29卷5期

• Link 公衛論壇 Public Health Forum
• 從古巴矛盾談社會與健康Cuban Paradox from the Perspective of Society and Health
• 曾育慧
  Yu-Hwei Tseng
• 無
  none
• 無
  none
• 379 - 383
• 10.6288/TJPH2010-29-05-01

• Link 綜論 Review Article
• 國際間對嬰幼兒飲食營養建議之現況分析A Current Review of the International Diet and Nutritional Recommendations for Infants and Toddlers
• 盧立卿、何沛穎
  Li-Ching Lyu, Pei-Ying Ho
• 嬰幼兒 ； 營養素建議量 ； 飲食指導 ； 嬰兒配方 ； 法規政策
  infants and toddlers ; dietary reference intakes ; dietary guideline ; infant formula ; regulatory policy
• 嬰幼兒生長發育乃是生命期中生長最快速的階段，其中飲食及所提供熱量與各種營養素為協助嬰幼兒生長之關鍵因素。此綜論整理國際組織及各國公共衛生單位針對零至六歲嬰幼兒飲食營養建議之現況，並分為三面向分析：一、膳食營養素參考攝取量(Dietary Reference Intakes, DRIs)之比較分析。二、嬰幼兒飲食指導(Dietary guidelines for infants and toddlers)之陳述；此二面向資料來源為台灣、美國、日本、新加坡及世衛組織的相關文獻。三、嬰兒配方之相關議題，探討內容包括：現今嬰兒配方營養標準法規，以及陳述“換奶”之相關議題。由於國內之食品成份資料庫不全及評估飲食方法學之高難度，需推動跨領域多項相關研究才得以檢視我國的嬰幼兒參考攝取量是否需作修正。台灣當今於嬰幼兒飲食指導資料來源及內容多元，而相關營養教育觀念亦需要公共衛生單位協助落實推廣政策。另外，雖然國內推廣母乳已與國際接軌，但對嬰兒配方管理議題卻少著墨，未來應精進相關法規標準並跨部會研發管理，才得以保護消費者之權益。
  The rate of growth during infancy and early childhood is the fastest in the lifespan. Energy and various nutrients provided by diet play key roles in the proper growth of infants and toddlers. This article reviews the current international standards and dietary guidelines published by international public health agencies for infants and toddlers from birth to age 6. We divided the related issues into three areas: 1. dietary reference intakes (DRIs), 2. dietary guidelines for infants and toddlers, 3. infant formulae. Published information from Taiwan, the USA, Japan, Singapore and WHO was analyzed with regard to the first two areas. The infant formula issues included the current domestic and international formula standards and ”change the milk” concept. The main suggestions are as follows, more research is needed in food composition and dietary assessment methodology in order to revise the recommended nutrient intakes for infants and toddlers. We also need to encourage multi-disciplinary collaboration in order to develop a better framework for nutrition education. Although the promotion of breastfeeding is gradually catching on international trends, issues regarding formula feeding are rarely discussed. The current commercial market for infant formula needs more comprehensive regulation by governmental agencies in order to protect consumers.
• 384 - 400
• 10.6288/TJPH2010-29-05-02

• Link 綜論 Review Article
• 舊瓶新酒：包皮環切術的演進與新貌New Wine in an Old Bottle: Evolution of and a New Look at Male Circumcision
• 許振東、丁志音
  Chen-Tong Hsu, Chih-Yin Lew-Ting
• 包皮環切術 ； 人類免疫缺乏病毒 ； 致癌性人類乳突病毒 ； 子宮頸癌 ； 人權
  circumcision ; human immunodeficiency virus ; oncogenic human papillomavirus ; cervical cancer ; human rights
• 包皮環切術是已知最古老也是執行最多的手術，在人類的發展歷史中，它已經變換許多面貌，呈現在不同時代不同社會的不同族羣人面前。傳統儀式性的包皮環切術，在近代醫學的加持下，曾經蔚為主流，但也因缺乏臨床效益而逐漸褪去光彩；然而近年來，越來越多流行病學及臨床試驗的研究結果，顯示它確實可以減少許多疾病的發生，特別是HIV/AIDS的預防。但如同其他的公共衛生計畫一樣，這項介入措施也涉及倫理的爭議。國內學界與相關單位並未對此議題有共識與建議，亦未提供民眾參考與指示，因此本文的目的除了對此議題作一綜合性的歷史回顧與論述其新的公共衛生意義外，更希望拋磚引玉引起學界與相關單位的重視與討論。
  Male Circumcision is the oldest known surgical procedure in the world, and it continues to be one of the most commonly performed operations today. Because of its diversified ritual features and multiple functions throughout human history, the value of this cultural practice cannot be overlooked. It was once very popular in the medical community but later faded away due to a lack of clinical effectiveness; however, recent findings have shown it to be effective in disease control, especially in the prevention of HIV/AIDS. The practice of male circumcision, however, evokes ethical concerns just as other public health measures do. Currently there is a lack of consensus about the practice of male circumcision in Taiwan and recommendations are not available for the general public. This article provides a comprehensive review of the origin, development, and emerging public health implications of this practice. The medical and public health communities in Taiwan should raise concern about this issue.
• 401 - 409
• 10.6288/TJPH2010-29-05-03

• Link 原著 Original Article
• 東台灣山地鄉兒童過動及注意力缺陷症的盛行率及相關因子The Prevalence of and Associated Risk Factors for Attention Deficit Hyperactivity Disorder in Children in Mountainous Towns of Eastern Taiwan
• 楊國明、朱正一
  Kao-Ming Yang, Cheng-I Chu
• 盛行率 ； 過動及注意力缺陷症候群 ； 山地鄉 ； 相對危險因子 ； 調整勝算比
  prevalence ; Attention-deficit hyperactivity disorder ADHD ; mountainous towns ; relative risk factor ; adjusted odds ratio AOR
• 目標：本研究目的為了瞭解山地鄉兒童過動及注意力缺陷症的盛行率和相關危險因子。方法：本研究為橫斷面研究設計，以花蓮縣三個山地鄉26個國小學童共2,634人為研究樣本。第一階段由教師版之兒童活動量表來初篩，共有疑似個案為386人進入第二階段，經兒童青少年精神科醫師確定診斷為352人；並針對家長關於ADHD之相關因子，包括父母親喝酒、吸菸、嚼檳榔等行為，或是否罹患精神疾病者等，進行量性問卷調查，以及深度訪談。結果：地區平均盛行率為14.2%。利用多變量邏輯式回歸模型來檢定及調整勝算比，發現過動及注意力缺陷症家長較非過動及注意力缺陷症家長在使用香菸(AOR=6.51, 95% CI=5.14-7.25, p=0.004)、檳榔(AOR=11.32, 95% CI=4.61-10.38, p=0.002)及酒精(AOR=14.56, 95% CI=3.21-19.32, p=0.001)，達顯著相關。結論：本研究顯示花蓮縣山地鄉兒童過動及注意力缺陷症的盛行率可能不見得較高，但其父母親喝酒、吸菸、嚼檳榔、罹患憂鬱症及失眠症等與過動及注意力缺陷症的盛行率有顯著相關。
  Objectives: To investigate the prevalence of ADHD and the relative risk factors among children in grades 1-6 and their parents in the mountainous region of Hualien. Methods: This was a cross-sectional study involving 2634 children in 26 primary schools. The first stage of the study utilized the clinical hyperactivity scale (teacher form), with the results providing 386 suspected cases for the second stage evaluation. Of these children, 352 were confirmed to have ADHD by a child-adolescent psychiatrist. Finally, through the use of questionnaires and intensive interviews, data were collected from their parents regarding parental factors relative to ADHD children. These included: drinking alcohol, smoking, chewing betel nut, and mental illness. Results: The average prevalence in this geographic area was 14.2%. A multivariate logistical regression model was used to identify factors significantly associated with adjusted odds rations: smoking (AOR=6.51, 95% CI=5.14-7.25, p=0.004), chewing betel (AOR=11.32, 95% CI=4.61-10.38, p=0.002) and drinking alcohol (AOR=14.56, 95% CI=3.21-19.32, p=0.001). Conclusions: The prevalence of ADHD among children might not necessarily be higher in the mountainous region of Hualien than in other areas of Taiwan, but it was significantly associated with the parental factors of drinking alcohol, smoking, chewing betel nuts, and the existence of depression or insomnia.
• 410 - 419
• 10.6288/TJPH2010-29-05-04

• Link 原著 Original Article
• 美沙冬替代療法對於海洛因成癮者藥物濫用信念及生活適應之成效分析The Effectiveness of Methadone Maintenance Treatment on Beliefs about Drug Abuse and Life Adjustment among Heroin Addicts
• 秦文鎮、張永源、侯瑞瑜、蔡毓瑄、 黃心蔓
  Wen-Cheng Chin, Yong-Yuan Chang, Jui-Yu Hou, Yu-Hsuan Tsai, Hsin-Man Huang
• 海洛因成癮 ； 藥物濫用信念 ； 生活適應 ； 美沙冬替代療法
  heroin addiction ; beliefs toward drug abuse ; life adjustment ; methadone maintenance treatment
• 目標：台灣近年來愛滋病感染人數急遽增加，衛生署於2005年12月開始推動「毒品病患愛滋減害試辦計畫」，美沙冬替代療法(methadone maintenance treatment)得以由國外引進台灣。本研究以介入組及比較組的前瞻性研究設計，探討美沙冬替代療法對於海洛因成癮之治療成效。方法：介入組為於某區域醫院精神科門診接受美沙冬替代療法之海洛因成癮者(n=67)，比較組為因違反毒品危害防制條例於某地檢署接受保護管束處分之海洛因成癮者(n=21)。兩組分別以濫用藥物信念量表及社區生活適應量表進行前測及後測，前後測間隔時間為三個月。結果：統計方法以重複量數雙因子變異數分析進行，結果顯示美沙冬替代療法之介入，可改善海洛因成癮者之藥物濫用信念偏差及其生活適應功能。結論：海洛因成癮後戒除不易，極易復發，個案常有多次毒品前科。建議政府相關單位應持續編列預算補助「美沙冬替代療法」，以降低進入治療的門檻及提高治療的普及率為目標，方能建立遠離毒害的健康社會。
  Objectives: Recently, the number of HIV-infected cases in Taiwan has increased dramatically. The Department of Health promoted ”AIDS Harm Reduction in Drug Abusers: A Pilot Project”, which incorporated methadone maintenance treatment, a concept brought into Taiwan from abroad. This prospective study was conducted with heroin addicts in an intervention and a comparison group to evaluate the therapeutic effectiveness of methadone maintenance treatment on beliefs about drug abuse and life adjustment. Methods: The intervention group was composed of heroin addicts receiving methadone maintenance treatment in the department of psychiatry of a regional hospital (n=67). The comparison group was composed of heroin addicts placed under probation in a district prosecutor's office due to violation of the Drugs Hazard Control Act (n=21). The two groups were evaluated with ”beliefs about drug abuse” and ”life adjustment” questionnaires before and after three-months of treatment. Results: A repeated measures two-way ANOVA was conducted to compare the intervention and comparison groups. The results demonstrated that methadone maintenance improved beliefs about drug abuse and life adjustment in heroin addicts. Conclusions: Heroin abstinence is extremely difficult after a person becomes addicted. Relapses are frequent and may result in multiple drug convictions. We suggest that the government allocate a budget for methadone maintenance treatment to lower the threshold for admission to a program and to increase popularization of the treatment. We can achieve a society without drugs.
• 420 - 430
• 10.6288/TJPH2010-29-05-05

• Link 原著 Original Article
• 台灣成年民眾對奈米產品與科技的公眾感知Perceptions of nano-products and Nanotechnology by Taiwanese Adults
• 林宜平、吳亭亭、 黎雅如、周桂田、鄭尊仁
  Yi-Ping Lin, Ting-Ting Wu, Ya-Ru Li, Kuei-Tien Chou, Tsun-Jen Cheng
• 奈米科技 ； 公眾感知 ； 風險 ； 利益 ； 信任
  Nanotechnology ; Public Perception ; Risk ; Benefit ; Trust
• 目標：本研究旨在探討台灣民眾對奈米產品與科技的公眾感知，並分析影響其利益、風險與信任的社會人口學變項與決定因子。方法：本研究於2007年8至9月，委託中央研究院調查訪問中心，以電話抽樣完成1,251例18歲以上民眾的橫斷性調查訪問。研究樣本具性別代表性，但是年輕與年老族群的代表性比較不足。結果：在全部受訪者中，有81.3%聽過奈米產品，女性、年輕，以及教育程度較高，聽過的比例較高。決定高利益感知的主要變項是男性、年齡介於50至59歲間、教育程度大專以上、低風險，以及高信任；決定高風險感知的主要變項，是年齡四十歲以上、低利益，以及低信任；而決定高信任感知的變項，則是低教育程度、高利益與低風險。結論：本研究發現台灣成年民眾對奈米產品有很高的熟悉度，除了性別、年齡與教育程度之外，對奈米科技的管制信任，是影響其利益及風險感知的重要因素。
  Objectives: To explore the public perception of nano-products and nanotechnology in Taiwan, and to analyze the demographic factors and determinants associated with the perception of risks and benefits. Methods: A cross-sectional telephone survey was conducted by the Center for Survey Research, Academia Sinica from August to September 2007, with a randomized sample of 1,251 adults aged 18 and older. The sample was representative in its distribution by gender, but not by age. Results: A total of 81.3% of participants had heard of nano-products, especially among female, younger, and more highly educated groups. General linear model analysis indicated that male, older age, higher education, lower risk, and higher trust were the determinants of perception of higher benefits of nanotechnology. Older age, lower benefit, and lower trust were the determinants of higher risk, and lower education, higher benefit and lower risk were the determinants of higher trust. Conclusions: A high percentage of Taiwanese adults have heard of nano-products. Other than gender, age, and education, trust played an important role in determining their perceptions of the risks and benefits of nanotechnology.
• 431 - 439
• 10.6288/TJPH2010-29-05-06

• Link 原著 Original Article
• 病人報告之醫院品質：問卷發展與信效度分析Patient Reported Hospital Quality (PRHQ): Scale Development, Reliability, and Validity
• 姚開屏、 蕭宇佑、郭耿南、鄭守夏
  Kai-Ping Grace Yao, Yu-Yu Hsiao, Ken N. Kuo, Shou-Hsia Cheng
• 病人觀點 ； 醫療照護品質 ； 量表 ； 信度 ； 效度
  Patient Perspective ; Hospital Quality ; Scale ; Reliability ; Validity
• 無
  Objectives: The purpose of this study was to develop and test the reliability and validity of the Patient Reported Hospital Quality (PRHQ) Scale. Methods: 2,675 discharged patients across 20 hospitals in Taiwan were used in the current survey. Core items of the PRHQ were selected by the process of item analysis. Reliability was then examined by conducting Cronbach's alpha and split-half reliability tests. Validity analyses including content validity, criterion-related validity, and construct validity were tested by applying Pearson's correlation coefficient, Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA). Results: Through the process of item analysis, the original questionnaire was revised to include 27 core items, which were defined by six domains: medical care, nursing care, overall interaction, respect, psychosocial support, and hospital environment. The internal consistency (Cronbach's alpha) coefficients and the splithalf reliability coefficients were 0.72 to 0.89 and 0.64 to 0.86 at the domain levels, showing good reliability of the scale. In addition, the range of the correlations between items and their domain scores was 0.57 to 0.88 (p<0.01), showing good content validity. The range of the correlations between domain scores and the criterion item was 0.41 to 0.58, indicating adequate criterionrelated validity. Results from EFA indicated that among the six hypothetical domains, overall interaction, respect, and psychosocial support could be integrated into one factor; however, CFA of the six-factor model showed it to be the best fit for the data, indicating good construct validity for the PRHQ. Conclusions: The first version of the PRHQ was confirmed to be reliable and valid and it can be applied in future studies to enrich the existing system for evaluation of hospital quality.
• 440 - 451
• 10.6288/TJPH2010-29-05-07

• Link 原著 Original Article
• WHA觀察員與WHO之互動分析－我國未來之策略建議Exploration of the Role of WHA Observership: Future Strategies for the Participation of Taiwan in the WHO
• 邱亞文、曾鈺珺、黃靜宜、 李俊翰、李明亮
  Ya-Wen Chiu, Yu-Chun Tseng, Ching-Yi Huang, June-Han Lee, Ming-Liang Lee
• 世界衛生組織 ； 世界衛生大會 ； 觀察員 ； 國際衛生合作 ； 參與策略
  WHO ; WHA ; observer ; international health cooperation ; participation strategy
• 目標：我國在2009年獲邀成為世界衛生大會(World Health Assembly, WHA)觀察員，如何藉由此身分在世界衛生組織(World Health Organization, WHO)貢獻國際衛生能力，而此一身分又是否限制與WHO之合作互動，是本研究探討之主要標的，期為我國參與WHO之方式提供策略建議。方法：搜尋回顧WHO官方資料及參酌其他五名WHA觀察員之相關文件，以內容分析法統整其與WHO之互動模式。結果：除WHA會議的參與外，WHO並未明確規範WHA觀察員的參與範圍及形式，主要之交流活動可綜整為五類：（一）參與WHA大會；（二）出席或主辦WHO相關會議；（三）參與WHO周邊網絡；（四）獲得衛生協助；（五）貢獻公共衛生能力。各WHA觀察員參與之項次與內容有別。結論：WHA觀察員身分並未侷限其與WHO之互動及合作，除皆能出席WHA大會，其他互動方式則依其個別能力、立場、需求等主客觀條件而異。WHA觀察員之參與範圍雖未明訂，但也因其模式之彈性，使我國未來在擬定參與WHO活動的策略時，可依我國之專長項目，發展與WHO獨特的合作方式，以貢獻我國之醫藥衛生能力。
  Objectives: Taiwan was invited to attend the World Health Assembly (WHA) for the first time as an observer in 2009. It is expected that the acquisition of observer status will pave the way for the country's further participation in World Health Organization (WHO) activities; however, whether we can participate in activities such as networks, meetings or projects, remains to be seen. The aim of this study was to analyze the past experiences of other WHA observers, and to learn how they interacted with the WHO. Methods: From the WHO website and other available information sources, we reviewed the official records of 5 other WHA observers. Content analysis was applied to summarize the interaction patterns among observers and WHO. Results: There were no significant regulations for observers' participation. Each observer developed a distinctive interaction model according to its nature, demands and ability. We determined 5 categories of major activities among them: participating in WHA, attending or hosting WHO meetings, joining WHO-related networks, gaining health assistance from WHO, and making contributions to the global public health field. Conclusions: Observer status did not limit cooperation with WHO, and, except for attending the WHA, their interactions varied. No regulation defines the scope of participation, so Taiwan can be more flexible. We can create a unique interactive model according to our own country's specialties, capabilities and needs, and thus contribute to international society through the WHO.
• 452 - 464
• 10.6288/TJPH2010-29-05-08

• Link 原著 Original Article
• 男女學生四至十一年級之社交焦慮發展軌跡研究A Study of the Developmental Trajectory of Social Anxiety among Boys and Girls from 4th Grade to 11th Grade
• 張奕涵、李蘭、張新儀、吳文琪
  Yi-Han Chang, Lee-Lan Yen, Hsing-Yi Chang, Wen-Chi Wu
• 社交焦慮 ； 發展軌跡 ； 兒童 ； 青少年 ； 長期追蹤
  social anxiety ; developmental trajectory ; child ; adolescent ; longitudinal
• 目標：探討男生和女生社交焦慮發展軌跡之類型與相關因素。方法：從兒童與青少年行為之長期發展研究（簡稱CABLE）資料庫中，選取2001年就讀國小四年級之世代，共1,621人為研究樣本，使用研究樣本連續八年間填答之資料，進行次級資料分析。本研究主要採用之統計方法為Group-based Trajectory Model及多項logit模型。結果：就四至十一年級各個年度的社交焦慮程度來看，女生皆顯著高於男生，且發現國中是學生社交焦慮提高的危險時期。就八年期間的社交焦慮發展軌跡而言，男生可以分成五類：持續微弱組(28.01%)、微弱變中等組(28.14%)、中等微降組(18.15%)、中等變嚴重組(21.44%)、持續嚴重組(4.26%)；女生也可分成五類：微弱且下降組(10.00%)、中等變嚴重組(16.63%)、中等偏微弱組(48.63%)、嚴重變中等組(17.75%)、嚴重且上升組(7.00%)。與男生社交焦慮發展軌跡類型相關的因素有：父母處罰、父母支持、父母衝突及與同學互動程度；與女生相關的因素則為父母處罰及與同學互動程度。結論：應特別注意女生在四至十一年級間的社交焦慮程度是否偏高，並將學生社交焦慮的預防介入提前自小學即開始。父母應多給予男生支持、避免與配偶發生衝突、減少處罰子女的頻率，並鼓勵孩童多與同儕互動。
  Objectives: To investigate the patterns of developmental trajectory of social anxiety among boys and girls from 4(superscript th) to 11(superscript th) grade and to examine the related factors. Methods: Data from 1,621 students followed from 4(superscript th) to 11(superscript th) grade (from 2001 to 2008) as part of the Child and Adolescent Behaviors in Long-term Evolution (CABLE) project were used for secondary analysis. The Group-based Trajectory Model and Multinomial Logit Model were used in the statistical analysis. Results: Girls had significantly higher social anxiety than boys from 4(superscript th) grade to 11(superscript th) grade. Students' social anxiety may increase greatly during junior high school. There were 5 trajectory patterns of social anxiety among boys: persistently low (28.01%), low to medium (28.41%), medium and declining (18.15%), medium to high (21.44%), and persistently high (4.26%). There were also 5 trajectory patterns for girls: low and declining (10.00%), medium to high (16.63%), medium-low (48.63%), high to medium (17.75%), and high and rising (7.00%). Developmental trajectory patterns of social anxiety among boys were significantly associated with parental punishment, parental support, parental conflict and interaction with peers. Girls' developmental trajectory patterns were significantly associated with parental punishment and interaction with peers. Conclusions: Girls' social anxiety is high from 4(superscript th) to 11(superscript th) grade. Preventive and intervention programs should be initiated early in elementary school. Parents should provide boys with more support, avoid conflicts, punish children less, and encourage children to interact more with their peers.
• 465 - 476
• 10.6288/TJPH2010-29-05-09