26卷5期

• Link 綜論 Review Article
• 病人及大眾對於醫師主動揭露醫療錯誤之看法－對實證文獻之回顧Views of Patients and the Public Regarding Physician Disclosure of Medical Errors-A Review of Empirical Literature
• 邱淑媞
  Shu-Ti Chiou
• 主動揭露 ； 醫療錯誤 ； 病人安全
  disclosure ; medical errors ; patient safety
• 主動揭露是處理醫療錯誤的重要環節，許多先進國家皆明訂醫師有主動揭露醫療錯誤之倫理義務，美國更列入醫院評鑑基準中。國內近年亦開始關注此一議題，但醫界仍存有相當疑慮。為瞭解病人、家屬或社會對醫師主動揭露醫療錯誤之看法以及釐清主動揭露與醫療訴訟或糾紛之間可能的關係，供醫界與醫療管理決策者參考，本研究檢索2006年7月前國內外內容涉及病人、家屬或民眾對醫療錯誤主動揭露之看法或反應之中、英文實證研究文獻，計找出以假設性狀況進行之調查或質性研究14篇，醫療訴訟或糾紛案件分析7篇，及以介入性案例報告2篇，納入回顧。研究發現，病人及大眾普遍期望一旦有醫療錯誤發生，醫師能在最短時間內主動揭露並提供詳盡訊息；以各種假設性狀況進行調查，在大多數情況下，有主動揭露時病人想要訴諸法律的比率顯著較未主動揭露者低，而錯誤的嚴重度、類型以及其他相關處置亦會影響病人的反應。訴訟案件分析發現最常見的訴求是希望類似事件不要再發生以及想獲得更多訊息釐清真相。美國Lexington榮民醫學中心與密西根大學醫療體系的經驗則顯示在推動主動揭露政策後醫療訴訟支出大幅降低。因此，主動揭露不僅是醫師倫理義務的一環，並可能有助於降低訴訟成本。建議國內應加速展開相關研究，並在醫院導入主動揭露系統過程進行更嚴謹的評估，建立適用於我國之模式。
  Disclosure is an important issue in handling medical errors. It is proclaimed as ethical obligation of physicians in many developed countries and is included in the accreditation standards by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in the U.S. Experts in Taiwan noticed this issue in recent years, but tremendous doubt of its necessity and effect still exists in medical society. Understanding the views of patients and the public regarding physician disclosure of medical errors and clarifying their potential impact on malpractice liability and the patient-physician relationship will provide needed information to assist with decision making in medical society and healthcare management. Data was gathered by comprehensively searching for empirical studies involving the views or response of patients, families, or the public towards disclosure of medical errors published in the English or Chinese language before 2006 July. We found and reviewed 14 surveys or qualitative studies using hypothetical scenarios, 7 studies which analyzed the causes of lawsuits or complaints, and 2 interventional case reports. It was found that patients and the public universally wanted the physicians to tell them the truth of everything as soon as possible once a medical error occurred. Under most hypothetical scenarios, patients had significantly lower intention to take legal action if the error was disclosed versus nondisclosure of the error. The severity and type of errors as well as other aspects of management after the events also affected patient response. Analysis of lawsuits and claims found that the most common reasons for action were to prevent similar events in the future or to get more information and explanation about the truth. Experiences from Lexington Veterans Affairs Medical Center and the University of Michigan Health System in the U.S. showed that implementing hospital-wide disclosure policy led to a significant reduction in their liability costs. We concluded that disclosing medical errors is not only an ethical obligation but also a way to reduce liability costs. To develop an appropriate model in Taiwan, we suggest that Taiwan should launch more investigations in this field and perform conscientious evaluations while introducing the disclosure system into hospitals.
• 339 - 352
• 10.6288/TJPH2007-26-05-01

• Link 綜論 Review Article
• 另一種流行趨勢－論成效計酬的趨勢與展望Just another Trend in Healthcare? A Perspective on Pay for Performance Programs
• 陳宗泰、鍾國彪、賴美淑
  Tsung-Tai Chen, Kuo-Piao Chung, Mei-Shu Lai
• 健康照護品質 ； 品質鴻溝 ； 論成效計酬 ； 支付制度設計
  healthcare quality ; quality gap ; pay for performance ; design of reimbursement method
• 歐美各國都面臨品質鴻溝的問題，主要的原因之一是因為過去的支付制度著重在成本／價格的競爭，而不是所謂品質/價值的競賽。在2000年後，歐美各國陸續推出論成效計酬(P4P)的支付制度企圖來解決前述的問題，然而在實務上的成效究竟如何？是否又只是另一股熱潮而已？本篇回顧的目的包含檢視國內外的P4P研究是否提供有效品質改善的證據？國外知名機構等所建議P4P制度設計的原則為何？要考量哪些設計上的兩難？實施後可能有哪些非預期的結果？最後提出國內P4P發展與研究的參考。本篇回顧結論包括，P4P仍缺乏充足且相關的研究、P4P制度最重要在於誘因及測量系統設計，但仍有些兩難尚待考慮，例如誘因量要大或小、要獎勵改善(improvement)或是獎勵成效(performance)，同時一些非預期的結果（例如gaming現象）要先預防。正當英、美如火如荼的試行P4P，並展開評估研究時，我們應截長補短，取法與借鏡歐美各國的經驗，以搭上這股風潮來帶動品質的提升。
  Many developed countries face problems related to gaps in quality of care. One reason is that past reimbursement schemes focused on a cost/price proposition, not a quality/value proposition. Since 2000, governments in North America, Europe and Australia have launched pay for performance (P4P) initiatives in an attempt to solve gaps in the quality of care. Objectives: This paper addresses several pertinent questions: 1) Does pay for performance really work? 2) Is P4P just another trend in healthcare? 3) Is there empirical evidence to prove the effectiveness of P4P on quality improvement? 4) What principles should be considered in designing a P4P system? 5) What are the unintended consequences after implementation? We conducted a literature review to address the questions posed about pay for performance, and developed a theoretical framework to assist researchers interested in studying P4P issues and programs. Major findings validate several pertinent points. The effectiveness of P4P is still lacking sufficient empirical support, and the development of performance measures and incentives is a major concern in designing a P4P system. Several problems were identified related to sources of money to pay for programs, and whether programs should encourage quality improvement or performance excellence. The prevention of unintended consequences, such as gaming the system to increase payment, is essential. Currently many countries are simultaneously implementing P4P, and conducting evaluations of its effectiveness. Incorporating available knowledge and experiences from a variety of sources may be an effective strategy to enhance the quality of care in Taiwan.
• 353 - 370
• 10.6288/TJPH2007-26-05-02

• Link 原著 Original Article
• 聯盟網絡之聯盟型態、產業與區域特質對醫院創新的影響Analyzing the Impact of Alliance Pattern, Partner Industry, and Partner Location of an Alliance Network on Hospital Innovation in Taiwan
• 翁瑞宏、黃靖媛、黃金安、蔡文正
  Rhay-Hung Weng, Ching-Yuan Huang, Jin-An Huang, Wen-Chen Tsai
• 策略聯盟 ； 醫院創新 ； 聯盟網絡 ； 組織創新
  Strategic Alliance ; Hospital Innovation ; Alliance Network ; Organizational Innovation
• 目標：探討現今台灣醫院聯盟網絡特質，並分析聯盟網絡之聯盟型態、產業與區域特質對醫院組織創新的影響。方法：以郵寄問卷方式，針對全國460家地區醫院級以上醫院之高階主管或聯盟管理者進行問卷調查，有效問卷回收率為35.45%，在檢驗樣本代表性、無反應偏差、共同方法變異與問卷信效度後，以階層迴歸進行驗證。結果：國內醫院有進行策略聯盟的醫院比率為85.18%，平均策略聯盟網絡規模為21.42家，醫院聯盟網絡不論在型態、產業與區域特質上皆具有相當的多元性，在這三種多元特質中，聯盟網絡型態多元性與地區多元性並無法對組織創新產生影響，而聯盟網絡產業多元性對管理創新乃是呈現倒U型的關係，然對醫院的技術創新卻呈現正向的直線影響。結論：醫院的聯盟網絡已相當多元，而在探討的網絡特質中，又以聯盟網絡產業多元性對於醫院創新的影響較為顯著，且此影響對管理創新與技術創新所發揮的效果是有所差異的。
  Objectives: We placed our emphasis on exploring the characteristics of an alliance network and analyzing the impact of alliance pattern, partner industry, and partner location of an alliance network on the organizational innovation in Taiwanese hospitals. Methods: A self-administered mail survey was used to collect data. Questionnaires were sent to the top managers or alliance managers of 460 hospitals accredited as district hospitals and above. The valid return rate was 35.45%. After testing sample representativeness, non-response error, common method variance, questionnaire reliability, and questionnaire validity, we adopted a hierarchical multiple regression to analyze our research data. Results: The rate of alliance formation of Taiwanese hospitals has reached 35.45% and the average network size of strategic alliances is 21.42. Alliance pattern, partner industry, and partner location has become much more diverse. With respect to these three characteristics of diversity, the pattern diversity and the location diversity of an alliance network had no significant impact on the organizational innovation of hospitals. However, the industry diversity of an alliance network affected technological innovation linearly, but the relationship between this diversity and management innovation exhibited an inverse-U curve. Conclusions: The alliance network of hospitals has become much more diverse. In regards to several network characteristics, the industry diversity of an alliance network affects hospital innovation most significantly and has a different impact on management and technological innovation.
• 371 - 385
• 10.6288/TJPH2007-26-05-03

• Link 原著 Original Article
• 從分析運動熱量談當前台灣全民運動政策－比較台灣與美國民眾的運動習慣、強度與頻率Evaluating the Physical Activity Policy in Taiwan: Comparison of the Prevalence of Physical Activity between Taiwan and the U.S.
• 溫啟邦、衛沛文、詹惠婷、詹益辰、江博煌、鄭丁元
  Chi-Pang Wen, Jackson Pui-Man Wai, Hui-Ting Chan, Yi-Chen Chan, Po-Hwang Chiang, Ting-Yuan Cheng
• 運動 ； 運動熱量 ； 盛行率 ； 代謝當量值
  Leisure time physical activity ; Energy Expenditure ; Prevalence ; MET metabolic equivalent task
• 目標：台灣缺乏深度分析民眾運動習慣之文獻，本研究以相同分析方法比較台灣與美國的運動習慣。方法：利用台灣國民健康訪視調查(NHIS 2001)及美國國民健康與營養調查(NHANES 1999-2002)，將運動時間、強度與頻率轉換為個人熱量消耗(MET)作分析比較。結果：台灣民眾有半數自認不運動，是美國人的2.5倍。以每週達1,000 kcal之運動熱量為標準，美國是台灣的2.5倍。青壯年族群（25-44歲）美國達到標準的有34.3%，是台灣的3-7倍。高教育美國人達標準的有40.2%，是台灣的2.5倍。運動盛行率在美國年輕人最高，隨年齡增加而遞減，但在台灣則呈現『U』字形現象，在老年（≥65歲）達最高峰。有運動（每週≥1,000 kcal）的美國人每天運動40分鐘，每週消耗1,083 kcal（每天155 kcal）（中位數），而台灣人只有20分鐘，每週消耗544 kcal（每天78 kcal），女生比男生又少1/3。結論：台灣民眾普遍不運動，一半人自稱沒有運動，運動習慣不到美國的一半，6/7人口運動不足。最嚴重問題出現在青壯年、高教育、高收入族群，而且即使有運動的少數，他們運動強度及熱量消耗也明顯偏低不足。建議有關單位以鼓勵民眾運動為當前急務，以每週運動熱量至少達750 kcal為全民運動新目標，以「日行萬步」來互勉，將可大幅提昇健康，也可減少健保可觀的支出。
  Objectives: In assessing the adequacy of leisure time physical activity (LTPA) in Taiwan, a cross-country comparison is an important approach. Using the same methodology, the prevalence of LTPA was compared between Taiwan and the U.S. Methods: The metabolic equivalent (MET), a unit of exercise intensity, or calories was assigned to each LTPA reported in the NHIS 2001 (Taiwan) and the NHANES 1999-2002 (U.S.), each consisting of nationally representative samples of the respective country. Results: More than one-half of the population in Taiwan (50.2%) reported no LTPA, 2.5 times more than in the U.S. (21.3%). The proportion reaching 1,000 kcal/week in the U.S. (31.7%) was 2.5 times that in Taiwan (13.9%), but among the young adult group (25-44 yrs of age), Americans (34.3%) had 4 times more LPTA reaching 1,000 kcal/week than Taiwanese (8.5%). Among the highest educated, Americans (40.2%) were 2.5 times more likely to reach the desired LPTA goal (i.e., 1000 kcal/week) than Taiwanese (16.6%). The prevalence of LTPA decreased with age in the U.S., but in Taiwan the prevalence peaked with the elders (65 yrs of age or older), with the prevalence curve showing a unique ”U” shape. Even among the physically active, the median daily LTPA energy expenditure for Americans was 155 kcal/day with 40 minutes of exercise per day, twice that of Taiwanese who expended 78 kcal/day and exercised 20 minutes/day. Conclusions: Taiwanese are deficient in LTPA in two ways: 1) few people exercise and 2) among the few who do exercise, energy expenditure is inadequate. Six out of seven adults in Taiwan fail to meet the minimal level of exercise recommended. The proportion who exercise in Taiwan was less than one-half that of Americans, but the most serious deficiency was found among the young adults (25-44 years of age), who are potentially productive, and the college-educated or the higher income group, who are potential role models. If the inactive Taiwanese could be encouraged to become more active through physician counseling, the health benefits would be substantial and significant savings would be realized in the medical expenditure by the National Health Insurance.
• 386 - 399
• 10.6288/TJPH2007-26-05-04

• Link 原著 Original Article
• 全民健保腹膜透析比血液透析省錢嗎？Is Peritoneal Dialysis Cheaper than Hemodialysis under National Health Insurance?
• 常逸平、錢慶文、楊耿如
  Yi-Ping Chang, Ching-Wen Chien, Keng-Ju Yang
• 血液透析 ； 腹膜透析 ； 透析費用 ； 察爾森合併症嚴重度指標
  Hemodialysis ; Peritoneal dialysis ; Dialysis cost ; Charlson Comobidity Index
• 無
  Objectives: To compare utilization of National Health Insurance (NHI) resources in terms of health expenses, including dialysis- and non-dialysis-related expenses, between hemodialysis (HD) and peritoneal dialysis (PD) patients. This study also analyzed the influence of different variables, such as gender, age, and disease severity, to two modalities of dialysis. Methods: This study was a retrospective study of new dialyzed patients and their health expenses between 2003 and 2005. Data were abstracted and analyzed from the inpatient/outpatient claim databases of the NHI for 30 consecutive months. Results: Two thousand four hundred seven patients were included in this study; 1,069 (44.4%) were males and 1,338 (55.6%) were females. Two thousand one hundred eighty-nine patients (90.94%) were classified as the ”HD” group and two hundred eighteen patients (9.06%) were classified as the ”PD” group. Most patients belonged to the 45-64 age group (46.28% of the total sample). The average Charlson Index was 5.06. The average individual outpatient dialysis expense in the PD group was NT$459,843/year and NT$618,306/year for the HD group. The average individual outpatient non-dialysis expense in the PD group was NT$47,388/year and NT$45,761/year for the HD group. The average individual inpatient dialysis expense in the PD group was NT$9,504/year and NT$18,981/year for the HD group. The average individual inpatient non-dialysis expense in the PD group was NT$ 37,531/year and NT$40,712/year for the HD group. Conclusions: The individual outpatient and inpatient dialysisrelated expenses of the PD group were significantly less expensive than the HD group (p<0.001). However, PD patients were younger and had milder disease severity than the HD patients. There were no significant differences in outpatient and inpatient No-ndialysis-related expenses between the PD and HD groups.
• 400 - 408
• 10.6288/TJPH2007-26-05-05

• Link 原著 Original Article
• 抽淡菸且認知淡菸較不影響健康者是否吸得更深或吸入肺中？Does the Perceived Safety of Light Cigarettes Make Smokers Inhale Deeper and Draw Smoke into Their Lungs?
• 李家銘、馬瑞杉、余德成、陳昇鴻
  Jie-Min Lee, Jui-Shan Ma, Te-Cheng Yu, Sheng-Hung Chen
• 淡菸 ； 低尼古丁／焦油 ； 安全認知 ； 吸更深 ； 吸入肺中
  Light cigarettes ; low nicotine/tar ; perception of safety ; inhaling more deeply ; drawing the smoke into the lungs
• 目標：本研究為進一步驗證認知淡菸較不影響健康對淡菸吸得更深或吸入肺中決策的影響。方法：建立抽淡菸吸得更深和吸入肺中之雙元普羅比模式(bivariate probit model)，使用「民國91年台灣地區國民健康促進知識、態度與行為調查」中1,900位淡菸吸菸者之社經背景與抽菸特性資料進行分析。結果：研究發現有43.1%的淡菸吸菸者認為抽淡菸較不影響身體健康。認知淡菸較不影響健康而對淡菸吸得更深及吸入肺中的比例分別為4.63%及81.22%。抽淡菸且認知淡菸較不影響健康者之年輕人、高中與大學或以上學歷者及重度吸菸者會增加淡菸吸得更深之機率，而年長者會增加淡菸吸入肺中的機率。結論：基於抽淡菸較不影響健康的認知下，抽淡菸者會增加將菸吸得更深或吸入肺中的機率。有鑑於此，政府在菸品管理政策上應禁止廠商使用淡菸、低焦油或其他可能使人誤認淡菸無害健康或危害輕微的文字及標示，以避免戒菸及重度上癮者視抽淡菸為減少健康傷害之短期策略。
  Objectives: This study sought to verify whether the erroneous assumption, smoking light cigarettes is relatively healthy and safe, makes light cigarette smokers inhale deeper and draw the smoke into their lungs. Methods: To establish a bivariate probit model of depth of inhalation and the prevalence of inhaling deeper and drawing the smoke into their lungs among light cigarette smokers, we analyzed the model by using socioeconomic background and smoking characteristic data from 1,900 light cigarette smokers in the ”Survey of the Health Promotion Knowledge, Attitudes, and Behavior of Taiwan Citizens,” which was conducted in 2002. Results: This study showed that 43.1% of the enrolled light cigarette smokers regarded ”light cigarettes” as less harmful to their health in comparison with regular cigarettes. Among those with the perception of light cigarettes being less harmful to health, 4.63% and 81.22% respondents tended to inhale deeper and draw the smoke into their lungs, respectively. Those who were younger, those with higher levels of education (at least high school graduates), and heavily addicted smokers tended to inhale deeper. The elderly population tended to draw the smoke into their lungs. Conclusions: With the perception of being less harmful to their health, light cigarette smokers tended to inhale deeper or draw the smoke into their lungs. The government's tobacco management policies should prohibit cigarette manufacturers from using ”light cigarettes,” ”low tar,” or other text or markings that may mislead people into believing that smoking light cigarettes is not hazardous or only a minor health risk. Taking this action may preclude heavily addicted smokers and smokers who want to quit from believing that smoking light cigarettes is a short-term strategy for reducing health hazards.
• 409 - 418
• 10.6288/TJPH2007-26-05-06

• Link 原著 Original Article
• 企業內安全衛生保護之勞工參與機制探析The Mechanisms of Workers' Participation and Their Problems in Occupational Health and Safety Protection in Taiwan
• 尤素芬、陳美霞
  Su-Fen You, Meei-Shia Chen
• 勞工參與 ； 職業安全衛生 ； 工會 ； 台灣
  workers' participation ; occupational health and safety ; trade union ; Taiwan
• 目標：西方與台灣有關勞工安全衛生保護的研究偏重技術層面的分析，欠缺對勞工參與層面的關注，為填補這個文獻的缺憾，本研究探討台灣職業健康保護的勞工參與機制，以及目前這些機制的侷限與問題。方法：從法律社會制度面出發，採用文獻及法律條文分析法，以「勞工參與」的概念為主軸，檢證目前制度中有關勞工參與職業安全衛生管理的機制，以及相關制度在規範設計面與制度執行面的問題。結果：目前台灣的職業安全衛生保護體系確實存在勞工參與機制，包括「工會」、「團體協商」、「勞資會議」、「勞工安全衛生工作守則」及「勞工安全衛生組織」五種制度，但是這個機制的落實卻有著種種的侷限與問題。結論：目前勞工參與安全衛生管理之機制難以發揮實質作用，未來需要從幾個面向加強這個機制。可能的做法包括：強化工會的力量、加強勞工界與職業醫學界的互動、與增強政府的角色功能。
  Objectives: Studies on the protection of workers' health and safety in Taiwan and the West address mostly technical issues, paying little attention to the aspect of workers' participation. To fill this literature gap, this study investigates the mechanisms through which workers participate in the protection of their own health and safety in the workplace in Taiwan. It also analyzes the problems and limitations of these mechanisms. Methods: This study is based on a literature analysis of the design and implementation of relevant laws and regulations Results: The current system of occupational health and safety protection does contain mechanisms through which workers may participate in the protection of their own health and safety. These mechanisms include the trade union, collective bargaining, the labor-management conference, the health and safety work rules, and the labor health and safety committee. However, these mechanisms have many limitations and problems. Conclusions: The mechanisms of workers' participation in occupational health and safety protection in Taiwan have limited impact and thus need to be strengthened. Possible strategies consist of empowering trade unions, increasing interactions between workers and occupational medicine experts, and strengthening the role of the government.
• 419 - 432
• 10.6288/TJPH2007-26-05-07

• Link 原著 Original Article
• 台灣中部地區運輸從業人員嚼食檳榔之職場相關因素調查The Workplace Relevant Factors of Betel Quid Chewing among Transportation Workers in Central Taiwan
• 莊淳宇、張傳馨、章珍珍
  Chun-Yu Chuang, Chuan-Hsin Chang, Chen-Chen Chang
• 嚼食檳榔 ； 盛行率 ； 職場相關因素 ； 運輸業
  betel quid chewing ; prevalence ; workplace relevant factors ; transportation workers
• 目標：本研究主要調查台灣中部地區運輸從業人員檳榔嚼食率，以及探討職場環境影響嚼食行為之相關因素。方法：本研究採橫斷性研究，以台灣地區嚼食檳榔盛行率最高之三個地區（彰化縣市、南投縣和雲林縣市）為研究地區，採分層隨機抽樣，有效問卷為698份，回收率約71.0%。結果：運輸業從業人員檳榔嚼食率22.0%，81.7%嚼食檳榔者亦有吸菸習慣。嚼食檳榔者認為與嚼食行為有關聯之職場因素－工作環境方面：「長途運輸」(81.1%)；工作性質和心理方面：「需要提神」(78.0%)、「工作時數長」(27.2%)、「壓力大、緊張」(26.4%)、「耗費體力」(17.3%)、「工作內容單調」(16.3%)等；工作危害因素：「長時間坐姿」(44.9%)和「重複性動作」(26.9%)會促使嚼食檳榔。邏輯式迴歸分析中發現嚼食檳榔者有喝酒習慣者和長時間坐姿，其嚼食檳榔之風險較高(OR=3.36, 95%CI=1.01-11.18; OR=5.31, 95%CI=1.67-24.15)。結論：運輸業從業人員中多數嚼食檳榔者亦有吸菸習慣，超過半數嚼食者會配合職場規定不吃檳榔，建議戒除嚼食檳榔之宣導活動可與戒菸活動並行，職場規定禁止嚼食檳榔和改善排班情形和調整工作內容，以降低檳榔嚼食率。
  Objectives: This study was to investigate the prevalence of betel quid chewing and workplace relevant factors among transportation workers in central Taiwan. Methods: A crosssectional survey was taken of residences in Changhua, Yunlin and Nantou, which have a higher prevalence of betel quid chewing in Taiwan. Six hundred ninety-eight transportation workers, recruited by a random stratified sampling, completed the interview (71.0%). Results: The prevalence of transportation workers' chewing was 22.0%, and 81.7% of betel quid chewers were also cigarette smokers. A survey of factors relevant to the workplace revealed that the chewing transportation workers sustain betel quid use because of long-distance transportation (81.1%), stimulation to counteract boredom (78.0%), long working hours (27.2%), demands of physical strength (17.3%), stress and tension (26.4%), and unchanging routine work (16.3%). The chewing transportation workers mentioned that prolonged sitting (44.9%) and repetitive action (26.9%) made them continue to chew betel quid. In logistic regression, betel quid chewers with a drinking habit and prolonged sitting had a higher risk to chew betel quid (OR=3.36, 95%CI=1.01-11.18; OR=5.31, 95%CI=1.67-24.15). Conclusions: Most of the betel quid chewing transportation workers were also cigarette smokers. Around half of the chewers can obey the workplace prohibition to abstain from chewing betel quid. Regarding the results in this study, it is recommended to promote the abstention of both betel quid chewing and cigarette smoking. For the workplace, it is recommended to prohibit betel quid chewing at the workplaces, and regulate the working time and working matters to reduce chewers to use betel quid.
• 433 - 442
• 10.6288/TJPH2007-26-05-08