28卷5期

• Link 綜論 Review Article
• 醫療品質指標發展的挑戰與展望：我們還能做什麼？Challenges and Perspectives of Development in Quality of Care Indicators: What Else Can We Do?
• 鍾國彪、游宗憲
  Kuo-Piao Chung, Tsung-Hsien Yu
• 醫療品質指標 ； 指標發展 ； 指標評估 ； Web of Science文獻資料庫
  Quality Indicators ; Indicators Development ; Indicators Evaluation ; Web of Science database
• 醫療品質指標是最常應用的品質改善工具之一，除了用於醫院內部品質改善之外，近年來更做進一步的外部應用。過去學界對於指標有許多論述，但卻缺乏發展脈絡的回顧，因此本研究的目的為利用Web of Science文獻資料庫進行文獻回顧，以探究醫療品質指標的沿革與發展。本研究共回顧430相關文獻，發現醫療品質指標相關的文章，於1990年代開始蓬勃發展，相關內容可分為(1)指標與品質測量的關係、(2)發展指標的方法、(3)指標風險校正方法、(4)指標的應用及(5)指標的挑戰及影響等五個部份來呈現。結果可以發現當今醫療品質指標的發展，已有一致性的作法，在應用上也越來越多元化，但在品質指標後續的維護與評估，仍有極大的進步空間。本文並從指標發展、指標評估、指標應用及指標輪替／汰換等四個重點，提出對醫療品質指標現況的檢討與未來的建議。
  Quality indicators are one of the most widely used tools for evaluating care. They can be used to provide not only internal quality improvement, but also (in recent years) external quality assurance. There are many previous studies but few reviews on quality indicators. Therefore, the purpose of this study was to use the Web of Science database to examine the development and evolution of quality indicators. A total of 430 papers were reviewed. Most related papers were published after the 1990s. These papers can be divided into 5 content groups including the relationship between quality measures and quality indicators, the methods of quality indicator development, the methods of risk adjustment, application of quality indicators, and impact of quality indicators. This review revealed that the methodology of quality indicator development is consistent, and the applications of quality indicators are diverse. However, implementation and evaluation of quality indicators still have room to improve. We also provide comments on the development, evaluation, application, and selection of quality indicators, and make recommendations for the future.
• 345 - 360
• 10.6288/TJPH2009-28-05-01

• Link 原著 Original Article
• 醫療院所之門診失約預測：類神經網路之應用The Application of the Neural Network to the Forecasting of Missed Hospital Appointments
• 葉金標、童春芳、張巍獻
  Jin-Biaun Yeh, Chun-Fang Tung, Wei-Hsien Chang
• 類神經網路 ； 過預約政策 ； 門診失約預測 
  Neural Network ; Overbooking ; Forecasting of Hospital Miss-appointments
• 目標：本文主要是利用類神經網路的預測能力，進而達到預測醫療院所門診失約情況之目的。方法：本文主要以類神經網路、迴歸分析與星期特性移動平均法預測醫療院所門診失約之情況，並比較三種預測方法何者預測能力較佳。結果：本文不只採用倒傳遞類神經網路進行門診失約預測，也使用星期特性移動平均模式、迴歸分析等預測方法進行績效分析評估，分別以MSE與MAPE兩種方式的績效指標作比較，藉以評估何種方式之預測能力較佳。實證結果為倒傳遞網路在預測顧客失約人數的兩項績效指標皆優於星期特性移動平均、迴歸分析，因而得到倒傳遞網路較其他兩者預測方法更準確之結果；其中三種預測方法的正確率比較：倒傳遞類神經網路約55.91%；星期特性移動平均約47.24%；迴歸分析約48.82%。另外當過度預測某一位病患時所喪失的機會成本大於預測某一位病患時會發生的資源成本0.71倍，倒傳遞網路的預測力優於迴歸分析；在機會成本小於資源成本7.25倍，倒傳遞網路的預測能力比星期特性移動平均佳；若機會成本大於資源成本3.16倍，迴歸分析的預測能力優於星期特性移動平均。結論：以預測值的誤差之MSE及MAPE來判斷，倒傳遞網路比其他兩者預測方法準確。
  Objectives: This research used a measurement of Back-Propagation Networking (BPN) to forecast missed hospital appointments. Methods: We compared BPN with Day-of-week Moving Average and a Regression model. Results: BPN predicted mean squared error (MSE) and mean absolute percentage error (MAPE) better than the others. The forecasting accuracy of BPN was 55.91%, Day-of-week Moving Average 47.24%, and regression 48.82%. On cost analysis: (1) the opportunity cost between Regression and BPN is 0.71 times larger than the resource cost. (2) The opportunity cost between Day-of-week Moving Average and BPN is 7.25 times smaller than the resource cost. (3) The opportunity cost between Day-of-week Moving Average and Regression is 3.16 times larger than the resource cost. Conclusions: When MSE and MAPE are used to compare the performance of these forecasting methods, our results showed that BPN was better than Day-of-Week Moving Average and Regression.
• 361 - 373
• 10.6288/TJPH2009-28-05-02

• Link 原著 Original Article
• 慢性腎臟病與其相關因子之探討－以社區成人健康檢查資料分析Factors Associated with Chronic Kidney Disease: Analysis of Outreach Community Adult Health Examination Data
• 吳希文、史麗珠、張睿詒、 陳為堅、楊銘欽
  Hsi-Wen Wu, Lai-Chu See, Ray-E Chang, Wei-Jen Chen, Ming-Chin Yang
• 慢性腎臟病 ； 盛行率 ； 相關因子 ； 成人健檢
  CKD Chronic Kidney Disease ; prevalence ; associated factors ; adult health examination
• 目標：末期腎臟衰竭病患消耗許多健保資源。幸而因慢性腎臟病引起的不良後果，是可透過早期偵測早期治療來預防或延緩其發生。本研究目的乃透過大規模社區成人健康檢查之資料，探討臺灣民眾慢性腎臟病之相關因子。方法：以2004-2006年參與桃園縣社區成人健檢的29345位民眾為研究對象，對其健康行為、疾病史、身體檢查、血液檢查、尿液檢查等資料，作描述性統計及以卡方檢定、及羅吉斯迴歸進行資料分析。慢性腎臟病的定義則是以腎絲球過濾率＜60ml/min/1.73平方公尺作界定。結果：慢性腎臟病盛行率分別為第三期15.2%、第四期0.7%、第五期0.2%。腎絲球過濾率隨年齡增加而下降，慢性腎臟病盛行率隨之上升，且女性盛行率高於男性。與慢性腎臟病相關的因子有高尿酸、肥胖、高血壓、高血糖、高三酸甘油酯、高膽固醇、代謝症候群。結論：參加成人健康檢查的民眾，在其檢查報告應計算腎絲球過濾率、慢性腎臟病的期別。又依慢性腎臟病相關因子的有無來提醒參加民眾罹患慢性腎臟病的風險，以早期發現、早期治療。
  Objectives: Treatment of end stage kidney disease is expensive. Moreover, early detection and appropriate case management can prevent or delay the onset of the adverse outcomes of chronic kidney disease (CKD). The purpose of this study was to identify factors associated with CKD that could be used in community screening to detect CKD early. Methods: We analyzed data from the health examination survey of an outreach community of adults. A total of 29,345 Taoyuan county adults participated in this survey during 2004-2006. Data on health behavior, disease history, physical examination, and blood and urine chemistry were analyzed. Descriptive statistics, ?^2 test, and logistic regression were applied. CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60ml/min/1.73m^2. Results: The prevalence of stages 3-5 CKD was 15.2%, 0.7%, and 0.2%, respectively; eGFR decreased with increased age, and consequently the prevalence of CKD increased; the prevalence of CKD was higher in females than in males. Factors associated with CKD included hyperuricemia, obesity, hypertension, hyperglycemia, hypertriglyceridemia, hypercholesterolemia, and metabolic syndrome. Conclusions: eGFR and CKD stage should be part of the community-based health examination of adults. Those who present with associated factors of CKD should be advised to seek close follow-up and appropriate treatment.
• 374 - 384
• 10.6288/TJPH2009-28-05-03

• Link 原著 Original Article
• 山地原住民無菸家庭之初探性研究－以南投縣仁愛鄉為例A Preliminary Study on smoke-free Homes among Aboriginal Residents in the Ren-ai Township of Nantou County
• 陳奕芝、廖淑娟、朱正一
  I-Chi Chen, Shu-Chuan Liao, Cheng-I Chu
• 原住民 ； 吸菸行為 ； 二手菸 ； 無菸家庭 ； 質性研究
  aboriginal ; smoking behavior ; secondhand smoke ; smoking-free homes ; qualitative research
• 目標：本研究深入探討山地原住民對無菸家庭的看法，以及衛生單位人員推展無菸家庭計畫之經驗，最後提出實施無菸家庭之策略建議。方法：深入訪談仁愛鄉的九位家中吸菸者及兩位衛生單位人員。結果：本研究發現無菸家庭之實施較可行的策略為完全禁止在家中吸菸，但允許在家庭戶外吸菸，其目的為避免他人受二手菸的危害。其他發現包括歸納出家中吸菸者的四種限制情形、對吸菸訪客的限制作法、家庭成員對吸菸者的影響力、家中貼無菸家庭貼紙的效用、由無菸家庭衍生家用車禁菸等主題概念。結論：本研究建議無菸家庭實施策略可考慮：1.家中成員對吸菸者產生的影響力；2.家中放置無菸家庭宣導品（如貼紙／小白板）；3.家中不放置菸灰缸；4.提供衛教單張宣導；5.無菸家庭家規的訂定。
  Objectives: The purpose of this study was to learn about the smoking behavior of aboriginals in mountainous regions and determine their attitudes towards smoking, second-hand smoke, and smoke-free homes. Preliminary experiences of public health professionals involved in the promotion and implementation of smoke-free home programs were collected in order to develop strategies and suggestions for smoke-free home policies. Methods: This study used a qualitative approach that included in-depth interviews. Nine smokers from Ren-Ai County and two local health department employees were interviewed. Results: Participants agreed that forbidding smoking in the home would diminish the threat to their children’s health due to the inhalation of second-hand smoke. Other findings included suggestions to limit smoking in the home, limit smoking by visitors, assess the impact of family members on smokers, determine the effect of smoke-free home stickers in the home, and promote the idea of smoke-free vehicles. Conclusions: Family members within a household can significantly influence smokers and help promote smoke-free homes. Smoke-free home promotional materials such as stickers or white boards, should be used appropriately. No ash trays should be allowed at home. Health education about the effects of smoke and smoking is highly recommended. Home-set rules are a more effective approach than legal regulations.
• 385 - 397
• 10.6288/TJPH2009-28-05-04

• Link 原著 Original Article
• 廣泛自閉症表現型：自閉症光譜量表對親代特質的篩檢與區別性分析The Broad Autism Phenotype: Screening Parents of People with Autism Spectrum Disorders using the Autism-Spectrum Quotient (AQ)
• 劉萌容
  Meng-Jung Liu
• 廣泛自閉症表現型 ； 自閉症光譜量表 ； 自閉症者之父母
  broad autism phenotype ; AQ Autism-spectrum Quotient ; parents of people with autism
• 目標：本研究測試「自閉症光譜量表」（Autism-spectrum Quotient，簡稱AQ）篩檢出具有類似自閉症特質的父母之預測效度，以及性別之得分差異，同時也比較自閉症者、自閉症者的父母與一般父母之AQ得分差異情形，研究結果希冀對具有類似自閉症特質的父母提供一項快速篩檢的工具。方法：研究對象包括33對自閉症者之父母和38對一般父母，以郵寄問卷和自我評量的方式填寫成人版的AQ量表。自閉症者的資料是引用自另一研究。結果：自閉症組AQ各五個分量表的得分和總分皆是3組中最高的，表現出自閉症連續性的特質。量表中的社交和溝通二個分量表最有效區分自閉症者父母和一般父母，自閉症者父母組中的男性在社交和溝通二個分量表的得分顯著高於自閉症者父母組中的女性以及一般父母組中的男性與女性。結論：社交和溝通是AQ中最具區辨力的二個分量表，若社交和溝通二個分量表的得分總和高於9者，並且在生活適應上出現困難，則增加趨近於廣泛自閉症表現型(broad autism phenotype)高危險群的可能性，建議尋求更進一步的諮商協助。
  Objectives: The term ”broad autism phenotype” is used to refer to the non-autistic relatives of people with autism spectrum disorders (ASD) who manifest mild forms of autistic-like characteristics. The study investigated the autistic-like characteristics and gender differences of the parents of people with ASD by using the Autism-Spectrum Quotient (AQ). The study also compared the AQ scores of people with ASD, parents of people with ASD, and parents of normal controls. Methods: AQ was administered to the two groups of participants by mail. One group consisted of 33 pairs of parents of people with ASD, while the other included 38 pairs of parents of controls. The data for people with ASD was retrieved from another study. Results: (1) Among the three groups, people with ASD scored the highest on AQ, while parents of normal controls scored the lowest. (2) The parents of people with ASD scored significantly higher on the social and communication subscales than did parents of controls. (3) Males in the group of parents of people with ASD scored significantly higher on the social and communication subscales than did females in the same group. Conclusions: The results supported the concept of an autistic continuum. The social and communication subscales can significantly discriminate the parents of people with ASD from the parents of controls. If the score obtained is more than 9 in the two subscales and social difficulties also occur, then further counseling is recommended.
• 398 - 406
• 10.6288/TJPH2009-28-05-05

• Link 原著 Original Article
• 國人嚼檳榔的現況與變化－探討嚼檳榔與吸菸之關係Trends in Betel Quid Chewing Behavior in Taiwan-exploring the Relationship between Betel Quid Chewing and Smoking
• 溫啟邦、鄭秋汶、鄭丁元、蔡旻光、江博煌、蔡善璞、詹惠婷、張晏甄、張新儀
  Chi-Pang Wen, Chiu-Wen Cheng, Ting-Yuan Cheng, Min-Kuang Tsai, Po-Huang Chiang, Shan-Pou Tsai, Hui-Ting Chan, Yen-Chen Chang, Hsing-Yi Chang
• 國民健康訪問調查 ； 嚼檳榔 ； 吸菸 ； 盛行率
  National Health Interview Survey NHIS ; betel quid chewing ; cigarette smoking ; prevalence
• 目標：本研究目的為描述國人嚼檳榔行為現況，分析2001年與2005年調查結果變化，探討吸菸與嚼檳榔特殊關係。方法：使用「國民健康訪問調查」18歲以上資料，樣本數各為16,136人與18,871人，依年齡、社經地位及地區別分析嚼檳榔盛行狀況，計算嚼食量、嚼檳榔與吸菸開始年齡、性別差異，對嚼檳榔行為及吸菸行為作交叉分析，利用SAS9.1.3版套裝軟體進行加權、統計分析。結果：男性嚼檳榔盛行率4年間由14.6%，增為15.8%。「每天嚼檳榔者」增加相當於16萬人。嚼食量也有增加的趨勢，每天嚼食顆數從18.3顆增加為19.6顆，台灣全年合計增加約7億顆。高嚼量者，每日檳榔嚼食重量與每日食米量相當。同一時期台灣吸菸率自46.7%（2001年）稍稍降為44.6%（2005年）。有嚼檳榔者十之八九(85.2%)也有吸菸，這群人絕大部分(94.1%)其開始吸菸年齡早於嚼檳榔或同時開始。間接觀察發現，吸菸者若能戒菸，3/4(77%)嚼檳榔的習慣就消失了。結論：近年來台灣男性吸菸率雖稍有下降，嚼檳榔的人口卻沒有減少，令人為這群日益增加的檳榔族群健康擔憂，因為他們的吸菸，使檳榔的害處因此加成。如果他們能成功戒菸，檳榔的習慣也將隨之減少，所以成功的檳榔防制政策將建立於推動有效的菸害防制政策，而且因為檳榔危害台灣民眾健康甚大，制定有效防制政策刻不容緩。
  Objectives: The goals of this study were to compare the prevalence of betel quid chewing between 2001 and 2005, and to analyze the relationship between chewing and smoking. Methods: Two sets of nationally representative data from the National Health Interview Surveys (NHIS), 2001 (n=16,136) and 2005 (n=18,871) were compared. The prevalence of chewing was calculated by age, educational level, occupation, level of income, geographic areas, smoking status, daily amount, and age of initiation. The analysis was carried out with the use of SAS 9.1.3 software. Results: The prevalence of chewing in men increased from 14.6% to 15.8% over the 4 year period, with 160,000 new daily chewers added to the addicted population. The amount of betel quid consumed also increased from 18.3 to 19.6 pieces a day, amounting to an annual addition of 700 million pieces. The weight of betel quid consumed daily by the heaviest chewers was equivalent to the amount of rice staple consumed. The majority of chewers (85.2%) also smoked, and nearly all of them (94.1%) started to smoke either before they started to chew or began the two habits at the same time. The chewing habit reduced sharply (77.0%) after smokers quit smoking. Conclusions: Despite an observed reduction in the smoking rate, the prevalence and the amount of chewing increased between 2001 and 2005. As most chewers also smoke, they suffer from double jeopardy. In view of the fact that most smokers who quit smoking also quit chewing, an effective tobacco control policy would be a prerequisite for betel quid control.
• 407 - 419
• 10.6288/TJPH2009-28-05-06

• Link 原著 Original Article
• 台灣地區新生兒臍帶血中元素濃度分佈初探Concentration Distributions of Elements in Umbilical Cord Blood in Taiwan
• 劉俊宏、吳惠琤、陳保中、 郭育良、 黃耀輝
  Jyung-Hung Liu, Hui-Chen Wu, Pau-Cheng Chen, Yue-Liang Leon Guo, Yaw-Huei Hwang
• 臍帶血 ； 金屬 ； 鉛 ； 汞 ； 鎘
  Cord blood ; Metal ; Lead ; Mercury ; Cadmium
• 目標：本研究利用臍帶血中金屬濃度作為環境暴露監測工具，初探國內新生兒臍帶血中各種金屬元素濃度分布常模值。方法：自2004年5月至2005年7月間，收集來自於不同層級醫療院所的1,526對產婦及其新生兒為研究對象。臍帶血樣本由醫護人員在產婦分娩時採集，之後以感應耦合電漿質譜儀進行分析，總共有1,407個臍帶血樣本完成十八種金屬含量分析。結果：鋅、銅、硒等濃度值最高，其中位數分別為2,296 μg/L，519 μg/L，204 μg/L。錳、鉛、汞、砷等濃度次之，中位數分別為47.6 μg/L，13.2 μg/L，9.4 μg/L，3.2 μg/L。鈹、鉑、鉈、釷及鈾等金屬元素濃度在臍帶血中相對較低。臍帶血樣本中只有硒之原始濃度符合常態分布，鋅、砷及汞等元素濃度經對數轉換後，也符合常態分布條件。結論：目前台灣地區臍帶血中鉛濃度已降至與已開發國家相當，汞與鎘濃度在過去二十年間雖有明顯下降，但仍比其他已開發或開發中國家為高。建議國內未來應建立長期性臍帶血金屬濃度監測系統，作為行政決策或研究長期污染暴露變化趨勢之基礎。
  Objectives: In this study, a survey of background multi-element exposure levels was conducted to establish exposure norms in Taiwan through the monitoring of levels of metals in umbilical cord blood. Methods: In total, 1,526 pairs of pregnant women and newborns were recruited between May 2004 and July 2005 at different levels of medical facilities. Cord blood samples were collected by nurses after delivery and 1,407 samples were successfully analyzed for 18 metals with inductively coupled plasma mass spectrometry. Results: The highest concentrations were found for zinc, copper, and selenium with medians of 2,296 µg/L, 519 µg/L, and 204 µg/L, respectively. These were followed by concentrations of manganese, lead, mercury, and arsenic with medians of 47.6 µg/L, 13.2 µg/L, 9.4 µg/L, and 3.2 µg/L, respectively. The lowest levels were observed for beryllium, platinum, thallium, thorium, and uranium. Only the original selenium level and the log-transformed zinc, arsenic and mercury levels were normally distributed. Conclusions: Currently, the cord blood lead level in Taiwan is comparable to those in developed countries. However, although significantly decreased in the past two decades, cord blood mercury and cadmium levels in Taiwan are still higher than those of either developing or developed countries. In the future, a longitudinal monitoring system for cord blood metals should be established to serve as the basis for policy decisions or research on the trend of long-term exposure to pollutants.
• 420 - 435
• 10.6288/TJPH2009-28-05-07

• Link 實務 Public Health Practice
• 台灣退伍軍人症防疫作業指標研究Evaluation of the Public Health Achievement Related to Legionellosis in Taiwan
• 蘇勳璧、詹大千、蘇治原、鄧振華
  Hsun-Pi Su, Ta-Chien Chan, Chih-Yuan Su, Zhen-Hua Deng
• 退伍軍人症 ； 嗜肺性退伍軍人菌 ； 發生率
  Legionellosis ; Legionella pneumophila ; incidence rates
• 目標：台灣退伍軍人症首次報告發生在1983年，並在1999年列為法定傳染病，本論文整理1999-2007年資料，以勾繪退伍軍人症在台灣公衛防疫的整體成果。方法：從1999年1月1日至2007年12月31日止，由疾病管制局傳染病倉儲系統收集原始資料，加以統計分析。結果：由1999年至2007年，總計通報病例數共11,205例，確定病例數563例，死亡數6人。確定病例每十萬人口發生率，分別是0.10、0.29、0.18、0.34、0.48、0.47、0.17、0.24和0.24，平均每十萬人口發生率為0.28。通報作業時效以日距平均數表示，從1999年平均為10.45日，至2007年平均為5.67日。檢體採檢率不論醫院層級或年代均達9成以上。檢驗陽性率由1999年平均1.34%，增至2007年10.51%。疫情調查完成率由1999年幾乎沒有實施(0.33%)，至2007年58.70%。結論：雖然在通報作業時效、檢體採檢率和檢驗陽性率方面，退伍軍人症防疫管理方面均有明顯進步，但在疫情調查完成率方面仍有可改善空間。
  Objectives: The first case of Legionellosis in Taiwan was reported in 1983. In 1999, the government of Taiwan classified Legionellosis as a notice infectious disease. This study evaluated the prevention and control of Legionellosis in Taiwan using data from 1999 to 2007. Methods: Data on Legionellosis were collected for the years 1999 to 2007 from the notice infectious disease information system of Taiwan's department of disease control. The data were subjected to statistical analysis. Results: A total of 11,205 cases of Legionellosis were reported in Taiwan from 1999 to 2007. Only 563 cases were confirmed, and 6 people died because of the disease. The incidence rates for the 9 years of the study were 0.10, 0.29, 0.18, 0.34, 0.48, 0.47, 0.17, 0.24, and 0.24 per 100,000 population, respectively, with an average rate of 0.28. The mean effective of notice work was 10.45 per day in 1999 and 5.67 per day in 2007. The sampling rate was more than 90%. The mean positive rate increased from 1.34% in 1999 to 10.51% in 2007. The epidemic survey rate increased from 0.33% in 1999 to 58.70% in 2007. Conclusions: The notification work effectiveness, the sampling rate, and the positive rate in the prevention and control of Legionellosis showed obvious progress from 1999 to 2007, but the epidemic survey rate still had room for improvement.
• 436 - 445
• 10.6288/TJPH2009-28-05-08

• Link 研究紀要 Research Brief
• 台灣中部某醫學中心沙門氏菌病患流行病學暨Salmonella enterica serovar Enteritidis感染之流行病學特徵探討Epidemiology of Salmonella infection and Identification of Epidemiological Characteristics of S. enterica Serovar Enteritidis in Patients from a Medical Center in Central Taiwan
• 李宗賢、 陳志銘、陳宛青、柯瑟琴、徐媛曼、張照勤
  Tsung-Hsien Li, Chih-Ming Chen, Wan-Ching Chen, Se-Chin Ke, Yuan-Man Hsu, Chao-Chin Chang
• S. Enteritidis ； 雞蛋 ； 有機蔬菜 ； 流行病學
  S. Enteritidis ; egg ; organic vegetable ; epidemiology
• 目標：藉由醫學中心的沙門氏菌感染臨床個案探討其流行病學特徵，並進一步分析病患感染Salmonella enterica serovar Enteritidis (S. Enteritidis)的相關流行病學特徵。方法：收集於醫學中心就診的人類沙門氏菌症病患及菌株，病患利用問卷訪視方式，獲得人口學資料、發病前一個月內其居家環境、畜產動物暴露史、豬畜產品的食用史、飲用水源以及居家飲食烹調和公共衛生習慣等相關資訊。進一步依照病人感染之沙門氏菌株血清型別分成S. Enteritidis感染者和非S. Enteritidis感染者，進行病例-病例比較研究(case-case comparison)以找出相關的流行病學特徵因子。結果：感染病患所屬血清群當中，以血清群D1的42.6% (26/61)和血清群B的32.8%(20/61)為主；若以血清型而言，以S. Enteritidis佔42.6% (26/61)、S. Typhimurium佔21.3% (13/61)及S. Stanley的9.8% (6/61)為最盛行的型別。單變項分析結果顯示發病前一個月內曾經食用雞蛋或有機蔬菜為感染S. Enteritidis的重要流行病學特徵，其危險勝算比分別為4.1 (95% CI: 1.4-12.2)及4.5(95% CI: 1.4-14.5)。結論：本研究提供中台灣之沙門氏菌病患流行病學特徵，並且為台灣首次針對S. Enteritidis感染的相關流行病學特徵所進行之研究。相較於其他非S. Enteritidis的沙門氏菌感染病患，S. Enteritidis 的感染患者與蛋或有機蔬菜之食用有密切相關。未來對於教育民眾並宣導如何正確且安全的飲食習慣，為防治S. Enteritidis之重要方向。
  Objectives: The objectives of this study were to understand the epidemiology of Salmonella infections in humans in Taiwan, and to identify the epidemiological characteristics associated with S. Enteritidis infection. Methods: 61 patients from a medical center in central Taiwan with confirmed cases of Salmonella infection were interviewed with a structured questionnaire to collect information with regard to demographic data as well as proximity to pig farms, history of animal contacts, consumption of animal products, source of drinking water, and kitchen hygiene. All exposure information was traced back for one month prior to the onset of illness. Patients infected with Salmonella other than S. Enteritidis served as references, and a case-case comparison study was conducted to identify epidemiological characteristics associated with S. Enteritidis infection. Results: The results indicated that the main sero-groups of Salmonella in patients were sero-groups D1 (42.6%; 26/61) and B (32.8%; 20/61). After serotyping, it was determined that the most three prevalent Salmonella serotypes were S. Enteritidis (42.6%; 26/51), S. Typhimurium (21.3%; 13/61) and S. Stanley (9.8%; 6/61). By univariate analysis, consumption of eggs (odds ratio: 4.1; 95% CI: 1.4-12.2) and organic vegetables (odds ratio: 4.5; 95% CI: 1.4-14.5) were found to be significant epidemiological characteristics associated with S. Enteritidis infection. Conclusions: Consumption of eggs and organic vegetables may play an important role in the transmission of S. Enteritidis in Taiwan. Therefore, public health education, especially with regard to proper food handling, is necessary to prevent people from contracting an S. Enteritidis infection.
• 446 - 453
• 10.6288/TJPH2009-28-05-09

• Link 評論 Commentary
• 評論：山地原住民無菸家庭之初探性研究－以南投縣仁愛鄉為例 Commentary: A Preliminary Study on smoke-free Homes among Aboriginal Residents in the Ren-ai Township of Nantou County
• 郭淑珍
  Shu-Chen Kuo
• 無
  none
• 無
  none
• 397-397
• 無

• Link 評論 Commentary
• 作者回覆：山地原住民無菸家庭之初探性研究－以南投縣仁愛鄉為例 Author's response: A Preliminary Study on smoke-free Homes among Aboriginal Residents in the Ren-ai Township of Nantou County
• 陳奕芝、廖淑娟、朱正一
  I-Chi Chen, Shu-Chuan Liao, Cheng-I Chu
• 無
  none
• 無
  none
• 397-397
• 無

• Link 評論 Commentary
• 評論：新生兒臍帶血中元素濃度是否可為環境汙染探針？ Can element concentr-actions in unbilical cord blood be a probe for environmental pollution?
• 吳聰能
  Trong-Neng Wu
• 無
  none
• 無
  none
• 435-435
• 無