19卷6期

• Link 公衛論壇 Public Health Forum
• 泥水工職業性皮膚病調查研究與改善對策泥水工職業性皮膚病調查研究與改善對策
• 石東生、謝俊明
  Tung-Sheng Shih, Chun-Ming Hsiech
• 無
  none
• 無
  none
• 407 - 410
• 10.6288/CJPH2000-19-06-01

• Link 原著 Original Article
• 試以相對價值表（RVS）訂定醫師費計算基準－以牙科79個處置為例Establishing the Relative Value Scale (RVS) of Physician Fees in Taiwan - A Review of 79 Dental Procedures
• 陳琇玲、溫信財、楊志良、張孝新
  Hsiu-Ling Chen, Hsyien-Chia Wen, Chih-Liang Yaung, Hsiao-Hsin Chang
• 牙醫師 ； 相對價值表 ； 支付標準 ； 醫師費
  dentist ; relative value scale ; payment system ; physician fee
• 目標：本研究圖訂定牙科處置的相對價值表，以作為未來醫師費計算基準。方法：由牙醫師全聯會推薦專家小組，選家問卷調查的處置及四個次專科基準處置。以全體會員為研究對象全層隨機抽樣，德菲（Delphi）法進行二次問卷調查，請樣本醫師依據該次專科基準處置等級估測每個處置的相對值。問卷結果依照各組樣本數比例修正後，由小組專家外推未調查之處置的相對值，再將各次專科之相對值調整為全科相對值共同量表。結果：(1)在問卷結果信效度可接受情況下，探討出79個牙醫師總工作量的相對值。(2)雖未包含執業成本的投入，研究結果與現行健保支付標準表之相關性高。四個次專科中，口腔顎面外科相對值與健保支付標準相關性最高，根管治療科相關性最低。(3)影響牙醫師處置之時間、體力、技術及風險四個構面（dimensions）中，作時間長短並非決定其工作量之主要考量因素。(4)除了「髓腔開擴＋根管治療（三根以上）」外，牙醫師對總工作量之估測，並不會因為執業地點位於城鄉，及執業場所為醫院或診所而有不同。結論：(1)以RBRVS方法適宜探討牙醫師工作評量方法。(2)建立79個本土牙醫師工作量相對價值表。(3)可考慮對目前健保部份處置的支付標準進行修正。
  Objective: The purpose of this study was to establish the relative value scale (RVS) of dental procedures, which may serve as the basis for a dentistry payment system. Methods: Upon the recommendation of the National Dental Association of the Republic of china, a Technical Consultating Group (TCG) was organized to select the Services/Procedures (S/Ps) to be investigated by survey and to establish the basic reference S/Ps for each of the four sub-specialties. After stratified random sampling, the Delphi Technique was used for two rounds of survey. In the questionnaire, we asked the respondents to magnitude estimate the weight of the S/Ps against the base S/P of each sub-specialty respectively. After adjusting the survey results to the sample size, we then asked the TCG to evaluate the results and to estimate the workload of the un-surveyed S/Ps. Finally, we readjusted them to a common scale for all S/Ps of the four sub-specialties. Results: (1)Both the validity and reliability of the survey were acceptable. We have set up a local RVS for 79 dental procedures. (2) Although other factors such as practice costs were not included, the results of the present study correlated well with the dental payment system of the NHI. Of the four sub-specialties, the RVS of Oral Surgery (OS) correlated best with the payment system of the NHI, while the lowest was the RVS of Endodontics (Endo). (3)Time is the least important of the four dimensions of a dentists’ workload. (4)The workload of a dentist is not affected by the location of his practice place, urban or rural, hospital or clinic. Conclusion: (1)It is appropriate to use the RBRVS method to establish a RVS for the workload of dentists in Taiwan. (2)We have set up a local RVS for 79 dental procedures. (3)The NHI dental fee scale for some S/Ps needs to be re-evaluated.
• 411 - 422
• 10.6288/CJPH2000-19-06-02

• Link 原著 Original Article
• 台灣地區成年人之吸菸率與吸菸行為：八十八年度之全國性調查Smoking Prevalence and Behaviors of Adults in Taiwan: A National Survey, 1999
• 李蘭、潘怜燕
  Lee-Lan Yen, Ling-Yen Pan
• 吸菸 ； 盛行率 ； 成人 ； 健康促進 ； 電話訪問
  smoking ; prevalence rate ; adult;health promotion ; CATI
• 目標：為使菸害防制工作順利推動，國人之吸菸率及吸菸行為需定期監測，故舉辦本次全國性之吸菸調查。方法：根據人口資料及歷年吸菸率，計算本調查應完成之樣本數。受委託之電話訪問公司於民國八十八年一月，利用吸菸行為問卷完成資料收集。結果：主要發現包括：(1)男性成人和女性成人目前有吸菸之比率分別為47.29%和5.23%；(2)有吸菸者第一次吸菸之平均年齡介於18.5至19.9歲；(3)有47.41%的每天吸菸者，和65.74%的偶而吸菸者，在過去一年曾經戒菸；(4)年齡、教育程度、居住地區、同住者是否吸菸、對公共場所禁菸的態度、及工作場所是否禁菸等變項，可分別預測男性和女性成人之吸菸狀態；(5)年齡、教育程度、同住者是否吸菸、及對公共場所禁菸之態度等變項，可以預測男性成人是否戒菸。結論：由於女性成人吸菸率有上升趨勢，應鼓勵以「女性吸菸」為題之研究計畫。為提昇吸菸高危險群想要戒菸之動機，可應用各種理論發展創新性之策略。為提高戒菸成功率，應提供想要戒菸者有效的戒方法。雇主應實執行職場禁菸之規定，使員工的健康獲得保障。
  Objectives: In order to facilitate tobacco control task, people’s prevalence and behaviors related to cigarette use need to be monitored regularly. A national smoking survey was thus conducted in Taiwan. Methods: Based on demographic data and previous smoking rates, the sample size was estimated. Using a set of structured questionnaires, a telephone company was entrusted to collect data in January 1999. Results: (1)Current smoking rates for male adults and female adults are 47.29% and 5.23%, respectively. (2)The average age for first trial of cigarette smoking is between 18.5 and 19.9 years, respectively. (3)Among the adults, 47.41% of daily smokers and 65.74% of occasional smokers reported that they had ever tried to quit smoking last year. (4)The variables including age, educational level, living place, whether the roommate is smoking, attitudes toward smoking ban in public places, and whether the workplace has smoking ban are significant predictors for male and female adults’ smoking status. (5)Age, educational level, whether the roommate is smoking, and attitudes toward smoking ban in public places are significant predictors to quit smoking for male adults. Conclusions: Female adults’ smoking rates tend to increase. The research projects focusing on investigating female smoking should be encouraged. In order to urge a smoker to quit, the innovative strategies should be created. The effective cessation methods should be introduced to those smokers who attempt to quit. In order to protect the employees’ health, the employers should conduct smoking ban in workplace.
• 423 - 436
• 10.6288/CJPH2000-19-06-03

• Link 原著 Original Article
• 住院病患對就醫選擇資訊之需求：初步調查發現Demand for Provider Selection Information of Inpatients: Findings from a Preliminary Study
• 謝慧欣、 鄭守夏、丁志音
  Huei-Shin Hsieh, Shou-Hsia Cheng, Chih-Yin Lew Ting
• 消費者健康資訊 ； 醫療服務市場 ； 就醫選擇
  Consumer Health Information ; Health Care Market ; Selection of providers
• 目標：由於醫療具有高度專業性，故醫療照護市場向來存有專業資訊不對等之問題，又因市場資訊並未完全公開流通，致使醫療消費者無法在擁有充分資訊的情況下做出其最適選擇決策，導致市場的無效率。本研究欲瞭解病患在求醫前搜尋就醫選擇資訊的行，並瞭解病人所需要的資訊內容，以及信賴的資訊提供者。方法：本研究立意選擇北部七家醫院之內科、外科與婦科18歲以上之住院病患為研究對象，以面訪方式完訪688位樣本。結果：約有43%及52%的病人在住院曾分別打聽醫院或醫師的消息，有56%的受訪者表示需要就醫選擇資訊，最需要的資訊項目，依序為醫師的專長、醫術、及醫德等。此外，需要就醫選擇資訊的受訪病患中，有63%希望資料能以印行小冊子之方式提供，而政府衛生單位為大多數受訪病患所信賴的資訊提供者。結論：有半數的受訪住院病患，對就醫選擇資訊有需要，且表示不易獲得，政府部門可考慮未來應有系統性彙整資訊公開流通，以降低民眾之資訊搜尋成本，增進醫療服務市場之效率。
  Objectives: This study aims to understand patients’ information searching behavior before selecting health care providers, and to investigate patients’ need for health information needs. Methods: During the study period, patients admitted to the internal, surgical and gynecology departments of seven hospital in north Taiwan were enrolled as subjects. A total of 688 inpatients aged 18 and above were interviewed. Results: About 43%-52% of the inpatients sought for information about hospitals and physicians. Fifty-six percent of the inpatients expressed the need for consumer health information. The top five items of information were: (1) the specialty of physicians, (2)their medical expertise, (3) their medical ethics, (4) their willingness to communicate with patients, and (5) the general information of a hospital. About 63% of those who need information preferred to receive the information via booklets, and the governmental health agency was considered the most reliable source of such information. Conclusions: The health authority and non-government organizations should collect and disseminate consumer health information to the public to facilitate their selection of health care providers.
• 437 - 445
• 10.6288/CJPH2000-19-06-04

• Link 原著 Original Article
• 台灣河川魚體多氯聯苯之濃度調查研究Polychlorinated Biphenyls Levels of Eights Species River Fish in Taiwan Area
• 王正雄、 黃輝榮、 洪文宗
  Cheng-Hsung Wang, Hui-Jung Huang, Wen-Tsung Hung
• 多氯聯苯 ； 同屬物 ； 生物累積 ； 生物濃縮
  polychlorinated biphenyl ; PCBs congener ; bioaccumulation ; bioconcentration
• 無none
  Objective: This research was to study the levels of polychlorinated biphenyls (PCBs) in fish collected from major rivers in Taiwan after 12 years of prohibiting the use of PCBs. Method: We sampled Oreochromis sp, Liza macrolepsis, Mugil cephalus, Megalops crprinoides, Chanos chanos, Channa sp., and Albula glossodonta in the following ten rivers: the Keelung River, the TaHam Chi, the Hsin Tien Stream, the Tanshui River, the Touchien Chi, the Chungkang Chi, the Potzu Chi, the Erhjen Chi, the Kaoping Chi, and the Tungkang Chi. We stabbed with a knife to collect the meat, skin, liver, eggs, and bowels of fish, which were homogenized and mixed with NaOH. The mixture was extracted with n-hexane and the solvent was evaporated to near dryness, then the mixture was cleanup through acidic silica gel column. Samples were analyzed by gas chromatography, which equipped with electron capture detector. If we found samples containing any PCB, then we would confirm it by GC/MS. Result: We found that the sample of meat of Oreochromis sp. Containing PCBs (ng/g in wet wt) in the Keelung River was 17.7 ng/g, in the TaHam Chi was 19.1 ng/g, in the Hsin Tien Stream was 65.1 ng/g, in the Tanshui River was 13.2 ng/g, in the Touchien Chi was 38.5 ng/g, in the chungkang Chi was 26.8 ng/g, in the Potzu chi was 9.8 ng/g, in the Erhjen Chi was 130.1 ng/g, in the kaoping Chi was 178.8 ng/g, and in the Tungkang Chi was 26.1 ng/g. The average concentration was 67.6 ng/g(1.2-884.7 ng/g). In Keelung River, different parts of the fish contained different PCBs level, it ranked as follows: livers (207.8 ng/g) > bowels (140.0 ng/g) > eggs (113.0 ng/g) > skin(37.1 ng/g) > meat(17.7 ng/g). Among PCBs congeners detected, we found hexachoroide (No. 153, 138) was the highest in percentage, but in the concentration, we found Trichloroide (No.28) > Tetrachloroide (No.77) > Pentachloroide (No.118). Conclusion: The levels of polychlorinated biphenyls in river fish collected from northern and central Taiwan were low, while in southern Taiwan they were mid to high. The PCBs concentration of fish meat was within ROC’s food regulation standards (1 ppm), but the liver, bowels, eggs, and skin were considered polluted. So we believe fish meat is safe to ingest but not fish liver, bowels, eggs, and skin were considered polluted. So we believe fish meat is safe to ingest but not fish liver, bowels, eggs, and skin.
• 446 - 461
• 10.6288/CJPH2000-19-06-05

• Link 原著 Original Article
• 血液樣本於不同保存溫度狀態下對血鉛濃度影響之初探A Preliminary Study on the Stability of Blood Lead Levels in Short - term Stored Specimens Subjected to Various Storage Temperature Conditions
• 楊燦、 吳德敏、孫建安、辜志弘、周雨青、劉紹興
  Tsann Yang, Der-Min Wu, Chien-An Sun, Chih-Hung Ku, Yu-Ching Chou, Saou-Hsing Liou
• 血鉛濃度 ； 溫度保存狀態 ； 穩定性
  blood lead levels ; storage temperature conditions ; stability
• 目標：本研究目的是要瞭解血液樣本在短時間內存放於不同保存溫度狀態下，對血鉛濃度之影響。方法：研究係針對非鉛暴露人員進行初期的探討，共計有12個血液樣本納入本研究。研究對象檢體收集是以內含Sodium Heparin抗凝血劑之真空採血採集，採集後立即以2ml之eppendorf micro test tube分裝檢體並置於室溫、4℃、0℃、-20℃、-85℃等五種溫度下保存。血中鉛的測量，係利用石墨爐原子吸收光譜儀（Graphite furnace atomic absorption spectrophotometer；GFAAS）來測定。結果：十二個血液樣本之血鉛分析時間間隔從0.3個月至4.6個月。其結果若以平滑曲線圖來看，研究對象血液樣本於五種不同保存溫度狀態下，血鉛濃度呈現相似的分佈。另以GEE（generalized estimating equation）分析模式發現，血液樣本在儲存時間因素上，並未對其血鉛含量造成顯著的影響，而在儲存溫度之影響因素上，僅於4℃與-85℃儲存之血液樣本，血鉛濃度呈現顯著的差異，由於此種差異在實質上甚微，因此本研究認為收取非釦暴露者之血液樣本，並將之於短時間內保存在不同溫度狀態下，其血濃度仍呈現穩定狀態。
  Objectives: To examine the effect of short-term stored blood speciments at various temperature conditions on the laboratory analysis of blood lead level (BLLs). Methods: A total of 12 blood specimens were collected from non-lead exposed individuals using vacuum tube containing sodium heparin as the anticoagulant and were kept in 2ml-eppendorf micro test tubes. These specimens were purposely placed at room temperature, 4?J, 0?J,-20?J and -85?J after phlebotomy. Blood lead levels in stored specimens subjected to various storage temperature conditions were analyzed by graphite furnace atomic absorption spectrophotometer (GFAAS). Results: The interval between specimen storage and performance of laboratory BLL analysis in these 12 samples ranged from 0.3 to 4.6 months. The distribution of BLLs was nearly identical across the samples subjected to a variety of storage temperature conditions based on the display of smoothing curves. Moreover, the analysis using Generalized Estimating Equation (GEE) revealed a non-significant difference in BLLs in stored samples with different storage intervals. In contrast, there was a significant difference in BLLs in the specimens stored at 4?Jand -85?J, the variations among studied samples were negligible from the practical standpoint. We conclude that srtorage of blood samples at various temperatures does not cause any significant change in BLL in these analyses studied.
• 462 - 468
• 10.6288/CJPH2000-19-06-06

• Link 原著 Original Article
• 罹患單純塵肺症台灣煤礦工之肺功能障害的盛行率The Prevalence of Pulmonary Impairment among Coal Miners with Simple Pneumoconiosis in Taiwan
• 楊錫欽
  Shieh-Ching Yang
• 單純塵肺症 ； 盛行率 ； 肺功能障害 ； 煤礦工
  simple pneumoconiosis ; prevalence ; pulmonary impairment ; coal miners
• 目標：依據現行勞保局塵肺症殘廢審定標準，探討台灣煤礦工單純塵肺症肺功能障害的盛行率，並觀察其與坑內工作年數間之關係。方法：本研究自1998年至1999年於礦工內科門診收集284位資料完整，且其胸部X光片依國際勞工組織塵肺症分類法顯現Category 0或Category 1，2或3之單純塵肺症變化的煤礦工，安排其作肺量測定及肺瀰散量檢查。進行性重度肺纖維化串者不包括在內。礦工的工作史由問卷調查而得知。結果：X光等級屬Category 1以上之單純塵肺症患者其FEV1/FVC異常低下的盛行率為42.6%(69/162)，而FVC及FEV1異常低下的盛行率分別為4.9%(8/162)與10.5%(17/162)。盛行率隨著X光等級與坑內工作年數而提高。肺瀰散量異常的盛行率較FEV1/FVC者為低。結論：煤礦工單純塵肺症肺功能障害的盛行率視參數的種類而有所不同，肺瀰散量測定可以補充肺量測定之不足。
  Objectives: To investigate the prevalence of respiratory impairment and its relation to underground exposure among coal workders with simple pneumoconiosis in Taiwan. Methods: This study investigated 284 coal miners, including 122 with X-ray Category 0 and 166 with Categories 1, 2, and 3 (simple pneumoconiosis), from the medical clinics of a hospital. Spirometric measurement and tests for pulmonary diffusing capacity (DLco) were conducted on each subject. Patients with progressive massive fibrosis (PMF) were excluded. Occupational histories were obtained from questionnaire survey. Results: The prevalence of an abnormally low FEV1/FVC (forced expiratory volume in 1s/forced vital capacity) in subjects with simple pneumoconiosis was 42.6%(69/162). For FVC and FEV1, it was 4.9(8/162) and 10.5%(17/;62), respectively. The prevalence of abnormally low spirometric values increased with higher X-ray categories and longer underground exposure. The prevalence of an abnormal DLco was also lower than that of FEV1/FVC. Conclusions: The prevalence of lung functional impairment in simple pneumoconiosis varies with the parameter measured, and DLco determination may be helpful in case of normal spirometric measurement.
• 469 - 476
• 10.6288/CJPH2000-19-06-07

• Link 實務 Public Health Practice
• 天然災害後環境衛生快速評估系統之開發A Quick Monitoring System for Evaluating Environmental Sanitation after Natural Disasters
• 姚永澔、林嘉明
  Yung-How Yao, Jia-Ming Lin
• 天然災害 ； 環境衛生 ； 快速評估
  natural disaster ; environmental sanitation ; quick monitoring
• 目標：本報告企圖建立一個快速簡單的評估機制，使天然災害後環境衛生的變化能早期反應，讓衛生決策者能依據環境衛生惡化的警訊，做出對應的適當措施。方法：先由研究者提出以快速評估表為主軸的系統架構，經過政府及學校專家學者檢討修正，並且取得部份921地震災區實測資料做應用評鑑。結果：設計完成的快速評估系統，藉結構式問卷收集資訊，以配分量化選項並且做環境衛生狀況分組；在Microsoft Excel 97的環境下以VBA語言設計輸入程式，以加速資訊的處理與傳輸。其中快速評估表曾在地震後的南投、台中試用，收集災後第六個月的資訊做處理，以評鑑災後環境衛生狀況。結論：整體而言，認為本快速評估系統，對發展災害後環境衛生評估系統提供了一個實用的參考經驗。
  Objectives: This study aimed to design a quick and simple monitoring system, which gives early warning of negative changes in the status of environmental sanitation after natural disasters, and provides a basis for prompt and proper response. Methods: The investigators provided a prototype of monitoring system consisting of mainly an evaluation table, which was reviewed by professionals and scholars from the government and schools. Then the revised table was employed to collect field data in some disaster-stricken areas of the massive Chichi earthquake for evaluating the monitoring mechanism. Results: The finalized quick monitoring system consists of structured questionnaires for collecting field data, a scoring rule for quantifying the items in the evaluation table and classifying the status of environmental sanitation, and a program written in Visual Basic for application within Microsoft Excel 97 environment, for data process and communication. Field data were collected in Nantou County and Taichung County using the evaluation table to assess the status of environmental sanitation six months after the Chichi earthquake. Conclusions: The study provided practical experience for developing a quick monitoring system for evaluating the status of environmental sanitation after natural disasters.
• 477 - 484
• 10.6288/CJPH2000-19-06-08

• Link 研究紀要 Research Brief
• 病例雙親對照研究法中基因型相對危險性之估計：Mantel-Haenszel法之應用Estimating Genotype Relative Risks in Case-parental Control Studies: A Mantel-Haenszel Approach
• 張晉豪、李文宗
  Chin-Hao Chang, Wen-Chung Lee
• 病例雙親對照研究法 ； 基因型相對危險性、Mantel-Haenszel法 ； 流行病學方法學 ； 遺傳流行病學
  case-parental control study ; genotype relative risks ; Mantel-Haenszel method ; epidemiologic methodology ; genetic epidemiology
• 目標：以病例對照研究法探討致病基因與疾病的相關強度時，研究族群中若有分層／融合的情況，基因型相對危險性的估計就可能有偏差。此時可使用「病例雙親對照研究法」之研究設計，以克服之。針對此種研究設計之資料，最近文獻上刊載三種非遞迴計算基因型相對危險性的方法。本研究應用Mantel-Haenszel（M-H）法，提出一個全新的非遞迴估計法。方法：上述四法之估計值公式頗為類似，其差異僅在加權常數的不同。而套用M-H法所推導出之加權數為1.5。結果：吾等進行電腦模擬試驗以比較此四法之統計性質，模擬結果顯示四法皆近似無偏差；而M-H法之變異數較小，表示其為較穩定之估計值。結論：以M-H法估算病例雙親研究法中之基因型相對危險性計算簡單且較前述三法穩定。
  Objectives: Epidemiologists often study the relationship between a susceptibility gene and a disease using the case-control design. Due to stratification/admixture that may exist in the study population, the conventional case-control design may lead to biased estimation of ‘genotype relative risks’(GRRs). This problem can be circumvented by using the ‘case-parental control design’ instead. Under this design, there have been three non-iterative methods for estimating GRRs proposed in the literature. Here we propose a new non-iterative method using the Mantel-Haenszel(MH) concept. Methods: The above four methods have similar formula apar from the weighting constants. The weighting constants used in the M-H method are 1.5 Results: Monte-Carlo simulation shows that the above four methods all produce estimates that are approximately unbiased. However, the M-H method has the smallest variance and hence is the most stable among the four methods. Conclusions: The M-H method is simple to calculated and more stable than the other three non-iterative methods for the estimation of the GRRs in the case-parental control study.
• 485 - 490
• 10.6288/CJPH2000-19-06-09

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• 對“全球環境變遷對公共衛生衝擊之評析”的幾點看法對“全球環境變遷對公共衛生衝擊之評析”的幾點看法
• 林澤聖
  Tser-Sheng Lin
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• 491 - 493
• 10.6288/CJPH2000-19-06-10