20卷5期

• Link 綜論 Review Article
• BBS電腦族操作習性與視覺疲勞研究Operation characteristics and visual fatigue in using bulletin board system
• 沈駿緯、莊弘毅、呂志維
  Jiunn-Woei Sheen, Hung-Yi Chuang, Chih-Wei Lu
• 電子佈告欄系統 ； 視覺疲勞 ； 電腦工作站 ； 網路問卷
  BBS ; visual fatigue ; VDT workstation ; network questionnaire
• 目標：電子佈告欄系統(BBS)具有虛擬電子社區的特性，在長時間的電腦操作下，可能會對身體造成傷害，尤其是視覺機能方面。本研究的目的是欲探討BBS族群的特性及電腦工作站之操作環境與視覺疲勞的相關。方法：研究期間先將問卷張貼在網頁上，選擇上站人數最多的前三名BBS站作為問卷訪查的母群體。在BBS線上隨機抽樣傳送訊息給使用者，再給予他們問卷的網址，讓其登入作答；若受試者對問卷內容有疑感，可以在BBS上傳送訊息跟研究者詢問討論，此調查方式如同現實社區的家訪。結果：問卷回收率87.3%，BBS族群以學生為主(74.6%)，絕大部分為大學生(59.7%)；男性平均每週上線16.21小時，女性10.95小時，男性比女性花較多時間於BBS上；女性在每次電腦操作後，眼睛酸澀、想睡及頭痛的發生頻率比男性來得高；電腦操作環境的滿意度與視覺疲勞的發生頻率呈負相關。結論：利用BBS虛擬電子社區的特性來進行研究，是一個具有高問卷回收率的線上調查方式；電腦終端顯示器(VDT)品質越差者，使用者越是容易覺得疲勞，所以改善電腦工作站的設備環境，是減少視覺疲勞的一種有效方法。
  Objectives:The Bulletin Board System (BBS) resembles a virtual community. Spending long hours on this system is detrimental to the body ,especially the visual function .This study aims at fatigue. Methods:The questionnaire was posted on the three most popular BBSs. Random sampling by the BBS users’ numbers,sending messages to the subject one by one ,offering the researcher’s e-mail address and asking them to answer the questions which were processed on-line . If there was any problem related to the questionnaire, the participant could send a massage to the researcher and discuss it .This interviewing technigue was the same as real-word face to face interviews in the virtual community .Results:The questionnaire return-rate was 87.3%. Most users were university students (59.7%) . On average ,male subjects spent 16.21 hours per week. This was more than females (10.95 hour per week). However, female subjects suffered from visual symptoms (eye soreness, drowsy , headache) more frequently than the males. There were signififatigue. Conclusions:Because BBS is a virtual community ,using an on-line questionnaire survey allowed for a high return rate. Subjects with a high degree of visual fatigue seemed to use worse visual display terminals (VDT). Thus ,improving the work environment and equipment of VDT workstations is necessary to decrease the symptoms of visual fatigue.
• 337 - 345
• 10.6288/TJPH2001-20-05-02

• Link 原著 Original Article
• 台南市安養機構病患及工作人員之皮膚疾患調查Skin Diseases Among Patients and Health Care Workers in Nursing Homes in Tainan City
• 李永凌、Derek R. Smith 、謝富森、 張素貞、郭育良、許漢銘
  Yung-Ling Lee, Derek R. Smith, Fu-Sen Hsieh, Suh-Jen Chang, Yueliang Leon Guo, Hamm-Ming Sheu
• 皮膚疾患 ； 安養機構 ； 疥瘡 ； 黴菌感染 ； 乾皮症
  Skin Disease?;?Nursing Home?;?Scabies?;?Fungus,Xerosis
• 目的：調查安養照護機構中，病患以及工作人員的皮膚疾患之盛行率及其潛在危害因子。方法：在1999年11月至2000年2月間，自台南市衛生局登記的21家安養照護機構，隨機選取受照護者人數5人以上的11家，對所有病患和工作人員做全身皮膚檢查及問卷調查。懷疑疥瘡或黴菌感染的檢體，都經標準程序處理後，再以顯微鏡檢查加以證實。結果：由臨床診斷，發現61.6%的病患患有黴菌感染，其病灶多發生在蹠部(95.1%)。58.3%的病患有乾皮症，但多集中在小腿(94.0%)，甲癬佔病患總數57.3%，癬34.4%，以及手癬11.6%。懷疑黴菌感染的病患中，顯微鏡鏡檢檢出率高達62.9%。另外，有3.3%的病患和10.7%的工作人員被診斷出疥瘡感染，經疥虫檢體檢查，在病患中確認出30.8%，以及工作人員中確認出12.5%帶有疥虫，共集中在三家(27.3%)安養機構中。針對病患來看，統計上發現黴菌感染與男性性別及長期臥床相關，乾皮症與年齡相關，而疥瘡感染的危險因子主要為過去的疥瘡病史。在工作人員方面，可能是取樣數目太少的原因(N＝75)，我們並未發現任何皮膚疾患的危險因子。結論：在台南市安養機構的病患及工作人員中，特定的皮膚疾患確實有很高的盛行率。雖然統計未達顯著的意義，我們仍有理由相信工作人員的疥瘡感染和職業上的接觸有著密切的關係。
  Objectives:To establish the prevalence of skin diseases in nursing homes, and determine possible risk factors for these disease. Methods:We undertook an investigation of patients and health care workers between November 1999 and February 2000 in Tainan City .Eleven palliative care institutions with more than 5 cared patients were randomly selected from 21 institutions registered by the Tainan Government Health Bureau. A structured questionnaire was completed before patients and staff were individually examined. For individuals with suspected scabies or fungal infections, skin samples were collected, prepared by standard procedures, and then examined microscopically. Results:Fungal infections were found in 61.6% of nursing home patients, of which most (95.1%) were on the foot. 58.3%of patients were diagnosed with xerosis, mainly on the lower leg (94.0%).57.3% patients were detected with Tinea unguium , 34.4% with Tinea pedis and 11.6% with Tinea manus. 62.9% of fungal diagnoses were authenticated by microscopic techniques. Scabies was noted in 3.3% patients and 10.7% stuff. We also confirmed scabies creatures in 30.8% and 12.5%of patients and staff with clinical diagnoses, gathered form three (27.3%) separate institutions . Among the patients, fungal infections wee correlated with male gender and bedridden status while xerosis was associated with increasing age. For scabies infection, a previous history of scabies was the most significant statistical risk factor. Among stuff, we could not determine any important statistical associations due to the relatively small number actually suffering skin disease (N=75) .Conclusions:Our study has revealed high skin diseases prevalence among patients and staff in nursing homes of Tainan city .Although not statistically significant, we believe there may be a relationship between staff with scabies and occupational contact with patients.
• 346 - 356
• 10.6288/TJPH2001-20-05-03

• Link 原著 Original Article
• 菸煙及油煙暴露與DNA修補酵素基因多形性對臺灣北部女性肺腺癌之交互作用Interactive Effects of Exposures to Tobacco Smoke and Cooking Fume and Genetic Polymorphisms of DNA Repair Enzymes on Female Lung Adenocarcinoma in Northern Taiwan
• 吳慧真、廖國盟、黃百婉、翁祖輝、楊泮池、陳建仁
  Hui-Chen Wu, Kuo-Meng Liao, Pai-Wan Hung, Tsu-Huei Weng, Pang-Chr Yang, Chien-Jen Chen
• 肺腺癌 ； DNA修補基因
  ?female lung adenocarcinoma?;?tobacco smoking?;?cooking fume?;?DNA repair enzyme
• 目的：本研究在探討台灣北部地區女性肺腺癌與環境暴露和DNA修補酵素基因多形性的相關性，同時探討DNA修補酵素基因多形性與環境因子的交互作用對女性肺腺癌的影響。方法：本病例對照研究自臺大醫院選取107名女性肺腺癌病例和263名健康檢查對照個案為研究對象，以結構式問卷進行環境危險因子之訪問，DNA修補酵素基因多形性是以聚合酵素鍊鎖反應為基礎的方法進行限制酵素片段長度多行性分析。結果：控制年齡與受教育年數後，曾暴露於菸煙者罹患肺腺癌的危險對比值為未曾暴露者的1.73倍、曾暴露於未裝設排油煙機之廚房油煙者的危險對比值為未曾暴露者的2.42倍、曾使用木炭或煤炭為烹飪燃料者的危險對比值為使用電或瓦斯者的2.70倍、曾使用動物油烹飪者的危險對比值為使用值物油者的2.88倍。DNA修補酵素XRCC1-399 Gln/Gln基因型的危險對比值為Arg/Arg或Arg/Gln基因型的2.31倍(95%信賴區間：1.12-4.76)，XRCC3-241Thr/Met基因型的危險對比值為Thr/Thr基因型的2.08倍(95%信賴區間：0.99-7.81)，XDP-751Lys/Gln或Gln/Gln基因型的危險對比值為Lys/Lys基因型的2.08倍(95%信賴區間：1.51-4.82)，hMLH1 GA或AA基因型的危險對比值為GG基因型的3.69倍(95%信賴區間：1.42-9.62)。結論：菸煙及油煙廚房暴露是女性肺腺癌的重要環境危險因子；DNA修補酵素XRCC1、XRCC3、XPD和hMLH1之基因多形性和肺腺癌的發生有密切相關，菸煙及廚房油煙暴露和DNA修補酵素多形性基因，對女肺腺癌之發生有加成協同作用。
  Objective:This case-control study was carried out to investigate the association of female lung adenocarcinoma with environmental risk factors and genetic polymorphisms of DNA repair enzymes, and to assess the effect of gene-environment interaction on the disease. Methods: A total of 107 female patients affected with lung adenocarcinoma and 263 healthy controls were recruited serially from National Taiwan University Hospital. History of exposures to environmental risk factors was obtained through personal interview using on a structured Questionnaire, Genetic polymorphisms of DNA repair enzymes were determined by polymerase chain reaction with restriction fragment length polymorphism. Results: After adjustment for age and schooling Years. The odds ratio of developing .adenocarcinoma was 1.73 for exposures to tobacco smoking, 2.42 for exposures to cooking fume in unventilated kitchen, 2.70 for using coal and charcoal as cooking fuel, and 2.88 for using lard as cooking oil. The multivariate-adjusted odds ratio of developing lung adenocarcinoma was 2.31 (95% CI: 1.12-4.76) for XRCCl Gln/Gln genotype compared with Arg/Arg or Arg/Gln genotypes, 2.08(95%CI:0.99-7.81) for XRCC3 Thr/Met genotypes compared with Thr/Thr genotype,2.70(95%CI:1.42-9.62)for XPD Lys/Gln or Gln/Gln genotypes compared with Lys/Lys genotype, and 3.69 (95%CI: 1.42-9.62) for hMLHl GA or AA genotypes compared with GG genotype. Conclusions: Exposures to tobaccosmoking, and cooking fumes were important environmental risk factors for female lung adenocarcinoma. The genetic polymorphisms o DNA repair enzymes including XRCC1,XRCC3,SPD and Hmlh1 were associated with an increased risk of the disease.
• 357 - 364
• 10.6288/TJPH2001-20-05-04

• Link 原著 Original Article
• 不同飲水砷濃度居民脂蛋白元E基因多形性與頸動脈粥狀硬化相關性研究A Study on the Association Between Carotid Atherosclerosis and Genetic Polymorphisms of Apolipoprotein E Among Various Arsenic Exposure People
• 周怡利、 邱淑媞、薛玉梅、邱弘毅、陳建仁
  Yi-Li Chou, Shu-Ti Chiou, Yu-Mei Hsueh, Hung-Yi Chiou, Chien-Jen Chen
• 無機砷 ； 頸動脈粥狀硬化 ； 脂蛋白元E
  inorganic arsenic ; atherosclerosis ; apolipoprotein E
• 目標：過去的研究中，無機砷除了會引起癌症，也會引起如糖尿病、高血壓、心血管與腦血管疾病。因此，本研究的目的係為探討不同飲水砷濃度居民脂蛋白元Ｅ基因多形性與罹患頸動脈粥狀硬化的相關性。方法：在蘭陽盆地選取不同飲水砷濃度居民為研究對象，共有304名個案，其中包括157位頸動脈粥狀硬化病人及147位健康個案。研究中對許多與頸動脈粥狀硬化有關之危險因子做探討，如：井水含砷濃度、血清中脂質濃度等。實驗部分利用聚合?連鎖反應(Polymerase Chain Reaction,PCR)和限制片段長度多形性(Restriction Fragment Length polymorphism,RELP)分析脂蛋白元Ｅ基因型分佈情形。資料分析使用對數迴歸分析，包含危險對比值及95％信賴區間。結果：研究結果發現，高血壓在高砷濃度組罹患頸動脈粥狀硬化的危險性(2.13倍，1.04-4.32)比低砷暴露組低(11.47倍,1.37-95.83)，均達統計上顯著意義。另外在低砷暴露組的脂蛋白元Ｅ基因型的不同，罹患頸動脈粥狀硬化的危險性也不同，但在高砷露組看不出此結果。結論：脂蛋白元Ｅ基因對頸動脈粥狀硬化在低砷暴露仍與一般族群模式相同，當有高砷介入後其基因所貢獻的效果則被砷所修飾。
  Objectives: Arsenic exposure has been reported to induce not only cancers but also many vascular diseases including ischemic heart diseases, cerebrovascular diseases, peripheral vascular diseases, diabetes mellitus, and hypertension. The study aimed at investigating the association between genetic polymorphisms of apolipoprotein E and carotid atherosclerosis among people with different arsenic exposure levels. Methods: A total of 304 study subjects including 157 atherosclerosis patients and 147 healthy controls were recruited from the residents of Lanyang Basin. The carotid atherosclerosis was examined by Doppler ultrasonography and genetic polymorphisms of apolipoprotein E were determined by PCR-RFLP. Logistic regression model was used to obtain odds ratio and the 95% confidence interval for the association between carotid atherosclerosis and genetic polymorphism of apolipoprotain. Results: The data showed that lower risk of developing carotid atherosclerosis was associated with hypertension in high-arsenic exposed group than in low-arsenic exposed group (2.13, 1.04-4.32 V.S. 11.47, 1.37-95.83). Different apolipoprotein E (3/4, 4/4) genotypes have different risk of developing carotid atherosclerosis was observed in low-arsenic exposed group but not in high-arsenic exposed group. Conclusions: Higher risk of developing carotid atherosclerosis was associated with hypertension in low-arsenic exposed group than in high-arsenic exposed group. The higher risk of carotid atherosclerosis for study subjects without e2 genotype of apolipoprotein were observed in low-arsenic exposed group than those in high-arsenic exposed group.
• 365 - 371
• 10.6288/TJPH2001-20-05-05

• Link 原著 Original Article
• 中學生支氣管過度反應與過敏及呼吸道症狀之關係Relation Beteen Bronchial Hyperresponsiveness,Atopy ,and Asthmatic Symptoms in Adolescents
• 陳迺聖、 蕭光明、周碧瑟、黃嵩立
  Nan-Shen Chen, Guang-Ming Shiao, Pesus Chou, Song-Lih Huang
• 過敏 ； 支氣管過度敏感 ； 氣喘 ； 肺功能
  atopy ; bronchial hyperresponsiveness ; asthma ; pulmonary function
• 目標：瞭解支氣管過度反應(bronchial hyperresponsiveness, BHR)在流行病學調查所代表的意義。方法：以台灣及金門地區的七所國中國二學生為研究對象，總抽樣人數為2211人，2173人(98.3%)完成呼吸道健康問卷，其中1403人(64.6%)完成過敏原皮膚測驗、肺功能檢查及支氣管誘發試驗等檢查；一年後再以問卷追蹤，共1934年完成問卷。結果：過敏體質的盛行率在不同學校間有顯著差異，以城市中的學校較高；在各校皆以塵?為最主要之過敏原。BHR(定義為讓用力呼氣一秒量減少20％之甲醯膽鹼濃度PC20≦10 mg/ml)的盛行率約為16.5%，男女之間沒有差異。對塵?過敏反應愈強者，其BHR及氣喘症狀之盛行率愈高。具BHR者，其過敏體質、氣喘症狀、氣喘家族史之盛行率皆高於不具BHR者一年後的追蹤發現，其發生呼吸道症狀的機會高於正常人(OR=3.0, 95%CI=1.2~7.6)。結論：具有BHR者其過敏體質及氣喘症狀比例較高，且肺功能較低。無呼吸道症狀BHR者經過一年後，產生呼吸道症狀的機會略高於正常人。
  Objectives: To clarify the significance of bronchial hyperresponsiveness (BHR) observed in epidemiological surveys. Methods: The survey included eighth grade students in seven junior high schools in Northern Taiwan and Kinmen. A total of 2211 were sampled; 2173 (98.3%) completed respiratory questionnaire, among them 1403 (64.6%) completed skin prick test, pulmonary function test, and methacholine provocation test. One year later, 1934 completed a follow-up questionnaire. Results: The prevalence of atopy was Significantly different among schools, with the school in urban area being the highest. The prevalence of BHR (defined as PC20?10 mg/ml methacholine) was 16.5%, with no significant difference between genders. BRR and asthmatic symptoms was significantly associated with skin reactivity to mite allergens. Those with BHR were more likely to be atopic, to have asthmatic symptoms, and to have a family history of asthma. Subjects with more reactive airways (PC2020?5 mg/ml) had lower pulmonary functions. The survey one year later found that those with asymptomatic BHR were more likely to develop asthmatic symptoms (OR=3.0, 95%CI=1.2-7.6). Conclusions: BRR was associated with atopy, asthmatic symptoms, and lower pulmonary functions. Those with asymptomatic BHR are more likely to develop asthmatic symptoms compared with normal individuals.
• 372 - 380
• 10.6288/TJPH2001-20-05-06

• Link 原著 Original Article
• 長期照護機構選擇屬性之研究-以知覺風險為市場區隔基礎The Choice Attributes for Long Term Care Facility-Market Segmentation Based on Perceived Risk
• 羅萱、楊美雪、邵文逸
  Hsuan Lo, Meei-Shieu Yang, Wen-Yi Shau
• 知覺風險 ； 市場區隔 ； 選擇屬性
  perceived risk ; market segmentation ; choice attributes
• 目標：本研究旨在利用知覺風險程度為市埸區隔基礎，比較各區隔市場的老人評估長期照護機構的選擇決策屬性之差異，並進一步瞭解各區隔老人對機構式照護的知識程度及使用服務的意願。方法：便利抽樣選取高雄市及嘉義市之長青學苑學員為調查對象，測量工具為自填式問卷，總回收問卷1024份(有效問卷共871份)，其中高雄長青學苑672份、嘉義市長青學苑199份。研究分析方法，首先依知覺風險程度之變項將樣本分為高、中、低三個區隔市場，再利用判別分析比較三個知覺風險集群的老人選擇長期照護機構時所偏好的決策屬性，並描繪各區隔市場之選擇屬性偏好知覺圖。結果：第一、與其他兩組比較，低知覺風險集群較偏好以「機構形象因素」、「便利性因素」及「照護品質因素」等屬性來評估機構品質好壞；而此群自認對機構式長期照護服務瞭解程度較高，並且對使用機構式照護的意願較高。第二、與其他兩組比較，中等知覺風險集群較偏好「醫療專業護照服務因素」及「尊重與安全的照護環境因素」等屬性來評估機構品質好壞；而此群自認對機構式長期照護服務瞭解程度較高，但使用機構式照護的意願較低。第三、與低知覺風險集群比較，高知覺風險集群較不以機構形象因素及便利性因素等屬性來評估機構品質好壞；而此群自認對機構式長期照護服務瞭解程度較低，而且使用機構式照護的意願也較低。結論：長期照護機構提供者可利用知覺風險程度為市場區隔的基礎，並針對不同區隔市場之選擇屬性的偏好與特色，發展不同的行銷組合策略。
  Objectives: This study aimed to explore the choice attributes, service knowledge and the intention of service utilization of long-term care consumers among the different market segments that were grouped by level of perceived risk. Methods: With convenience sampling, self-administered questionnaires were distributed to 1024 program learners of the Kaohsiung and Chiayi. Municipal Senior Citizen Services Center. The 871 respondents were available. The differences in choice attributes among different market segments were analyzed by discriminant analysis and then depicted by a perception map of choice attributes. Results: This study found that the institutional image attribute, convenience attribute and quality attribute were the three most favored choice attributes of the low-perceived risk segment, taking precedence over the middle- and high-perceived risk segments. Besides this, the low-perceived risk segment possessed a higher subjective service knowledge of long-term care of the three segments and expressed a strong intention to utilize institutional long-term care. However, the middle-perceived risk segment preferred to use the professional-service component attribute as well as the esteem-and-safety environment attribute for evaluation of long-term care institutions. Although the middle-perceived risk segment had the highest subjective service knowledge of long-term care among the three segments, they had the least intention to utilize institutional long-term care service. Furthermore, this result veiled that unlike the low-perceived risk segment, institutional image attribute, convenience attribute and quality attribute were not the best choice for the high-perceived risk segment in evaluating long-term care institutions. As to the subjective service knowledge and utilization intention of long-term care attributes, the high-perceived risk segment was less than the low-perceived risk segment. Conclusions: From our results, we suggested that the long-term care providers should develop an appropriate marketing mix strategy commensurate with the choice attributes of the specific market segment to attract potential consumers.
• 381 - 394
• 10.6288/TJPH2001-20-05-07

• Link 原著 Original Article
• 醫藥分業政策推行對藥師專業的影響The impacts of the implementation of the policy toward the separation of drug dispensing from medical practice on the pharmaceutical profession
• 謝文紘、 陳美霞
  Wen-Horng Hsieh, Meei-Shia Chen
• 衛生政策 ； 醫藥分業 ； 藥局 ； 藥學專業 ； 專業化
  health policy ; the policy on the separation of drug dispensing from medical practice ; pharmacy ; pharmaceutical profession ; professionalization
• 目的：本研究分析台灣醫藥分業政策內容轉變及其對藥學專業的影響。方法：我們使用三種資料來源，包括：醫藥分業政策相關之二手資料、台南縣醫藥分業社會調查、及深度訪談。結果：醫樂分業政策原先的規劃與最終實施的內容有重大轉變：(1)單軌制(診所中不聘請藥師從事調劑業務)轉變為雙軌制(診所可聘請藥師調劑)；(2)除在無藥事人員或偏遠地區外全國全面實施轉變為診所與藥局數比例達三比一地區先實施；(3)放寬醫療急迫之定義而擴展醫師調劑權的範圍。台南縣社會調查結果顯示，大多數藥師(生)(71.2%)贊成實施醫藥分業，但卻有一半以上(54.7%)的樂師(生)反對醫藥分業中雙軌制的作法，且自行開業的藥師(生)有最高的比例(67.8%)反對現行雙軌制作法。我們的深度訪談顯現，雙軌制政策的實施使大部分藥局收入降低，且對藥局經營及藥師專業有負面的影響，甚至導至「去專業化」的現象。結論：醫藥分業政策最終實施內容與原始規劃有很大的不同，這種政策轉變使得衛生署當初醫藥分業的目標－藥學專業地位的增進及社區藥局功能的健全－無法充分實現。
  Objectives: We analyze the changes of the policy toward the separation of drug dispensing from medical practice and their Impacts on the pharmaceutical profession. Methods: We use three Sources of data, including secondary data on the policy toward the separation of drug dispensing from medical practice, the social survey of the pharmacists and physicians in Tainan county, and in-depth interviews. Results: There are great differences between the original design and the final in-depth interviews. Results: There are great differences between the original design and the final contents of the policy toward the separation of drug dispensing from medical practice. Major changes include (l) that from a “single track” system (the clinics not allowed to dispense drugs by hiring a pharmacist) to a “double track” system (the clinics allowed to dispense drugs by hiring “a pharmacist); (2) that from the implementation of the policy in the whole nation except the rural areas without pharmacists to only in those areas with the clinics/pharmacy ratio of 3 to 1; and (3) that of expanding the scope of medical emergencies in which the physician can dispense drugs. Our survey indicates that, although majority (71.2%) of the pharmacists in Tainan county support the policy on the separation of drug dispensing from medical practice, more than half (54.7%) disagree with the “double track” system. The pharmacists who own the pharmacy in the community have the greatest proportion (67.8%) opposing the “double track” system. Our in-depth interviews indicate that the implementation of the “double track” system led to the decline of the income of the community pharmacies and had negative impacts on the management of the community pharmacies and the pharmaceutical profession as a whole, leading to the “de-professionalmunity pharmacies and the pharmaceutical profession as a whole, leading to the “de-professionalization” of the pharmaceutical profession. .Conclusions: The above policy changes result in the failure of the Ministry of Public Health to fully meet the objectives of the policy – the promotion of the status of the pharmaceutical profession and the function of the community pharmacy.
• 395 - 411
• 10.6288/TJPH2001-20-05-08