25卷6期

• Link 綜論 Review Article
• 我國參與全球衛生體系策略之探討：以世界衛生組織及亞太經濟合作會議為例An Investigation of Taiwan's Participation in the Global Health System: The World Health Organization and Asia-Pacific Economic Cooperation
• 邱亞文、李明亮
  Ya-Wen Chiu, Ming-Liang Lee
• 世界衛生組織 ； 嚴重急性呼吸道症候群SARS ； 禽流感 ； 國際衛生合作 ； 亞太經濟合作會議
  World Health Organization WHO ; Severe Acute Respiratory Syndrome SARS ; Avian Influenza ; International health cooperation ; Asia-Pacific Economic Cooperation APEC
• 近年來新興傳染病如SARS的爆發及禽流感可能帶來的威脅，造成全球衛生安全及經濟的衝擊，使得衛生議題備受國際關注。世界衛生組織在2006年所發佈的「開發中國家之疾病控制優先項目」一書中指出，新興傳染病的大流行及其準備工作是當前人類衛生政策面臨的四大核心挑戰之一。隨著禽流感的威脅昇高，世界衛生組織在這場全球傳染病戰役中扮演關鍵的指揮整合角色。然而台灣自1972年後就不再是世界衛生組織會員，多年來使得我國無法及時獲得最新的醫療資訊與協助，台灣各項醫療成就與發展亦無法分享各國，然而現今局勢已不容我國自外於全球防疫網，因此研擬如何爭取加入國際衛生合作與防疫機制之策略成為當務之急。本文首先回顧歷年我國所參與的政府間國際衛生相關組織與活動，以世界衛生組織與亞太經濟合作會議為主軸，並針對近年我國之策略、國際的相關支持及困境加以探討。本文也針對此兩大新興傳染病對全球防疫備戰之國際局勢，及其對我國重回世界衛生組織之影響進行觀察與剖析，並提出我國短、中、長期之因應策略。
  The outbreaks of emerging infectious diseases, such as SARS and avian influenza, seriously impact national security and global economy, causing international organizations to pay close attention to health issues. Disease Control Priorities in Developing Countries, published by the WHO in 2006, clearly states that preparation for emerging diseases and the influenza pandemic is one of the four principle challenges in contemporary human health policies.As the threat of avian influenza increases, the WHO acts as a key coordinator in controlling global infectious diseases. Because Taiwan has not been a member of the WHO since 1972, Taiwan is not able to obtain the latest medical information and assistance, nor is able to contribute its medical achievements at the international level. The current international situation is such that Taiwan is not allowed to actively participate in the global epidemic prevention network. It should be the top priority for the government of Taiwan to formulate workable strategies to join the international health cooperative network.The current study reviews international government's health-related organizations, mainly the WHO and APEC, and Taiwan's participation in international health over the years. We also reviewed Taiwan's strategies, challenges, and international support in recent years.Finally, this article describes and analyzes the current status of the global epidemic prevention effort, especially with respect to the two aforementioned emerging infectious diseases, and discusses their influence on Taiwan's participation in the WHO. We thus propose some short- and long-term strategies for the government of Taiwan in the years to come.
• 405 - 418
• 10.6288/TJPH2006-25-06-01

• Link 綜論 Review Article
• 正視女性飲酒問題：性別角度的初探Exploring the Alcohol Consumption Behavior of Women from a Gender Perspective
• 洪兆嘉、張珏
  Chao-Chia Hung, Chueh Chang
• 性別 ； 飲酒 ； 性別檢視
  gender ; alcohol ; gender perspective
• 飲酒一直被視為是與男性健康有關的健康問題，隨著社會變遷，女性的飲酒行為及飲酒問題增加，性別間飲酒行為的差距逐漸縮小，已受全球已開發國家重視。目前婦女與飲酒行為的相關文獻多著重於流行病學之盛行率的探討，較少由性別觀點分析社會及環境因素的影響。本文主要目的是回顧國內外有關婦女飲酒的相關文獻，由性別的觀點探討影響女性飲酒的可能原因。首先是討論生理性別及社會性別對婦女飲酒行為的影響，進一步討論婦女飲酒行為與負面情緒的因應、職場的性別不平等及社會行銷策略的關係。針對這些影響因素，作者建議應重視婦女飲酒行為與性別不平等之社會制度的關係。最後提出對女性飲酒問題之政策、研究及實務應用的建議。
  In the past, alcohol-related problems were considered to be an important health issue for men alone. However, the consumption of alcohol by women has increased and the gender convergence in alcohol consumption and alcohol-related problems has gradually gained recognition amongst developed countries. Previous research pertaining to alcohol consumption by women has focused mainly on descriptive epidemiology in prevalence studies, with little emphasis on social and environmental factors from a gender perspective. The aim of this article was to review the literature on the alcohol consumption behavior of women and to explore the basis for such behavior from a gender perspective. Accordingly, the effect of biological sex and sociological gender on women's consumption of alcohol is discussed. The relationship between women's alcohol consumption and coping with negative emotions is also explored. How gender inequality in the workplace and the social marketing of alcohol affect a women's alcohol consumption is addressed. The results suggest that the relationship between a women's consumption of alcohol and the social institution of gender inequality should receive greater attention. Finally, the implications of these findings for future policy, research, and practice are discussed.
• 419 - 429
• 10.6288/TJPH2006-25-06-02

• Link 原著 Original Article
• 運用決策樹技術探討急診病患醫療費用之消耗Utilization of a Decision Tree for High Expenditure Patients in the Emergency Department
• 周歆凱、蘇喜、黃興進、蔡明足、翁林仲
  Hsin-Kai Chou, Syi Su, Hsin-Ginn Hwang, Ming-Tsu Tsai, Lin-Chung Woung
• 急診醫學 ； 資料探勘 ； 決策樹
  Emergency Medicine ; Data Mining ; Decision Tree
• 目標：傳統上，決策樹之分類技術在市場上多運用於顧客資料的區隔分析。然而，本研究也應用該工具來探討急診病患醫療費用之耗用，期望從大量之費用資料庫中，探勘出病患屬性與其醫療費用消耗之潛在關係。方法：本研究收集某醫學中心急診室一年之病患就診資料，並利用資料探勘技術中之決策樹工具來觀察各醫療費用群（低費用組、一般費用組、高費用組）間之病患特質（人口學特質、就醫屬性）的分類；藉由分類規則的建立，可預測病人於就診時可能消耗之醫療費用多寡。結果：決策樹以多層次之樹枝分佈及顏色區塊等視覺化方式呈現研究結果；其中資訊增益順序為（滯留時間＞疾病分類＞離院後動向＞檢傷分級＞科別），該資訊增益之順序也代表屬性影響醫療費用分佈之程度，意即滯留時間為決定急診病色醫療費用多寡之首要因素。結論：本研究建議個案醫院能針對不同類型之病人，給予個人化的照護服務，期望改善病人再回診的情形、降低滯留急診的時間，同時也能降低病人於急診發生之醫療費用。
  Objective: Traditionally, classification via a decision tree has been primarily used to distinguish between types of customers. In the current study, however, a decision tree was used to track a patient's medical expenditures in the emergency department and determine the potential relationship between patient attributes and expenses, as derived from a large database maintained in the emergency department of the hospital. Method: Patient records were collected inform the emergency department of a medical center over the course of approximately one year and a decision tree was used to classify patient data based on the magnitude of medical expenses incurred (i.e., lower, average, or higher); in the future, we will be able to predict the potential medical expenditures of emergency department patients according to such a classification. Result: The decision tree consisted of multiple levels of branches and color blocks to present the output and the sequence of information gathered (e.g., length of stay>disease classification>mode of departure from the hospital>triage>medical specific) and reflected the degree to which the distribution of medical expenses were influenced. Conclusion: This research suggests that the hospital can supply professional and personal services to various patients who have some special needs; at the same time, the hospital also can reduce the number of patients that re-visit the emergency department within 72 hours or remain in the emergency department >24 hours, thereby decreasing the expenditures within the emergency department.
• 430 - 439
• 10.6288/TJPH2006-25-06-03

• Link 原著 Original Article
• 非營利醫院的負債融資與社區公益活動The Association of Debt Financing with Community Benefit Services Provided by Private, not-for-profit Hospitals in Taiwan
• 郭振雄、何怡澄、羅德城
  Jenn-Shyong Kuo, Yi-Cheng Ho, Der-Cherng Lo
• 非營利醫院 ； 社區公益活動 ； 負債融資
  private not-for-profit hospital ; community benefit services ; debt financing
• 目標：非營利醫院採用負債融通資金，影響其提供社區公益活動情況，本文採用台灣實證資料。方法：採用35家醫療財團法人2002年的資料為樣本，分析負債額度對醫院提供教育與研究活動、免費醫療活動，以及社區公益活動的影響，並控制醫院特性與市場情況。結果：迥歸分析顯示負債對免費醫療支出有排擠效果。結論：非營利醫院兼具商業與社會角色，當非營利醫院採用負債融通資金時，會排擠社區公益支出且降低其社會公益角色，故研究結果顯示短期的利潤目標與長期社區公益活動目標存在衝突，冉法透過負債解決經理人與社會大眾之期待的問題。
  Objective: To examine if debt financing imposes constraints on Taiwan's private, not-for-profit hospitals' capacity to deliver community benefit services. Method: By using data collected in 2002 through audited financial statements and surveys from 35 private, not-for-profits hospitals in Taiwan, this study investigated whether the extent of debt financing has an impact on education and research expenditures, uncompensated care service expenditures, and community benefit services offered by these hospitals. Result: Regression analysis data suggest that debt financing had a crowding-out effect on uncompensated care service. Conclusion: All private, not-for-profit hospitals have the mission to provide charity services, while making a profit. The results presented herein showed that debt financing of these hospitals decreased expenditures for community benefit services, thereby impairing their social mission. The conflict between the short-term goal of profit maximization and the long-term goal of community benefit services cannot be resolved by debt financing.
• 440 - 448
• 10.6288/TJPH2006-25-06-04

• Link 原著 Original Article
• 醫院品管圈的團隊結構與衝突處理行為Group Structure and Styles of Handling Conflict within the Quality Control Circles of Hospitals
• 劉佩芬、謝碧晴、蘇慧芳
  Pei-Fen Liu, Pi-Ching Hsieh, Hui-Fang Su
• 團隊合作規範 ； 團隊任務凝聚力 ； 團隊衝突 ； 團隊衝突處理行為 ； 品管圈
  group cooperation norms ; group task cohesion ; group conflict ; conflict handling styles ; quality circle
• 無
  Objectives: This study investigated the relationship between group structures (i.e., cooperation norms and task cohesion) and styles of handling conflict within the quality control circles (QCCs) of Taipei-area hospitals. Method: Utilizing a cross-sectional design with the distribution of questionnaires, a valid sample was collected which included 263 groups comprised of 1914 individuals from 16 hospitals. The instruments with acceptable Cronbach's alpha values, ranging from 0.70~0.92, were included in this study. Because of unit for group level analysis, the aggregated individual level data in a single group were used as representative values of the group. The results of intra-class correlation coefficients, eta-square, and one-way analysis of variance indicated that the aggregated individual level data satisfactorily represented group level data. Four hypotheses were tested by regression analysis. Results: The response rate was 86.8%. After controlling for the variables of group size and times of QCC formation, cooperation norms (b=0.49, p<0.01) and task cohesion (b=0.10, p<0.05) together accounted for 58% of the variance in the ”integrating” style of handling conflict, while cooperation norms (b=-0.17, p<0.05) alone accounted for 15% of the variance in the ”dominating” style of handling conflict. ”Avoiding” and ”obliging” styles of handling conflict were not predicted by cooperation norms and task cohesion. Conclusions: The findings of the current study suggest that cooperation norms and task cohesion are good predictors of the ”integrating” and ”dominating” styles of handling conflict for the QCCs of hospitals. The results may thus be helpful for health care institutions seeking to improve the quality of in-service education, practice, and research.
• 449 - 461
• 10.6288/TJPH2006-25-06-05

• Link 原著 Original Article
• 成癮藥物使用情境脈絡與HIV感染關聯之初探Exploring the Pattern of Intravenous Drug Use in Relation to Infection with HIV
• 張嫚純、 丁志音
  Man-Chun Chang, Chih-Yin Lew-Ting
• 注射藥癮者 ； HIV感染 ； 次文化 ； 藥物濫用 ； 減害計畫
  IDUs ; HIV infection ; subculture ; substance abuse ; harm reduction
• 目標：探究成癮藥物使用者感染HIV的原因，以及導致其產生感染HIV高危險行為的因素。方法：自94年2月開始至94年12月，於某矯正機關內，針對成癮藥物使用者，透過典型與深入選樣、滾雪球、最大變異三種選樣方式，以深度訪談法以及焦點團體法進行資料收集，從鉅視、中視與微視面等三層次，歸納受訪者的共用藥物脈絡與經驗。結果：以藥癮者的觀點，詮釋其生活的樣貌，描繪出藥的吸引力、藥友間的網絡關係。接著勾勒出吸食與注射等用藥行為上的差異以及注射的情境脈絡，並分析共用稀釋液，共用針具、HIV知識缺乏等危險因子。再者諸如毒品政策的改變、新興災難的衝擊、人口及成癮藥物的跨國流動、與同志族群的互動等大環境事件，亦對藥癮者及其用藥模式造成影響。結論：藥癮文化的特色、藥友間盤根錯節的網絡關係，成為HIV防疫上的一大障礙，以「群」為單位的感染，為HIV感染通報人數戲劇性上升的原因。建議應充分運用藥癮者既已建構的緊密社會網絡，加強知識的宣導，而通盤全面的藥癮愛滋防治工作如減害計畫，更須要跨部會的合作方能達成。
  Objectives: The current study examined factors that contribute to the outbreak of HIV infection among the IDU population in Taiwan. Methods: Three sampling methods were used: 1) typical cases and intensity sampling, 2) snowball sampling, and 3) maximum variation sampling. Participants were recruited from a correctional facility located in the northwestern part of Taiwan between February and December 2005. Qualitative data were collected through both individual in-depth and focus group interviews. The context within which drug-sharing behavior was shaped was derived and delineated from the perspective of macro-, meso-, and micro-levels. Results: From an IDUs' point of view, their style of living was articulated, the attraction of the substance was emphasized, and the networking and relationships among peer IDUs was outlined. Then, the pattern of drug use was detailed. Particularly highlighted was the difference between inhaling and injecting drugs, and the context in which the injection of the addictive substance was carried out. IDU situations that pose a threat under the threat of infection with HIV were identified, including solvent-sharing, syringe- and needle-sharing, and deficiencies and misconceptions in knowledge regarding HIV/AIDS. Moreover, the impact of the macro-level forces on the IDUs and their drug use pattern was specified. The most significant points were the change of drug control policy, the attack of disasters such as SARS, the transnational drift of the population and drugs, and the contact with another high risk group such as MSM (men who have sex with men). Conclusions: The characteristic sub-culture of drug users and the intricate networks of IDUs constitute the most challenging barriers to HIV/AIDS control. The HIV infection in the past few years among the IDUs has dramatically turned out to be an outbreak due mainly to collective transmission, i.e., the spread of HIV was achieved through contagion between ”groups,” not individuals. It is suggested that we should utilize their unique and powerful networking to enhance their knowledge and skills in HIV/AIDS prevention. Comprehensive and effective HIV/IDU interventions, such as harm reduction, can only be achieved through inter-sector cooperation.
• 462 - 473
• 10.6288/TJPH2006-25-06-06

• Link 實務 Public Health Practice
• 產婦個人特質與妊娠狀況對新生兒體重的影響The Effects of Maternal Characteristics and Pregnancy Status on Birth Weights
• 王心妙、管中閔、 羅紀琼
  Sin-Miao Wang, Chung-Ming Kuan, Joan C. Lo
• 分量迴歸 ； 新生兒體重
  quantile regression ; birth weight
• 目標：本研究旨在以分量迥歸探討產婦個人特質與妊娠狀況對新生兒體重的影響。方法：研究資料為民國90年的出生證明檔與戶籍檔的串連。樣本的選取條件是：單胞胎、出生體重介於500~4800公克、妊娠週數介於20~42週、母親年齡介於10~50歲。以分量迥歸進行分析，並與最小平方法的結果相比較。結果：在控制母親妊娠週數之下，母親教育程度與婚姻狀況在每個分量下皆為不顯著的影響因素，母親年齡、病史、妊娠週數、新生兒性別則在每個分量下皆為顯著的因素。結論：當新生兒體重較高時，最小平方法可能會低估母親年齡、病史、新生兒性別的影響；當新生兒體重較低時，最小平方法則可能會高估這些因素的影響。
  Objective: To evaluate the effects of maternal characteristics and pregnancy status on birth weights. Methods: A merged file of birth certificates and household registration for 2001 in Taiwan was used. Samples with singleton births, birth weight between 500-4800 g, gestational age between 20-42 weeks, and maternal age between 10-50 years were included in the analysis. A quantile regression based on Koenker and Bassett (1978) was employed; the results were compared with those obtained by OLS. Results: After adjustment for confounding variables, gestational age, maternal education, and marital status were not significantly correlated with birth weight at any quantile. However, maternal age, maternal medical history, gestational age, and newborn sex were significantly correlated with birth weight at every quantile. Conclusions: When birth weight is expected to be high, OLS is likely to underestimate the impact of maternal age, maternal medical history, and newborn sex, but when birth weight is expected to be low, OLS is likely to overestimate the impact of these factors.
• 474 - 481
• 10.6288/TJPH2006-25-06-07