18卷6期

• Link 公衛論壇 Public Health Forum
• 醫療人員之針刺傷害醫療人員之針刺傷害
• 郭育良
  Yue-Liang Leon Guo
• 無
  none
• 無
  none
• 373 - 374
• 10.6288/CJPH1999-18-06-01

• Link 綜論 Review Article
• 工作暴露矩陣的發展及其在流行病學研究上的應用Development of a Job Exposure Matrix and Its Applications in Epidemiological Studies
• 張火炎、吳麗杏、莊弘毅、賴永昌
  Ho-Yuan Chang, Li-Shin Wu, Hung-Yi Chuang, Yung-Chang Lai
• 工作暴露矩陣 ； 同質暴露群 ； 陽性預測值 ； 暴露指標
  Job exposure matrix ; homogenous exposure group ; positive predictive value ; exposure index
• 限於過去暴露資料缺乏或不完整，及連續性暴露資料創定的準確性、精巒度皆會隨時間的不同而有所改變，導致流行病學的研究上暴露與健康效應之確切關係常無法得到一致的結果。工作暴露矩陣模式由於暴露評估之限制與假設較少，因此在因果型流行病學上用來定量個體累積暴露值的機會，有日益增加之情形。工作暴露矩陣模式建立之步驟，隨著研究主題、研究對象特性不同而不同。本文依據文獻上多項研究之綜合，歸納成四個步驟：(1)暴露群的篩選(2)工作職務與暴露因子建立關聯(3)權重大小之決定(4)建立陽性預測值(5)綜合加權給分訂定暴露指標等。而建立－“工作暴露矩陣模式”時需注意誤差的產生及效度之評估，以避免實際暴露被高估或低估。現行的“工作暴露矩陣模式”所在流行病學的研究上，廣泛地應用於評估職業－暴露或暴露－疾病的關係，而由一些研究發現“工作暴露矩陣”所推估的暴露量與實際量創資料，與研究主體面談或專家學者意見的驗證結果相近，可知在現今或未來的暴露－健康效應的關係推估研究上，及暴露量之推估方法學上，工作暴露矩陣模式可提供－潛在可行的方向。本研究建議國內工業衛生學者與專家應共同訂定符合本國國情之分類準則，以作為爾後暴露評估之重要依據。
  Due to incomplete information about past exposure data and inconsistent accuracy and precision in the monitoring of data during study periods, there have been some problems in exploring the true relationship between exposure and the corresponding health effects in causal epidemiological studies. Compared with the methods of exposure assessment applied in traditional epidemiological research, the use of a job exposure matrix makes a smaller number of assumptions and suffers from fewer limitations. Therefore, the application of a job exposure matrix in determining the exposure level for a homogenous exposure group or individual has become increasingly popular. In general, there are four steps to develop a job exposure matrix: (1) selecting the exposure group, (2) establishing the link between the work task and the hazards, (3) determining the corresponding positive predictive value (PPV), and (4) prioritizing the weighing factors among the variables and scoring the exposure of the homogenous exposure group or individual. The mitigation of bias and evaluation of validity are also important issues throughout the whole process to avoid over- or under- estimation of the true exposure. This article also reviews the applications of research which used a job exposure matrix to explore the relationship between the occupation-exposure and exposure-disease among various epidemiological domains, including in general population or community-based studies, industry- or plant-specific studies, hypotheses generation, and study-specific. Some studies have shown a relatively small difference in the exposure estimate between the job exposure matrix and the actual measurement. The use of the job exposure matrix has been showing promising potential in the study of defining exposure-health effect relationships and the methodology of the exposure estimate.
• 375 - 386
• 10.6288/CJPH1999-18-06-02

• Link 綜論 Review Article
• 膀胱癌之描述性流行病學、危險因子及遺傳易感受性Descriptive Epidemiology, Risk Factors and Genetic Susceptibility of Urinary Bladder Cancer
• 許鈴宜、陳建仁
  Ling-I Hsu, Chien-Jen Chen
• 膀胱癌 ； 描述性流行病學 ； 危險因子 ； 遺傳易感受性
  Bladder cancer ; descriptive epidemiology ; risk factors ; genetic susceptibility
• 本文綜述近年來膀胱癌的描述性流行病學特徵、危險因子、個人易感受性之文獻，並回顧台灣往年的研究成果。比較全世界各國之膀胱癌發生率，發現歐洲及北美洲為膀胱癌的高發生地區。膀胱癌好發於男性，發病年齡多在65歲以上。根據歐美的研究，膀胱癌的主要危險因子為抽菸及職業暴露，其可歸因百分比在男性分別可達50%及35%。進一步分析香菸成分及職業暴露資料，成認芳香胺類是膀胱癌的主要致癌物。此外，游離輻射、服用止痛藥、無機砷及有機氣暴露、住血吸蟲感染、膀胱發炎既往史、飲食因素等，也是重要的致病因子。個人遺傳易感受性的研究中，最常被探討的氮－乙醯轉移酵素(N-acetyltransferase, NAT)與麩胺硫轉移酵素(glutathione S-transferase, GST)之遺傳多形性與膀胱癌的相關性，前者並未有一致的結果，而後者則多數的証據支持有顯著正相關。台灣雖屬膀胱癌低發生地區，但高發生鄉鎮市區明顯集中於西南沿海，尤其以烏腳病盛行區的北門、學甲、布袋、義竹最高。一系到流行病學調查顯示，當地高砷飲用井水與膀胱癌的發生率有顯著相關。戴至目前，砷引起膀胱癌的致病機轉、分子遺傳模式、以及個人易感受性與環境暴露間的交互作用等，仍有待闡明。未來需要進行更多分子及遺傳流行病學研究，來闡明台灣－特別是烏腳病盛行地區膀胱癌發生的機轉。
  This review focuses on the descriptive epidemiology, risk factors, and genetic susceptibility of urinary bladder cancer, including the recent studies in Taiwan. International comparison has shown Europe and North American are the high-incidence areas of bladder cancer. In these countries, the major risk factors of bladder cancer are cigarette smoking and occupational exposure with attributable risk percentages in males of 50% and 35% respectively. It has been well recognized that aromatic amines are the main urinary bladder carcinogens from tobacco smoke and occupational exposure. Ionic radiation, analgesics, arsenic exposure, drinking water containing chlorinated byproducts, S haematobium infection, urinary infection, and dietary factors are also attributable to an increased risk of urinary bladder cancer. Recent studies on individual susceptibility showed inconsistent association with urinary bladder cancer for N-acetyl transferase (NAT), but positive association was observed between glutathione S-transferase(GST) and bladder cancer. The incidence of bladder cancer is comparatively low in Taiwan, but areas with unexpected high incidence are clustered in southwestern Taiwan, especially in the endemic area of blackfoot disease(BFD) in Paimen, Hsuechia, Putai and Ichu. Several epidemiological investigations showed an increased incidence of bladder cancer associated with the long-term consumption of high- arsenic drinking water. However, the mechanism of arsenic-induced urinary bladder carcinogenesis, as well as the interaction between individual susceptibility and environmental exposure remain unclear. Further genetic and molecular epidemiological studies are essential for the elucidation of the carcinogenesis of urinary bladder cancer in the BFD area.
• 387 - 412
• 10.6288/CJPH1999-18-06-03

• Link 原著 Original Article
• 活動量與高血壓及高血脂症的相關探討－金山成年居民的研究Association between Physical Activities, Blood Pressure and Cholesterol Level in Chin-Shan Community Cardiovascular Study, Taiwan
• 張薰文、李源德、 林端雄、許秀卿、蘇大成、簡國龍、陳文鍾、黃玉眞、宋鴻樟
  Hsiun-Wen Chang, Yuan-Teh Lee, Ruey S. Lin, Hsiu-Ching Hsu, Ta-Chen Su, Kuo-Liong Chien, Wen-Jone Chen, Yuh-Chen Huang, Fung-Chang Sung
• 活動量 ； 高血壓 ； 高血脂症 ； 血壓 ； 總膽固醇值
  physical activity ; hypertension ; hyperlipidemia ; blood pressure ; total cholesterol
• 目的：活動量可以預防心血管疾病的發生，本文究利用台灣大學附屬醫院內科在金山鄉所建立的研究族群，觀察活動量對總對膽固醇及血壓的影響，同時對其他心血管疾病影響因子與活動量的相關亦加以探討。方法：以1990年完成第一階段的追蹤調查(N=2718)。活動度以問卷訪視的方式完成，採用簡潔式的Baecke問卷時行活動度測量，其中包括有關工作指標、運動指標、休閒活動指標。至於其他心血管疾病危險因子的資料，包括總膽固醇值和血壓的檢測、人口特性資料問卷調查等。結果：在控制年齡、BMI、抽菸、喝酒、糖尿病史及心血管疾病家族史後，總活動量?高度者比低度者有較底的平均總膽固醇（男性為190.0比197.8mg/dl，女性則為195.8比207.2mg/dl，p=0.001）。平均收縮壓及舒張壓與活動量則都末顯示出明顯相關，但以複回歸控制影響高血壓及高血脂的相關因子後，則發現男性總活動量為高度者，其高血壓的勝算比，約為低度者的0.7倍，而女性工作活動量較高者，有高血壓的危險性，亦為低度的0.66倍。休閒者活動指標與男女性高血脂有一致且明顯活動量與總膽固醇之間的關系較明顯，但運動指標與5.6mg/dl的總膽固醇。結論：本研究顯示活動量與總膽固醇之間的關系較明顯，但運動指標與高血脂及血壓之間的關系，則較不明顯。
  Objectives: This study used data obtained from a community-based cohort for cardiovascular disease study to investigate the effect of physical activity on total cholesterol and blood pressure. Methods: A cohort, consisting of 1703 men and 1899 women (response rate 82%) aged 35 and above, living in Chin-Shan for at least six months, was established in Chin-Shan Township, Taipei county, Taiwan in 1990. Data with complete information obtained from the first follow-up survey (N=2718) in 1993 were used for this study. In the first follow-up survey, information on physical activity was obtained using questionnaires developed by Baecke et al. Levels of physical activity were scored into four categories: physical activity at work (work index), leisure time exercises (exercise index), leisure time activity without exercise (leisure-time index) and total activity index. Sociodemographic characteristics, lifestyle and medical history etc, were also obtained from questionnaires. Overnight fasting blood samples were obtained for lipoprotein analysis; other anthropometric and blood pressure measurements were also performed at the same time. We compared blood pressure and total cholesterol (TC) using means or proportional values, included with 95% confidence intervals, by the level of physical activity. Logistic regression analysis was also used for risk measurements. Results: Controlling for age, body mass index, smoking, drink, diabetes and family history of cardiovascular disease, significant inverse trends were found for TC across groups with low, moderate and high levels of total physical activity. The average adjusted TC for individuals with high and those with low total activity levels were 190.0 vs. 197.8 mg dl for men and 195.8 vs. 203.2 mg dl for women. In a multiple logistic regression model, a negative association was observed between hypertension and total physical activity in both men (OR=0.7) and women (OR=0.66) after controlling for other co-factors. We also observed that TC was negatively associated with leisure time activities both in men and women. Conclusions: The effect of total physical activity is greater to total cholesterol than to blood pressure. No strong correlation among exercise activity and lipid level and blood pressure was found for the study population.
• 413 - 422
• 10.6288/CJPH1999-18-06-04

• Link 原著 Original Article
• 台灣地區大氣中臭氧濃度逐時分佈特性之分析－並應用1小時與8小時濃度標準探討臭氧污染問題Variations of Ambient Ozone Concentrations in Taiwan: Application of 1-and 8-hour Standards in the Examination of the Ozone Pollution Problem
• 洪雪芬、王秋森
  Hsueh-Fen Hung, Chiu-Sen Wang
• 逐時變化 ； 臭氧濃度 ； 臭氧空氣品質標準
  hourly variation ; ozone concentrations ; ozone air quality standards
• 目標：本研究之目的在於透過大氣中臭氧濃度逐時變化型態之檢視以探討近年來台灣地區之臭氣汙染問題，並使用不同規格的濃度標準對不同地區之臭氣空氣品質進行符合標準之測試。方法：利用環保署空氣品質監測站於1994至1997年間測得之臭氣氧濃度數據進行資料分析，選擇台北市內的中山測站和高雄市內的三民測站代表都市地區，台北縣新店創站代表大台北都會區下風處，台北縣萬里創站代表人為活動較少之地區，陽明測站代表國家合園，另外高屏地區下風處則選擇屏東縣的潮州與美濃測站為代表，分析此七個測站在高臭氣汙染日之季平均逐時臭氧濃度變化情形。此外，以1小時／120ppb與8小時／80ppb兩種臭氧空氣品質標準進行符合標準之測試。結果：高臭氧汙染日之數據分析結果顯示：逐時臭氧濃度變化型態可分成五種不同類型地區，各類型地區之季平均逐時臭氧濃度變化曲線大致呈單尖峰型態，其每日尖峰濃度出現的時間介於12:00-16:00之間。夜間時段之臭氧濃度隨地區而異，國家合園和偏遠地區分別為25-45 ppb與10-25ppb，明顯高於都會區（10 ppb以下）和都會區下風的鄉村地區(10-20 ppb)。臭氧濃度符合標準之測試結果顯示：台北盆地內之測站每日最高1小時臭氧濃度平均值大於120 ppb的日數明顯多於最高8小時臭氧濃度平均值大於80 ppb的日數，而其他地區正好相反，此差異顯示台北盆地之臭氧濃度逐時變化型態不同於其它地區。結論：由於不同類型地區之季平均逐時臭氧濃度變化型態差異甚大，且此差異會影響應用不同規格標準進行符合標準之測試的結果，因此，在訂定臭氧空氣品質標準的規格與標準值時，宜考慮不同類型地區臭氧逐時分布型態的差異。
  Objectives: The primary objective of this study was to analyze the ozone pollution problem in Taiwan by examining the hourly variations of the ambient ozone concentrations. In addition, compliance tests were performed for various regions using 1-hour/120 ppb and 8-hour/80 ppb standards. Methods: This study made use of hourly average ozone concentration data from 1994 through 1997 reported by Taiwan Environmental Protection Administration. Analyses of hourly variation patterns of ozone concentrations were carried out for the following seven monitoring stations: Chung-Shan and Shan-Min in two metropolitan centers, Shin-Dian in a downwind area of a metropolitan center, Mei-Nung and Chao-Chou in rural areas downwind of a metropolitan center, Yang-Min in a national park and Wan-Li in a remote area. To examine the patterns of hourly variations, the average values of hourly average ozone concentrations for all days with high ozone concentrations in each season were calculated for each area. Results: The results of analysis for days with high ozone concentrations show that there were five types of hourly variation patterns including: metropolitan centers, down- wind areas of a metropolitan center, rural areas downwind of a metropolitan center, national parks and remote areas. For all types, the hourly average ozone concentration curves had a single peak appear- ing between 12:00 and 16:00. The nocturnal ozone concentrations were considerably higher in the national park (25-45 ppb) and the remote areas (10-25 ppb) than in the metropolitan centers (<10 ppb) and rural areas downwind of a metropolitan center (10-20 ppb). The results of compliance tests show that the number of days exceeding the 1-hour/120 ppb standard was higher than the number of days exceeding the 8-hour/80 ppb standard in the Taipei basin, while the situations in other areas were the opposite. This indicates that the hourly variations of ambient ozone concentrations in the Taipei basin differed from those of other areas. Conclusions: The results suggest that the differences among various patterns of hourly variations of ozone concentrations should be taken into consideration when revising ozone air quality standards.
• 423 - 431
• 10.6288/CJPH1999-18-06-05

• Link 原著 Original Article
• 醫院因應外在環境變化之能力研究：以闌尾切除術實施論病例計酬制度為例Assessing Managerial Competence of Hospitals in Response to External Environmental Change: The Case of Appendectomy
• 錢慶文、邱瓊慧
  Ching-Wen Chien, Chiung-Hui Chiu
• 管理能力 ； 論病例計酬制度 ； 醫院特質
  Managerial competence ; Case Payment System ; Hospital types
• 目標：醫院對外在環境改變而採取的因應行為（策略）和醫院的營運績效息息相關，尤其在競爭非常激烈的醫療市場上，愈快能針對外在環境改變而加以有效因應的醫院，通常也愈能在市場上維持競爭優勢，創造出比較好的績效。根據國內外許多研究醫院策略行為的文獻顯示，評估醫院對外在環境改變立即反應的結果（反應的速度）是評估醫院管理能力的一種很好的方法。因此本研究主要的目的就是要藉研究論病例計酬制度的實施（外在環境改變）來研究不同性質的醫院其因應外在環境改變的管理能力。方法：在以民國八十六年七月至十二月中央健康保險局台北分局特約醫療院所申報3,209例Appendectomy之資料為例。結果：透過美國Medicare DRG分類後分析發現，區域醫院和財團法人醫院因應外在環境變化的能力比其他性質的醫院好。此外，在論病例計酬制度實施三個月後，並無證據顯示在不同性質的醫院之間有所謂不當的轉介病患的行為。結論：論病例計酬制度因具有在短期之內刺激醫療院所降低健保住院醫療支出的功能，各醫院應該改善其管理能力，以因應未來全民健保論病例計酬制度的全面實施。
  Objectives: How a hospital can adjust in response to environmental changes has been proved to be strongly associated with its financial performance. In a very competitive health care market, those hospitals that can adjust their behavior quickly to accomodate environmental changes usually can keep their competitive advantage and achieve better performance. According to the literature, evaluating the pace of a hospital effectively responding to its environmental change is very useful in assessing its managerial competence. Therefore, the objective of this study was to assess the managerial competence of different hospitals by their response to the environmental change of a Case Payment System (CPS) adopted by the National Health Insurance program. Methods: Included in the study were 3209 appendectomy cases occurring either before or within 3 months after the implementation the CPS in 1997. These cases were grouped into Medicare DRGs (Diagnostic Related Groups) before they were analyzed. Results: Results of this study indicated that regional hospitals and not-for-profit hospitals were more competent in adjusting to this new environmental change. Moreover, there was no evidence of unethical case dumping among the different types of hospitals. Conclusions: Since NHI will adopt CPS in paying all its inpatient services in the future, all hospitals should improve their managerial competence to face future environmental changes. Conclusions: Since NHI will adopt CPS in paying all its inpatient services in the future, all hospitals should improve their managerial competence to face future evritonmental changes.
• 432 - 444
• 10.6288/CJPH1999-18-06-06

• Link 原著 Original Article
• 社區老人對居家護理之認識及其影響因子Awareness of Home Health Care Services among non-institutionalized Elderly in Taipei
• 劉佳安、吳淑瓊
  Jia-An Liou, Shwu-Chong Wu
• 居家護理 ； 認知 ； 老人
  home health care ; awareness ; elderly
• 目的：本研究旨在瞭解社區老人對居家護理服務存在之認識情形，並進一步探討其影響因子。方法：研究資料取自台大合共衛生學研究所「老人健康及長期照護調查研究」於1996年收集之第二波資料，該研究樣本由設籍台北縣市四社區65歲以上老人隨機抽樣而得，共完訪1911人。本研究由其中去除6名曾經使用過居家護理、1名因抽樣誤差未滿65歲以及由家人代答之315名老人，總計本研究分析之樣本數為1589人。結果：調查發現1589名老人中僅有192人(121%)知道居家護理服務的存在，對數複迥歸分析結果則指出，在控制其他變項後，老人的年齡、籍貫、家庭月收入、教育程度、居住地區等社會人口特性以及自覺健康狀況和參與社交活動程度等特質皆為影響老人知道居家護理與否的顯著影響因子。結論：以上研究結果提供政府未來加強推動居家護理及長期照護服務之參考。
  Obiectives: care services as well as related factors. Methods: The data came from a 1996 survey of a representative sample involving 1911 elderly aged 65 and over living in 4 communities in the Taipei area. Results: Of the 1589 respondents selected in this study, only 12.1% had knowledge about home health care services. The results of multiple logistic regression analysis showed that factors significantly associated with the awareness of home health care included age, ethnicity, family income, education, resident area, self-rated health and social interaction. Conclusions: We suggest that health authorities should strengthen the extension of home health case services.
• 445 - 452
• 10.6288/CJPH1999-18-06-07

• Link 原著 Original Article
• 抽菸、飲酒與嚼檳榔習慣個人聚集之初探：以健康檢查族群為例A Preliminary Study on the Individual Aggregation in Cigarette Smoking, Alcohol Drinking, and betel-nut Chewing in a Health check-up Population
• 吳德敏、白璐、宋丕錕、蔡宗仁、徐黎玲、李旻貞、 孫建安
  Der-Min Wu, Lu Pai, Pei-Kun Sung, Johnson T. Tsai, Li-Ling Hsu, Ming-Chen Lee, Chien-An Sun
• 抽菸 ； 飲酒 ； 嚼檳鄉 ； 盛行率 ； 個人聚集
  cigarette smoking ; alcohol consumption ; betel-nut chewing ; prevalence ; individual aggregation
• 目標：本研究目的為瞭解臺灣地區參加健康檢查之20-64歲成年人在抽菸、飲酒及嚼檳鄉等聚集現象及此一聚集的人口學因素。研究族群包括61，564位（男性：28，129，女性：33，435）在民國85年2月至12月前往某一健康檢查機構實施常規健康檢查之20-64歲的健康檢查民?。抽菸、飲酒和嚼檳榔習慣的資料是取自健檢民?在實施健康檢查時所完成之自填填式問卷。生活習慣的個人聚集分析，系以健檢民?所具有前述三項生活習慣之數目之目的實際觀察比率之比值(O/E ratio)及信賴區間來作比較分析。結果：分析結果顯示，具有兩項生活習慣（男性之O/E ratio-1.40，95%信賴區間[CI]=1.35-1.45：女性具有兩項及以上生活習慣之O/E ratio=10.04，95%CI-8.23-11.21）及同時合併有三項生活習慣（男性之O/E ratio=6.18，95%CI=6.27-7.34）之O/E ratio具有統計學上顯著的意義。多變項的分析結果顯示，在此一健檢族群中，影響前術生活習慣?生個人聚集的顯著人口學因素包括男性、年齡較輕及低教育程度。結論：抽菸、飲酒及嚼食檳鄉這些不利健康的生活習慣在健檢族群中有明顯的個人聚集現象。而且此一個人聚集現象較易出現於男性、年齡較累及低教育程度的健檢者。
  Objectives: The authors studied the prevalence of the aggregation of common lifestyle habits, namely, cigarette smoking, alcohol consumption, and betel-nut chewing and the demographic correlates of individual aggregation of these lifestyle behaviors among Taiwanese adults aged 20 to 64. Methods: A total of 61,564 individuals, including 28,129 men and 33,435 women who attended a periodic health check-up program in a private health testing institute between February 1996 and December 1996, were available for analysis. Information on smoking, drinking, and betel-nut chewing habits was ascertained as part of a self-administered questionnaire completed by the examinees upon registration for health testing. The aggregation of lifestyle habits was studied by comparing the observed and expected proportions (O/E ratio) with their 95% confidence intervals (CI) for zero, one, two, and three simultaneously occurring lifestyle habits. Results: The study results showed a significant clustering of lifestyle habits studied; the number of subjects was greater than expected in groups with two (for males, the O/E ratio=1.40, 95% CI=1.35-1.45; for females with two or three lifestyle habits, the O/E ratio=10.04, 95% CI=8.23-11.21) and three (O/E ratio for males: 6.81, 95% CI=6.27-7.34) lifestyle habits. Determinants for this clustering of lifestyle habits included male gender, younger age, and lower educational levels. Conclusions: There was a significant individual aggregation of lifestyle habits including cigarette smoking, alcohol consumption, and betel-nut chewing in the health check-up population studied. In addition, male subjects, younger individuals, and persons with low educational levels had an apparent tendency toward the aggregation in these lifestyle habits.
• 453 - 459
• 10.6288/CJPH1999-18-06-08

• Link 實務 Public Health Practice
• 早產兒危險因子之探討－社區性病例對照研究Risk Factors of Prematurity-A community-based Case Control Study
• 潘懿真、謝功毅、陳保中
  I-Jen Pan, Gong-Yih Hsieh, Pau-Chung Chen
• 病例對照研究 ； 早產兒 ； 危險因子
  ase-control studies ; prematurity ; risk factors
• 目標：早產發生率約為5-10%，其所造成的新生兌死亡佔所有新生兌死亡（嚴重胎兌畸形除外）的85%。現階段國民保健計畫目標中，希望將台灣早產兌發生率降為4%；目前已知造成早產兒的原因只有三分之一可以被確認，其他的原因依然不明。故本研究以苗栗縣頭份鎮為研究族群，使用病例對照法，調查造成早產兒發生的潛在危險因子。方法：研究對象為86年1月至87年4月的出生嬰兒，所有病例及對照個案皆由該衛生所的出生通報資料隨機抽樣選出，並使用結構性訪問式問卷進行面訪搜集資料。結果：病例組完訪153個個案，對照組121個個案。結果發現在懷孕中未滿29週，若每天經常上下樓梯的危險勝算比為2.79（95%信賴區間＝13.33-5.87）；母親曾感染過水痘病毒者危險勝算比為2.49（95%信賴區間＝1.30-4.22）；懷孕前曾使用過避孕藥者危險勝算比為5.27（95%信賴區間＝1.75-15.89）；另外，曾有早產經驗者為12.85（95%信賴區間＝1.60-103.51），於孕前十二個月有抽菸習慣者為3.19（95%信賴區間＝1.02-9.98）。結論：本研究發現文獻中未曾提及之母親曾感染過水痘、於孕前服用口服避孕藥者，為可能的危險因子，此外，母親的身體活動量亦對該地區早產兒的發生有貢獻性。
  Objectives: The incidence of prematurity is about 5-10%, but it causes 85% of neonatal death (excluding serious congenital malformations). Health Plan 2000 in Taiwan states that the incidence of prematurity will be reduced to 4%. Up to now, the causes of prematurity were only established in one third, and the others are still unknown. Thus, we used a population-based case- control study to investigate the potential risk factors of prematurity in Toufen. Methods: Cases were born from January 1997 to April 1998 and controls were randomly selected from birth registration data. Each case was interviewed using a structured questionnaire. Results: There were 153 cases and 121 controls completing the questionnaire. We found several significant risk factors such as frequently up- and downstairs before 29 weeks of gestation (odds ration (OR)=2.79,95% confidence interval (CI)=1.33-5.87), maternal chicken pox history (OR=2.49; 95% CI=1.30-4.22), oral contraceptive use (OR=5.27; 95% CI=1.75-15.89), previous prematurity(OR=12.85; 95% CI= 1.60-103.51), and smoking during one year before pregnancy (OR=3.19; 95% CI=1.02-9.98). Conclusions: Previous studies have not shown a significant relation between the exposure of chickenpox or oral contraceptives and prematurity. Otherwise, we also found that maternal physical activities may have the contribution to prematurity in Toufen.
• 460 - 465
• 10.6288/CJPH1999-18-06-09