變下：專家預測會「熱門科人力過剩，冷門科人力不足」、「醫師集中在大醫院，中小型醫院招募不易」。(3)二十四項改革方案評估，首要改革方案為「全面檢討支付標準」，評價最低為「增加醫學系公費生」。結論：本研究結果可做未來立法或施政之參考。
  Objectives: This study analyzed physician manpower and specialty structure after the implementation of National Health Insurance, predicting and finding adaptive policy. Methods: The study utilized the Delphi Method and Grounded Theory Method to estimate future changes in physician manpower in Taiwan. Analysis of the questionnaire collected from 44 experts showed the following results. Results: First, implementation of National Health Insurance has had a greater influence on the structure of subspecialties than on physician manpower. Second, all other things being equal, there will be an uneven distribution of specialists in the future. There will be an excess of physicians in popular specialties and a shortage in unpopular specialties. In addition, physicians will flock to large hospitals, causing a shortage in small hospitals. Finally, an across-the-board evaluation of the reimbursement scheme is the top priority among the twenty-four proposals, whereas increasing the number government scholarship-sponsored medical students is the least favorable proposal. Conclusions: The results of this research can be used as a reference for lawmakers and administrators.
• 334 - 340
• 10.6288/CJPH1999-18-05-07

• Link 原著 Original Article
• 臺灣地區成年人之吸菸與嚼檳榔行為的組合及其相關因子探討Factors Related to Adults' Smoking and betel-nut Chewing Combination Behavior in Taiwan
• 陳富莉、李蘭
  Fu-Li Chen, Lee-Lan Yen
• 健康行為 ； 吸菸 ； 嚼檳榔 ； 成年人
  health behavior ; smoking ; betel-nut chewing ; adult
• 目標：本研究旨在探討吸菸且嚼檳榔、吸菸但不嚼檳榔、嚼檳榔但不吸菸、不吸菸也不嚼檳榔四類不同行為聚集者的相關影響因素。方法：研究資料採自臺灣地區青少年與成年人有關嚼檳榔之認知與行為調查，利用其中年滿十八歲以上成人樣本之社會人口學變項、菸與檳榔危害認知、吸菸與嚼檳榔行為等資料進行分析。結果：經統計分析結果，成人是否「吸菸且嚼檳榔」行為有顯著相關的因素包括教育程度、族群、職業別、性別、年齡、菸及檳榔危害認知；與成人是否「嚼檳榔但不吸菸」的行為有顯著相關的因素為地區別、族群和性別三項；與成人是否「吸菸但不嚼檳榔」行為有顯著相關的因素為性別和教育程度。結論：由本研究發現，「吸菸且嚼檳榔」者主要是男性、低教育程度者、原住民、及勞動階層者，為降低此類行為應針對高危險群研擬介入計畫。本研究同時發現，「嚼檳榔但不吸菸」者主要是山地居民及原住民，故應深入了解原住民的傳統文化及習俗，鼓勵原住民參與戒嚼檳榔和預防嚼檳榔之健康計畫。另外，因「吸菸但不嚼檳榔」者多屬於中學程度者及男性，所以建議導正這些高危險群有關吸菸和嚼檳榔對健康危害的認知，並藉各種管道協助其戒菸。
  Objectives: The purpose of this study was to investigate the patterns of the behavioral combination of smoking and betel-nut chewing and related factors. Four patterns of this behavioral combination were identified (i.e., both smoking and betel-nut chewing, smoking without betel-nut chewing, betel-nut chewing without smoking, and neither smoking nor betel-nut chewing). Methods: Data were obtained from a nationwide survey focusing on betel-nut chewing. Variables including adults' socio-demographic variables, knowledge of damage about smoking and betel-nut chewing, smoking and betel-nut chewing behavior were used for analysis. Result: Education, ethnic group, occupation, gender, age, and knowledge of damage about smoking and betel-nut chewing were found significantly related to the behavior of ”both smoking and betel-nut chewing”. Region, ethnic group and gender were found significantly related to the behavior of ”betel-nut chewing without smoking”. In addition, gender and education were found significantly related to the behavior of ”smoking without betel-nut chewing”. Conclusions: These results showed that the males, people who had only a primary school education, aborigines, and technical workers were more likely to smoke and chew betel nuts. A high prevalence of betel-nut chewing was found among males, people who lived in mountain areas, and aborigines. In addition, males and the subjects who graduated from junior high schools were more likely to smoke only. It was suggested that information about the adverse effects of smoking and betel-nut chewing should be taught to high risk groups and the abstaining skills should be taught.
• 341 - 348
• 10.6288/CJPH1999-18-05-08

• Link 原著 Original Article
• 傳播管道與健康行為之關係研究：以嚼檳榔為例The Relationship between Communication Channels and Health Behavior with betel-nut Chewing as an Example
• 葛梅貞、 李蘭、 蕭朱杏
  Mei-Chen Ko, Lee-Lan Yen, Chuhsing K. Hsiao
• 成年人 ； 檳榔 ； 傳播管道
  adult ; betel-nut ; communication channel
• 目標：本研究在瞭解臺灣地區成年人接收有關檳榔訊息的傳播管道及其與訊息接受者特性、檳榔之知識、態度及行為之關係。方法：以1996年台灣地區1652名成年人之家戶訪視資料進行分析。結果：(1)接收檳榔訊息之管道多為電視、報章雜誌及親友；(2)年齡較輕、教育程度較高、學生及白領階級者較多由報章雜誌、單張小冊、海報、書籍、演講及學校師長等管道接收檳榔訊息，而原住民及居住在東部、山地地區者，較多從親友、醫護衛生人員接收檳榔訊息；(3)曾從電視、醫護衛生人員得到檳榔訊息者，在檳榔危害知識測驗上之得分較高，反對嚼檳榔之態度亦較強；(4)曾從學校師長上課接收檳榔訊息者，嚼檳榔行為的比率較低。結論：建議檳榔訊息之宣導應針對不同的對象採取不同的訊息傳播管道及訴求，電視、報章雜誌及學校教育、醫護衛生人員之宣導管道應多加利用，以擴大檳榔危害訊息傳播的範圍及效果。
  Objectives: This research investigated the relationship among communication channels regarding betel-nut information, characteristics of the recipient, and betel-nut chewing knowledge, attitude and behavior. Method: A structured questionnaire was used to interview subjects in Taiwan from October, 1995 to February, 1996. Altogether, 1652 adults consisted the sample. Results: (1) The most frequently mentioned channels of betel-nut information were television, journals and relatives/friends. (2) Younger adults, who had a higher education, students or middle-class adults received betel-nut information from magazines, newsletters, brochures, posters, lectures and schooling. Aborigines, eastern Taiwan residents, and those who lived in mountainous areas frequently received betel-nut information from interpersonal channels (i.e., relatives/friends and health professionals). (3) Those who had received betel-nut information from television, magazines, and health professionals, tended to have higher scores in knowledge about betel-nut chewing. (4) Those who had received information from television, and health professionals, tended to have stronger attitude against the use of betel-nuts. (5) Those who had received betel-nut information in school were less likely to chew betel-nuts. Conclusions: According to these findings, it is recommended that betel-nut information be focused on people who are rarely exposed to the relative information. The right channels should be used to approach the recipients. Communication channels such as television, magazines, schooling, and health professionals should be used more frequently to disseminate information related to the harmfulness of betel-nut chewing.
• 349 - 362
• 10.6288/CJPH1999-18-05-09

• Link 實務 Public Health Practice
• 從醫院管理角度論全民健保資料庫The Application of National Health Insurance Database to Hospital Management
• 曾淑芬
  Su-Feng Tseng
• 健保資料庫 ； 醫院管理系統 ； 配合條件 ； 特性 ； 策略分析
  health insurance database ; hospital management system ; supporting condition ; characteristics ; strategy analysis
• 背景說明與目標：我國全民健保制度的實施，對於醫院的經營管理，造成許多直接與間接的衝擊，尤其是在醫療成本控制與醫療品質管制等方面影響最大，醫院管理者除了要確實作好內部控制外，對於外在環境的變化與政府政策走向，更要瞭若指掌。隨著社會時代的變遷，「閉門造車」與「單打獨鬥」的醫院經營型態，已不合時宜了，因此，透過健保的行政作業系統，將各醫院的資料彙整建立後所形成的健保資料庫，對於醫院管理者而言，將能更快速便捷的掌握院際間的動態。資料來源：本文乃參考國家衛生研究院所召開的「全民健康保險學術研究資料庫開發與應用研討會」，將學術界對健保資料庫在學術研究可用性等方面的意見，加以整合後，從醫院管理的角度，來討論健保資料庫對醫院管理層面的應用。結論與建議：所謂「知己知彼，百戰百勝」，醫院管理者若欲充分利用健保資料庫，使其發揮最高效益，則必須要有如下幾個條件的配合：建立院內完整的資料庫、確立院內的管理重點與指標項目、院內明確的管理目標與策略、及管理者具備足夠的資料統計分析能力等，經由醫院對內部控制的努力與對外部資料的分析研判，將可強化醫院的管理系統。
  Backgrounds and Objectives: The implement of National Health Insurance in Taiwan [beginning in 1995] has causesed a lot of direct and indirect impacts on hospital management, especially in the areas of cost and quality control related to medical care. In addition to well-conducted internal controls, a hospital supervisor must remain well-informed about a variety of external environments and government health policies. As the society changes, working behind closed doors and in a single-handed hospital management style have become obsolete. Therefore, a sound database of National Health Insurance is critical and valuable for hospital management. It can provide a hospital supervisor with quick and comprehensive information about various hospitals. Data Sources: In this paper, comments and suggestions concerning how to apply NHI Database to hospital management are made based on opinions expressed at ”The symposium of the NHI database Development and Application” held in Taipei on 12 April 1999. Conclusions and Suggestions: There is an old saying ”Know enemy and know yourself, and you will fight with no danger of defeat”. A hospital supervisor who wishes to take advantage of the NHI database system more efficiently will have to establish a sound, integrated hospital database with clear goals and strategies of management, and posses capabilities of data analysis. In brief, it is important for us to realize that hospital management system will be improved through efforts of internal control and research on external environments. In this regard, a sound NHI database can be a great assistance.
• 363 - 372
• 10.6288/CJPH1999-18-05-10