27卷6期

• Link 綜論 Review Article
• 老人跌倒之預防介入策略Strategies for fall-prevention in Older People
• 林茂榮、黃慧芬
  Mau-Roung Lin, Hei-Fen Hwang
• 老人 ； 跌倒預防 ； 多因子介入 ； 運動 ； 太極拳
  older people ; falls prevention ; multifactorial intervention ; exercise ; tai chi
• 老人跌倒預防是全球公共衛生最重要議題之一。老人跌倒預防介入策略主要包括：跌倒風險評估、多重因子介入、運動訓練、調整用藥、改善環境、改善視力、補充維他命D與鈣、裝置心律調節器以及教育等。介入前應評估老人跌倒風險，對社區老人可使用簡易的步態平衡測試，對機構內（含安養院及醫院）老人可使用周全性跌倒風險評估。多重因子介入為同時減少跌倒多項危險因子，已被證明是最有效且可靠的跌倒預防方法，但人力與經濟成本也最高；平衡運動（如太極拳）不只降低跌倒發生且能同時獲得其他身心健康利益；減少老人精神異常治療用藥可大幅較低跌倒，但老人用藥習慣不易改變；環境改善介入適合過去曾跌倒的老人；白內障手術能減少大部分視力不良老人的跌倒；維他命D與鈣補充與髖部護具對機構內老人跌倒的減少有顯著效果；裝置心律調節器只適合極少數老人；教育無法顯著降低老人跌倒。最後，本文討論跌倒預防介入方法選擇、臨床人員角色、機構內跌倒預防與研究、跌倒相關教育、以及健康專業間結合等老人跌倒預防相關議題。
  Fall prevention in the elderly is one of the most important public health issues worldwide. Strategies for fall-prevention consist of fall-risk assessment, multifactorial interventions, exercise training, reduction in medications use, environmental modifications, vision improvement, vitamin D and calcium supplementation, cardiac pacing, and education. Before an intervention can be prescribed, a fall-risk assessment, including functional balance and mobility tests for the community-dwelling elderly and a more comprehensive battery of tests for the institutionalized and hospitalized elderly, needs to be conducted. Labor intensive and costly multifactorial interventions are the most effective and most consistent in reducing falls. Balance exercise programs, particularly tai chi, efficiently and effectively reduce falls and have other health-related benefits. Psychotropic medications can be reduced to prevent many falls, but it is difficult to change medication-taking behavior in the elderly. Changing the environment is an appropriate response in cases with a history of falls, and cataract surgery can reduce falls in those who are visually impaired. Vitamin D, calcium supplementation, and hip protectors are also effective for institutionalized elderly. Cardiac pacing can help only a few elderly people while educational programs are ineffective. Finally, fall-related issues (including selection of an appropriate strategy for prevention), role playing of clinicians, study of falls prevention in institutionalized and hospitalized elderly, fall-related education, and coordination of health care practices, are discussed in detail.
• 447 - 462
• 10.6288/TJPH2008-27-06-01

• Link 原著 Original Article
• 職場疲勞狀況與工作過度投入之相關因素：以台北市36家職場受僱員工為例Factors Associated with Workers' Burnout and "over-commitment to Work": A Survey among Employees of 36 Companies in Taipei City
• 葉婉榆、鄭雅文、陳美如、邱文祥
  Wan-Yu Yeh, Ya-Wen Cheng, Mei-Ju Chen, Allen Wen-Hsiang Chiu
• 疲勞 ； 工作投入 ； 量表 ； 工作壓力
   commitment to work ; inventory ; work stress
• 目標：探討受僱者的疲勞狀況與工作過度投入行為傾向之分佈與相關因素。方法：參考「哥本哈根疲勞量表」與「付出－回饋失衡模型」，發展職場疲勞量表，包括「個人疲勞」、「工作疲勞」、「服務對象疲勞」與「工作過度投入」四個面向；問卷也同時測量人口學（性別、年齡、婚姻與教育程度）與工作背景資料（職等、公司規模、工時、工作負荷、工作控制與就業不安定性）。調查對象為台北市36家職場共2891名男性與2704名女性受僱者，其中製造業佔41%，營造業佔7%，服務業佔52%。結果：應用複迴歸模型，控制個人、工作變項後，女性在「個人疲勞」(β=4.2)與「工作疲勞」(β=2.9)之得分顯著高於男性，「服務對象疲勞」(β=-3.2)得分顯著低於男性，而「工作過度投入」(β=0.1)則無顯著性別差異。在男女性中，年輕者的「個人」、「工作」、與「服務對象疲勞」得分均顯著高於年長者；但「工作過度投入」則以35~45歲青壯年族群的得分明顯高於35歲以下及45歲以上者。此外，每週工時54小時以上、工作負荷高、工作控制低、就業不安定性高者，在上述四個面向的得分均顯著較高。結論：本研究指出職場疲勞與工作過度投入的高危險族群，可作為職場健康介入策略之參考。
  Objectives: This study was designed to investigate the distribution and correlates of workers' burnout and ”over-commitment to work”. Methods: Burnout status was measured using revised items from the Copenhagen Burnout Inventory (CBI), which includes 3 subscales (personal burnout, work-related burnout, and client-related burnout). The scale measuring over-commitment to work was modified from Siegrist's Effort-Reward Imbalance Questionnaire (ERI-Q). Also collected were socio-demographic characteristics (sex, age, marital status, and education) and work-related factors (employment grade, company size, working hours, work demands, job control, and job insecurity). A total of 2891 male and 2704 female employees from 36 worksites in Taipei city participated in this survey. Among them, 41% was in manufacturing, 7% was in construction, and the remaining 52% in service sectors. Results: After controlling for demographic and work-related variables in regression analyses, women had significantly higher levels of personal burnout (ß=4.2) and work burnout (ß=2.9) but significantly lower levels of client burnout (ß=-3.2) and comparable levels of over-commitment to work (ß=0.1) compared to men. Among both sexes, younger employees had significantly higher levels of burnout in all three subscales; however, the middle-aged group (aged 35~45) reported the highest levels of over-commitment as compared to other age groups. Longer working hours (= 54 hours per week), higher psychological work demands, lower job control, and job insecurity were found to be positively associated with scores on all four subscales. Conclusions: This study identified groups at high risk for burnout and over-commitment to work and provided directions for health promotion strategies in the workplace.
• 463 - 477
• 10.6288/TJPH2008-27-06-02

• Link 原著 Original Article
• 公寓大廈地下停車場空氣品質之研究Air Quality in Underground Parking Lots of Condominium Buildings
• 林建隆、賴榮平、謝宏仁、林厚順
  Chien-Lung Lin, Rong-Ping Lai, Hung-Ren Hsieh, Hou-Shun Lin
• 公寓大廈 ； 地下停車場 ； 空氣品質
  condominium Buildings ; underground parking lots ; air quality
• 目標：公寓大廈地下停車場多為密閉型空間，導致污染物無法自然排出，造成空氣品質不良。因此，本研究以公寓大廈地下停車場為調查對象，探討空氣品質之現況及問題點，並且解析其空氣品質影響因素。方法：本研究針對台灣南部地區16棟（39個地下樓層）公寓大廈地下停車場進行污染物(CO、CO2、NO(下標 X)、PM10)量測及住戶問卷調查，並針對可能影響因素進行現況調查後，再利用SPSS統計軟體進行相關性檢定。結果：氣狀污染物濃度越往下樓層越高，尖峰時段每往下一層樓CO濃度提升2.1 ppm、CO2濃度提升21.0 ppm、NO(下標 X)濃度提升59.9 ppb，其中CO尖峰最大平均濃度26.1 ppm；NO(下標 X)尖峰最大平均濃度為743 ppb。有關滿意度調查顯示，住戶對地下停車場的綜合不滿意度為27%，其中以通風狀況不滿意度最高(37%)。結論：在公寓大廈地下室停車場污染物中以NO(下標 X)（平均濃度超過250 ppb為14棟(87.5%)）最為嚴重。另外，案例抽排風系統之效能不佳（平均效能下降至原設計值49%），造成地下停車場污染物無法有效排出。
  Objectives: Most underground parking lots for condominium buildings are closed spaces. The pollutants cannot be discharged naturally, resulting in poor air quality. This study investigated the air quality and pollution problems affecting the underground parking lots of condominium buildings, and analyzed the factors affecting air quality. Methods: Measurements of the pollutants CO, CO2, NO(subscript X), and PM10 were taken from the underground parking lots of 16 condominium buildings (39 floors) in southern Taiwan, a household questionnaire was given to users of these underground parking lots, and the status of probable affecting factors was investigated. A statistical analysis of the data was conducted with SPSS. Results: There was a higher concentration of gaseous pollutants at the lower floors. During peak traffic time, for every floor that was lower, the CO concentration increased by 2.1 ppm, the CO2 concentration increased by 21.0 ppm, and the NO(subscript X) concentration increased by 59.9 ppb. The maximal average peak CO concentration was 26.1 ppm; and that of NO(subscript X) was 743 ppb. A satisfaction survey showed that the overall dissatisfaction rate of residents toward the underground parking lot was 27%, with the ventilation earning the highest dissatisfaction rate (37%). Conclusions: Among the pollutants present in the underground parking lots of condominium buildings, NO(subscript X) (average concentration exceeding 250 ppb in 14 tested buildings (87.5%)) was the most severe. In addition, it was found that inferior performance of the air ventilation system in the buildings (average efficiency dropped to 49% of the original design value) led to the failure of effective discharging of underground parking lot pollutants.
• 478 - 495
• 10.6288/TJPH2008-27-06-03

• Link 原著 Original Article
• 以SARS經驗推估禽流感爆發對醫療利用可能影響之初探A Preliminary Analysis of the Possible Influence of H5N1 Influenza Outbreak on Medical utilization-experience from SARS Outbreaks
• 張琇珺、林恆慶、陳靖宜、陳楚杰
  Hsiu-Chun Chang, Herng-Ching Lin, Chin-Yi Chen, Chu-Chieh Chen
• 禽流感 ； 醫療利用 ； 嚴重急性呼吸道症候群
  H5N1 influenza ; medical utilization ; Severe Acute Respiratory Syndrome
• 目標：以嚴重急性呼吸道症候群(SARS)相關病患的醫療利用資料，推估禽流感人傳人疫情爆發時，不同侵襲率下的住院醫療利用及其相關因素。方法：運用國家衛生研究院發行之全民健康保險資料庫，選取與禽流感傳染毒力相似的366位SARS相關住院病患為研究對象。統計方法包括卡方檢定、獨立t檢定、變異數分析、複迴歸分析。結果：以同時考量是否院內死亡與病患年齡時所推估的住院費用總額為11.69億元至27.27億元最高，且以65歲（含）以上的老年人病患的總住院費用最高；其次，獨立影響住院費用的顯著相關因素有病患性別、是否院內死亡、醫院層級別、醫院權屬別及住院天數，且以區域醫院的住院費用最低；最後，獨立影響住院天數的顯著相關因素為就醫醫院層級別。結論：建議衛生主管機關事先制定相關衛生政策及規劃禽流感專責醫院時應以區域級醫院為優先考量，以降低老年人罹病之風險及減少醫療費用的支出。
  Objectives: This study calculated the hospital admission expenditures required for responding to different attack rates of pandemic H5N1 influenza, and explored the factors related to medical utilization that were required during Severe Acute Respiratory Syndrome (SARS) outbreaks. Methods: Records retrieved from the National Health Insurance (NHI) database developed by the National Health Research Institution (NHRI) showed that there were 366 inpatients with SARS in 2003. The data were analyzed using inferential statistical techniques, including the independent t-test, ?2-test, ANOVA and linear regression. Results: The findings revealed that for attack rates of 15%, 25% and 35%, the estimated admission expenditures were the highest when considering in-hospital death and patient age simultaneously. Total admission expenditures for elderly patients over the age of 65 years were higher than those for other age groups. Secondly, factors that were determined to be related to admission expenditures were patient gender, in-hospital death, hospital level, hospital ownership and length of stay (LOS). Finally, the related factors of LOS were at the hospital level. Conclusions: Total admission expenditures for elderly patients over the age of 65 years were higher than those for other age groups. Hence, we suggest a specific health policy for this group to reduce the risk of disease and medical expenses. Secondly, because admission expenditures were highest in local hospitals and lowest in regional hospitals, we suggest that regional hospitals be given priority if health authorities designate exclusive hospitals for treating H5N1 influenza.
• 496 - 506
• 10.6288/TJPH2008-27-06-04

• Link 原著 Original Article
• 影響急診病患暫留時間之相關因素探討Exploring the Factors Related to Length of Stay in Emergency Departments
• 吳秋芬、吳肖琪、石富元、許銘能
  Chiu-Fen Wu, Shiao-Chi Wu, Fuh-Yuan Shih, Ming-Neng Shiu
• 急診 ； 暫留時間 ； 檢傷分類 ； 醫療品質
  Emergency ; Length of Stay ; Triage ; Quality of Heath Care
• 目標：利用全民健保資料檔檢視我國急診病患之急診暫留情形及急診長時間暫留相關因素探討。方法：採橫斷式研究法，利用2005年衛生署全民健保門住診資料選取該年急診就診個案。利用邏輯斯迴歸分析影響不同急診暫留時間之相關因素探討。結果：2005年急診就醫總人次為6,508,597人次，平均當年度每百人就醫次數為26.43次，急診後留觀率為7.7%，留觀者中留觀超過一日佔13.0%，留觀超過二日佔5.6%。急診留觀情形受病患特質（年齡越大、男性、非假日就醫、緊急程度越高、共病情形嚴重、非重大傷病者）、區域特質（居住地都市化程度越低、在地就醫）、醫院特質（公立醫院、醫學中心、教學醫院、總佔床率高、急診量高或低者）等影響。急診留觀者（暫留大於六小時者）中是否需留觀超過一日或超過二日，皆以假日就醫、重大傷病身份、非緊急程度、跨區就醫、至急診量低的醫院就醫易超長急診留觀。結論：我國急診留觀時間過長情形仍舊存在，應加強輔導改善，以提升急診醫療品質。
  Objectives: The National Health Insurance database was used to explore the length of stay (LOS) and related factors in patients utilizing emergency rooms. Methods: In this cross-sectional study, patient use of emergency medical care was analyzed using clinic and hospital claims data from the Bureau of National Health Insurance (BNHI) in 2005. The factors related to emergency department length of stay (EDLOS) were analyzed by logistic regression. Results: There were 6,508,597 persons who had used emergency medical services in 2005, averaging every hundred human of every year 26.43 times. The was 7.7% patients staying at emergency room for observation, 13% and 5.6% of these patients staying at emergency room longer than one and two days for observation, respectively. Patient characteristics associated with EDLOS included old age, male gender, and visiting during a non-holiday. In addition, the presence of urgent medical conditions, comorbidity, or non-serious illness was associated with EDLOS. The regional characteristics associated with EDLOS were as follows: less urbanized area and local visits. Public, medical centers and teaching hospitals with higher occupancy rates and extremely high or low emergency visits were also associated with EDLOS. An observation time of more than one or two days was also influenced by these characteristics including a holiday visit, serious illness, non-urgent illness, visiting at hospital with low emergency department service volume, and cross-boundary visits. Conclusions: The length of stay in emergency rooms still long in Taiwan. Interventions for facilitating emergency medical services are necessary for improving quality.
• 507 - 518
• 10.6288/TJPH2008-27-06-05

• Link 原著 Original Article
• 國中生的幽默概念及表現類型：焦點團體討論結果The Concept of Humor and Performance Patterns among Junior High School Students: Results of Focus Group Discussions
• 李蘭、江宜珍、邱玉蟬、鄭其嘉、吳文琪、楊蕙如
  Lee Lan Yen, Yi-Chen Chiang, Yu-Chan Chiu, Chi-Chia Cheng, Wen-Chi Wu, Hwei-Ju Yang
• 幽默 ； 青少年 ； 焦點團體 ； 質性研究
  Humor ; adolescent ; focus group ; qualitative research
• 目標：利用焦點團體討論法收集資料，探討國中生的幽默概念及相關經驗。方法：自台灣北、中、南、東四個地區各選取一所國中。徵得校方同意後，從各校一至三年級學生中，隨機抽出8名男生和8名女生，再依性別分成男生組和女生組。最後有八個團體共64位國中生參與焦點團體討論。2005年底，根據各校排定的日程前去執行焦點團體，討論過程以錄音筆全程錄音並輔以觀察員之文字記錄。所有錄音內容及觀察記錄均鍵入電腦轉成逐字稿後，由研究人員共同閱讀及討論，完成質性資料的歸納與分析。結果：1.學生普遍認為幽默與「好笑」、「脫離慣性思考」或「負面形容詞」有關；2.根據學生的經驗，表現幽默的方式可歸納成貶抑自己、貶抑他人、言語動作和機智反應四種類型；3.幽默表現的主題多與「個人特色」或「生活事件」有關，尤以「性議題」及「黃色笑話」最常被提及；4.多數學生認為「正向的幽默表現」對心理及社會健康有幫助。結論：國中生對於幽默之概念及表現有正反兩方之看法，唯多數人認為「正向的幽默表現」有助於壓力抒解且對心理和社會健康有益。至於幽默表現是否確實與健康有關，值得繼續做更廣泛且深入的探討。
  Objectives: To investigate the concept and experiences of humor among junior high school students in Taiwan through focus group discussions. Methods: Four junior high schools were selected from the northern, southern, eastern, and western regions of Taiwan, respectively. Eight boys and eight girls were randomly selected from grades 7 to 9 in each school, and their consent to participate in the study was obtained. The students were grouped for discussion by sex, resulting in a total of 64 students in eight focus groups. The focus group discussions were carried out in late 2005 at times arranged by each school. The discussions were taped using a mini-digital recorder in addition to being documented by the observer's written notes. The contents of the recordings and the observer's notes were entered into a computer word for word. The resulting manuscripts were then read and discussed by the researchers and the final data summarized and analyzed. Results: 1. Students commonly associate humor with ”funny,” ”escaping inertia of thought,” or ”negative adjectives.” 2. Based on students' experiences, humor consists of four types: making fun of oneself, making fun of others, verbal or physical humor, and quick-witted reactions. 3. The topics about which students express humor are related to individual characteristics and life events, with sex topics and dirty jokes predominating. 4. Students believe that the positive expression of humor is beneficial to psychological and social health. Conclusions: Junior high school students have both positive and negative attitudes toward the concept of humor and performance patterns. They believe that the positive expression of humor can help relieve stress and is beneficial to psychological and social health. The exact relationship between humor performance and health deserves in-depth future research.
• 519 - 529
• 10.6288/TJPH2008-27-06-06

• Link 原著 Original Article
• 學生的攻擊行為與其初次使用菸和酒時間之關係Relationship between Aggressive Behavior and Initiation of Tobacco and Alcohol Use among Students
• 張齡尹、李蘭、張新儀
  Ling-Yin Chang, Lee Lan Yen, Hsing-Yi Chang
• 攻擊行為 ； 吸菸 ； 飲酒 ； 兒童與青少年 ； 存活分析
  aggressive behavior ; tobacco ; alcohol ; child and adolescent ; survival analysis
• 目標：瞭解學生的攻擊行為與其初次使用菸和酒時間之關係。方法：應用兒童與青少年行為之長期發展研究（簡稱CABLE計畫）的資料進行分析。本研究選取CABLE計畫中，於2001年就讀國小四年級之世代且完整追蹤至2006年者為分析樣本，共1,486人。主要的研究變項為攻擊行為（分成口語攻擊、肢體攻擊和破壞物品）與初次使用菸和酒之時間。利用SAS9.1統計軟體，執行存活分析。結果：(1)研究樣本自陳初次吸菸與初次飲酒的時間，平均為8.34年級和6.65年級。(2)研究樣本初次使用菸和酒的可能性在國中階段有明顯上升的情況。(3)以攻擊行為隨時間變化(time-varying)的變項值分析後，自陳有口語攻擊行為者相對於無此行為者，於往後年度發生初次吸菸（相對風險為1.86）或初次飲酒（相對風險為1.44）的可能性較高；自陳有破壞物品行為者，於次年出現初次飲酒的風險為無此行為者的1.39倍。結論：攻擊行為中的「口語攻擊」與「破壞物品」兩種類型是預測學生初次使用菸酒時間之顯著因子。建議相關單位及人員重視國小學生中有攻擊行為者，且相關之預防教育及介入計畫宜在國小階段開始，除降低攻擊行為的發生外，也可預防或延遲兒童與青少年初次使用菸和酒的時間。
  Objectives: To examine the relationship between aggressive behavior (e.g. , verbal aggression, physical aggression, and property destruction) and the initiation of tobacco and alcohol use among students. Methods: Data was obtained from the Child and Adolescent Behaviors in Long-term Evolution (CABLE) project. The participants included 1,486 students who were continually followed from 4 to 9(superscript th) grade (from 2001 to 2006). Survival analysis was also performed. Results: (1) Tobacco and alcohol use was initiated in 8.34(superscript th) and 6.65(superscript th) grades, respectively. (2) The survival probability of tobacco and alcohol initiation greatly decreased between 7th and 9th grades. (3) Verbal aggression was a significant predictor of both tobacco and alcohol initiation (HR: 1.86 and 1.44, respectively); property destruction was also related to a higher risk of alcohol initiation (HR: 1.39). Conclusions: Verbal aggression and property destruction were significant predictors of tobacco and alcohol initiation. To prevent and delay tobacco and alcohol initiation, it is important to target students who have aggressive behavior, especially those who are verbally aggressive and engaging in property destruction. Furthermore, tailored preventive programs were suggested to be designed, and the time of intervention should be initiated earlier in elementary school.
• 530 - 542
• 10.6288/TJPH2008-27-06-07

• Link 原著 Original Article
• 影響台灣地區青少年營養知識、態度與行為的個人與家庭因素Demographic and Family Factors Affecting Nutritional Knowledge, Attitudes, and Behaviors of Adolescents in Taiwan
• 陳惠欣、林薇、周麗端
  Hui-Hsin Chen, Wei Lin, Li-Tuan Chou
• 營養知識 ； 營養態度 ； 飲食行為 ； 家庭溝通 ； 家長監督
  nutrition knowledge ; nutrition attitude ; dietary behavior ; family communication ; parental control
• 目標：了解台灣地區青少年飲食營養知識、態度、行為之現況，並探討其影響因素。方法：橫斷式問卷調查法，問卷內容包括食物與營養知識、態度及行為。以分層集束法選取15所國中、6所高中、6所高職及4所五專，共計31所學校的國中、高中、高職、五專二年級學生，發出問卷2919份，回收問卷2804份，有效問卷2777份。統計方法包括描述性統計、皮爾森相關及線性迴歸分析等。結果：台灣地區青少年飲食營養知識、態度、行為的平均得分率分別為49.7%、69.0%、56.5%。半數以上的青少年期望較輕的體型，並曾經有過減重的經驗。88.7%的青少年回答「未曾接受過營養相關課程」；且這些學生的營養知識、態度與行為顯著低於回答「曾經接受過營養相關課程」之青少年。家庭因素與個人因素對青少年營養知識、態度與行為的影響同樣重要，本研究發現性別、就讀於直轄市（相較於鄉鎮地區）、家長監督、家庭溝通、和營養態度是預測營養行為直接與顯著的決定因子；而性別、身體質量指數、和家庭社經在預測行為時與態度具有交互關係。結論：當學校教育提供營養相關課程以促進青少年的飲食行為時，必須要強調正向的營養態度。此外，家庭也應該負起更積極的角色以促進與其子女的關係。
  Objectives: To understand the current status and factors related to nutritional knowledge, attitudes, and behaviors among high school students in Taiwan. Methods: A cross-sectional study was carried out using nationally representative subjects from Taiwan. Questionnaires assessing knowledge, attitudes, and behaviors regarding food and nutrition were administered to 2777 students in grades eight and eleven. The students were obtained from fifteen junior high schools, six senior high schools, six vocational schools, and four five-year colleges using a multistage-stratified sampling method. Descriptive analysis, Pearson correlation, and linear regression were used to analyze the data. Results: The correct or positive response rates for nutritional knowledge, attitude, and behavior scales were 49.7%, 69.0%, and 56.5%, respectively. More than half of the adolescents expected to be thin and had tried to lose weight. 88.7% of the adolescents surveyed had never attended a food or nutrition-related course. These students scored significantly lower in nutritional knowledge, held less positive attitudes, and performed worse on the behavior scale than those who had attended nutrition-related courses. The influence of family factors on nutritional knowledge, attitudes, and behaviors among Taiwanese adolescents was as important as demographic variables. Grade, metropolitan area (vs. rural townships), parental control, family communication, and attitude were found to be direct and modest determinants of nutritional behavior in this study. Sex, BMI, and parents’ SES were related with attitudes that predict behavior. Conclusions: Nutrition-related courses designed to improve dietary behaviors of adolescents should emphasize attitudes throughout the school system. In addition, families should take a more active role in improving their relations with children.
• 543 - 555
• 10.6288/TJPH2008-27-06-08