31卷5期

• Link 綜論 Review Article
• 台灣發展WiMAX之潛在健康風險與風險治理探討Potential Health Risks and Risk Management Issues as a Result of Introducing WiMAX Technology in Taiwan
• 王瑞庚、周桂田
  David Walther, Kuei-Tien Chou
• WiMAX ； 電磁場（波） ； 射頻輻射電磁場 ； 電磁場（波）健康影響 ； 風險治理
  WiMAX ; magnetic wave ; radiofrequency electromagnetic fields ; magnetic wave health impact ; risk governance
• 台灣2004年規劃以WiMAX為骨幹建設全國「寬頻無線網路」系統，其投資高達260億元。然而考察近年來一些國際上之射頻輻射健康影響研究，除了已知知識的部分提到：無法證明射頻輻射有健康危害，尚有一些研究具有知識上的不確定性以及隨之而來的科學解釋與價值判斷的爭議，因此也不能完全排除其潛在健康風險之可能。Stirling提出的知識不確定矩陣，區分出已知知識、知識不確定性以及模稜兩可的科學解釋與價值判斷，已知知識可以採用傳統的風險評估工具，但其他範疇則需要風險溝通等不同方法來進行管理。研究發現我國WiMAX計畫之決策和執行過程，缺乏公衛、醫學等多元專家參與決策或徵求健康評估相關計畫，未對其健康風險進行良好風險溝通並開放公民參與管道，政府委託研究無法影響既定之政策，政府也並未遵循研究建議，改善現有治理架構。本文建議WiMAX應參考加州與歐盟對行動通訊電磁波之風險治理實踐作法，進行擴大科學審查和公民參與等新興風險治理典範，以形塑優質的科技決策。
  WiMAX is a brand new mobile communication technology whose impact on health and the environment has never been fully researched and evaluated by Taiwanese academia or regulatory departments such as the Environmental Protection Administration (EPA). This article introduces WiMAX technology, reviews the international scientific literature, investigates the potential health risks of WiMAX, considers risk management in Taiwan, and applies the concept of Uncertain Matrix of Knowledge. We found that the government used insufficient scientific evidence prior to drawing up and implementing WiMAX policy. The principles of deliberative and participatory democracy in Taiwan were eroded and ignored. By introducing the concept of the Uncertain Matrix of Knowledge and the methodology of the California EMF Program and SCENIHR, we addressed the problems of risk management and WiMAX policy making in Taiwan and also gave suggestions such as extended peer communities, technological democracy and risk communication.
• 399 - 411
• 10.6288/TJPH2012-31-05-01

• Link 綜論 Review Article
• 青少年之睡眠問題與物質使用的關係The Relationship between Sleep Problems and Substance Use in Adolescents
• 林立寧、李蘭
  Linen Lin, Lee-Lan Yen
• 青少年 ； 睡眠問題 ； 物質使用
  adolescent ; sleep problem ; substance use
• 「睡眠問題」和「物質使用」是目前青少年最常見的兩種精神疾患，且與其他精神疾患有群聚現象，但是過去的文獻中，較少有系統地同時討論，為了促進青少年的健康，有必要進一步瞭解兩者間的關係。青少年的睡眠問題包括：睡眠時間不足、入睡困難、睡眠持續問題、睡眠周期不規律、日間疲倦等，可能會導致他們使用各種物質。反之，青少年的物質使用包括：飲酒、吸菸、使用含咖啡因物質、吸食大麻、使用古柯鹼、使用含安非他命物質、使用鎮靜安眠藥物、使用含鴉片類物質藥物、使用俱樂部用藥等，對他們的睡眠也有影響；嚼檳榔和使用吸入劑對睡眠的影響則不確定。本文藉由文獻回顧，證實青少年「睡眠問題」和「物質使用」之間可能有互為因果的關係，但台灣學者探討兩者因果關係的不多，並發現「睡眠問題」導致「物質使用」的研究多以心理及行為層面為主，而「物質使用」導致「睡眠問題」的研究則涵蓋生理、心理和行為等層面，因此未來在青少年健康促進的研究，除了要注重本土特色外，也應該同時顧及多元觀點，才能將研究成果轉譯為具體的政策。
  Sleep problems and substance use are the most prevalent mental health issues in adolescents. Moreover, individuals with these two problems may also be susceptible to other psychiatric disorders. A lack of systematic understanding of the relationship between sleep problems and substance use hinders our ability to promote health in adolescents. Sleep problems, such as inadequate total sleep time, difficulty in falling sleep and in maintaining sleep, irregular sleep patterns, and excessive daytime fatigue, may subsequently contribute to substance use in adolescents. Conversely, the use of substances, such as alcohol, tobacco, coffee or caffeine, marijuana, cocaine, amphetamines, sedatives or hypnotics, opioid containing prescriptions, and club drugs, affects sleep in adolescents. The effects of betel nut chewing and administration of inhalants on sleep are undermined. This review suggests a bidirectional relationship between sleep problems and substance use. The paucity of causal studies in Taiwan and the lack of biological evidence for sleep problems leading to substance use should prompt further research among native adolescents from multidimensional perspectives in order to determine practical policies to address both problems.
• 412 - 424
• 10.6288/TJPH2012-31-05-02

• Link 原著 Original Article
• 生活飲食習慣與壬基苯酚暴露－夫婦樣本的觀察結果Nonylphenol Exposure in Married Couples as Measured by Urinalysis
• 陳志郎、呂宗烟、童寶玲、楊友仕、馬一中
  Jyh-Larng Chen, Chung-Yen Lu, Pao-Ling Torng, Yu-Shih Yang, Yee-Chung Ma
• 壬基苯酚 ； 夫婦 ； 飲食 ； 尿液
  nonylphenol ; married couple ; foodstuffs ; urine
• 目標：壬基苯酚（nonylphenol, NP）是一種廣流布在環境中的內分泌干擾物，人體暴露深受關切。本研究以橫斷式研究探究不孕治療之夫婦的飲食和生活習慣與尿液壬基苯酚暴露的相關。方法：經由婦產科對53對就診夫婦進行調查，每名應允參加者均填答一份問卷提供人口、社經、生活與飲食習慣等資料，41位男士和49位女士提供了尿樣。結果：男士年齡較大，身體質量指數較大，也較多抽菸和飲酒，但尿樣的壬基苯酚含量平均值並無男女差別（分別為1.26±0.39對1.28±0.31 μg/g creatinine，p = .821; Pearson correlation相關係數 r= .31, p= .012）。比較所有人口，社經及生活型態、食物變項，只發現多服食保健食品者的含量明顯高(1.35±0.34對1.16±0.34 μg/g creatinine) (p = .012)。多喝高脂奶者亦有較高的含量，但不顯著。結論：此為首次以共同生活的夫婦樣本為對象，討論生活飲食習慣與人體壬基苯酚暴露濃度的關聯的論文，男性與女性的尿液壬基苯酚含量無顯著差別，多服食保健食品者的尿液壬基苯酚含量較高，其餘生活飲食習慣與尿液壬基苯酚含量無明顯關聯。
  Objectives: Nonylphenol (NP) is an endocrine disrupter with wide distribution in the environment, particularly in foodstuffs and polluted water. Human exposure to NP has been of concern. This study evaluated the NP levels in couples with infertility, by using urinary 4-nonylphenol (4-NP) as a biomarker. Methods: Subjects were 53 married couples who were visiting the obstetrics and gynecology clinic. Of these, 41 men and 49 women provided urine samples. Each participant also completed a self-reported questionnaire to provide information about sociodemographic status and life style including diet. Results: Men were older, had a higher body mass index and were more likely to smoke, drink and use betel nut; however, the mean urinary NP levels were similar in men and women, 1.26 (SD 0.39) vs. 1.28 (SD 0.31) µg/g creatinine (p= .821; Pearson correlation r= .31, p= .012). Among all measured sociodemographic and life style factors, only those individuals who had consumed more healthy food had significantly higher urinary NP levels than did subjects who had consumed less or did not consume healthy food at all. (1.35 (SD 0.34) vs. 1.16 (SD 0.34)) µg/g creatinine (p= .012). Those who consumed more whole milk also had higher mean urinary NP levels, but this finding was not statistically significant. Conclusions: Our findings demonstrated that married couples had similar exposure to NP from the consumption of foodstuffs. Eating healthy food was associated with higher urinary nonylphenol levels. Other eating habits showed no significant correlation.
• 425 - 435
• 10.6288/TJPH2012-31-05-03

• Link 評論 Commentary
• 評論：生活飲食習慣與壬基苯酚暴露－夫婦樣本的觀察結果Commentary:Nonylphenol Exposure in Married Couples as Measured by Urinalysis
• 李俊璋
  李俊璋
• 無
  none
• 無
  none
• ?
• 10.6288/TJPH2012-31-05-10

• Link 評論 Commentary
• 作者回覆：生活飲食習慣與壬基苯酚暴露－夫婦樣本的觀察結果Response:Nonylphenol Exposure in Married Couples as Measured by Urinalysis
• 陳志郎、呂宗烟、童寶玲、楊友仕、馬一中
  Jyh-Larng Chen, Chung-Yen Lu, Pao-Ling Torng, Yu-Shih Yang, Yee-Chung Ma
• 無
  none
• 無
  none
• 435 - 435
• 10.6288/TJPH2012-31-05-04

• Link 原著 Original Article
• 母親手機使用與孩童神經認知行為發展Maternal Mobile Phone Use and Children's Neurocognitive Development
• 吳佩璇、林靜君、廖華芳、曹峰銘、謝武勳、陳保中
  Pei-Hsuan Wu, Ching-Chun Lin, Hua-Fang Liao, Feng-Ming Tsao, Wu-Shiun Hsieh, Pau-Chung Chen
• 產前暴露 ； 手機 ； 神經認知行為發展 ； 孩童
  prenatal exposure ; mobile phone ; neurocognitive development ; young children
• 目標：手機使用已越趨頻繁，然而手機之電磁波對於孩童健康發展之不良影響仍有爭議。本研究之目的為，描述從妊娠期到產後一年之母親手機使用情形，並進一步探討其手機使用量和孩童神經認知行為發展之影響。方法：自2004年至2005年間，收集來自大台北地區不同醫療院所的產婦及其新生兒為研究對象，最終納入133對產婦及其新生兒進行分析。我們使用「嬰幼兒綜合發展測驗」（Comprehensive Developmental Inventory for Infants and Toddlers,簡稱CDIIT）以及「魏氏兒童智力量表第四版」（Wechsler Intelligence Scale for Children-Fourth edition,簡稱WISC-IV）評估孩童之神經認知行為發展。另外，我們也使用「瑞文氏圖形推理測驗」（Standard Progressive Matrices, 簡稱SPM+）評估母親智力。藉由自填式問卷評估母親的手機使用量，再使用迴歸模式進行統計分析。結果：從妊娠期至產後一年，多數的母親每天手機的接聽通數皆少於3通，且每通電話之通話時間皆少於3分鐘。研究結果並未發現手機暴露對於孩童的神經行為發展有不良之影響。結論：目前仍未有明確的證據足以證明手機之暴露會造成孩童神經行為之不良影響，未來仍需要更多的研究針對此議題進行探討。
  Objectives: Today, mobile phone use is common and has increased rapidly in many countries. The health effects of exposure to mobile phone use on children are controversial. We described maternal mobile phone use from pregnancy until the 12 months post-birth and examined the association between exposure to mobile phone use and the children's neurocognitive development in the general population in Taipei, Taiwan. Methods: The study was a part of the Taiwan Birth Panel Study. A total of 133 pairs of parents and their singleton child were recruited into this study. We used the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT) and Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) to assess child neurocognitive development. We also assessed the intelligence of the mothers using the Standard Progressive Matrices Plus (SPM+). Mothers completed questionnaires to report their mobile phone use. Regression modeling was used to estimate the association between mobile phone exposure and children's neurocognitive development. Results: Most of the mothers answered less than 3 phone calls per day, and the call duration was less than 3 minutes for each phone call from pregnancy until 12 months post-birth. We found no significant association between maternal mobile phone use and neurocognitive development in young children. Conclusions: There is no convincing evidence that maternal mobile phone use has an adverse effect on the neurocognitive development of young children. Prospective research using a personal exposure assessment is needed to elucidate a causal relationship.
• 436 - 445
• 10.6288/TJPH2012-31-05-05

• Link 原著 Original Article
• 居家失能老人之經濟狀態對居家護理使用及照護品質之影響The Impact of the Economic Status of the Disabled Elderly Dwelling at Home on the Use of Homecare and the Quality of that Care
• 張淑卿、吳肖琪
  Shu-Ching Chang, Shiao-Chi Wu
• 失能老人 ； 居家護理 ； 經濟狀態 ； 照護品質 ； 全民健保
  Disabled elderly ; Home nursing ; Economic status ; Care quality ; Health Insurance
• 無
  Objectives: The aims of this study were to determine the effects of the economic status of the disabled elderly on the risk of too infrequent use of homecare and the quality of long-term care. Methods: The subjects of the study were a retrospective cohort of disabled elderly in Taiwan who received homecare services for the first time and were covered by the National Health Insurance from 2002 to 2006. A generalized estimate equation (GEE) used for the logistic regression was utilized to analyze the factors affecting the risk of fewer homecare visits (<3 times per year). The factors affecting the risks of infection-related hospitalization or pressure sore-related hospitalization were analyzed with a comprehensive Cox regression. Results: A total of 44,856 disabled elderly received homecare for the first time from 2002 to 2006. After the confounding variables were controlled, the comparative risks between different economic status groups were as follows: the risk of fewer homecare visits for the disabled elderly with high economic status was lower than the risk for those with low economic status (Odds ratio [OR]=0.92; 95% confidence interval [CI], 0.86-0.99, p=0.0307). The risk of infection-related hospitalization for the disabled elderly with high economic status was lower than the risk for those with low economic status (Hazard ratio [HR]=0.95, 95% CI:0.92-0.98, p=0.0025). The risk of pressure sore-related hospitalization for the disabled elderly with high economic status was lower than the risk for those with low economic status (HR=0.92, 95% CI:0.85-1.00, p=0.0422). Conclusions: The disabled elderly of low economic status made less use of homecare services and received a lower quality of homecare even though it was provided by National Health Insurance for free. Based on these findings, we suggest that policy makers provide a traffic subsidy to the economically disadvantaged disabled elderly who receive homecare services, improve household sanitation, and promote specialized instruction about homecare during discharge planning and home visits.
• 446 - 459
• 10.6288/TJPH2012-31-05-06

• Link 原著 Original Article
• 醫院創新之外部知識來源使用與影響因素Exploring the Use of External Sources of Knowledge for Hospital Innovation
• 翁瑞宏、曾雅禎、吳宗晉、黃靖媛
  Rhay-Hung Weng, Ya-Chen Tseng, Tsung-Chin Wu, Ching-Yuan Huang
• 醫院創新 ； 外部知識 ； 知識獲取
  hospital innovation ; external knowledge ; knowledge acquisition
• 目標：外部知識的使用為影響醫院創新之關鍵因素，本研究試圖探討醫院進行創新發展時，對於各外部知識來源之使用程度，並深入分析影響外部知識來源使用度的因素。方法：研究採用問卷調查方式，以全國地區醫院級以上之高階主管為研究對象，共回收問卷211份；以皮爾森相關、複迴歸及邏輯斯迴歸來進行研究分析。結果：研究結果以醫院評鑑標準、全民健保相關法規，及衛生政策相關標準與法規三個專業知識項目使用度最高，而使用度最低的則為市場知識中的外部醫藥研發實驗室或公司、顧問與顧問公司，及機構知識中的營利性公司機構；根據迴歸分析結果顯示，醫院規模、正式化程度、學校附設醫院會影響外部知識使用。結論：醫院在進行創新發展時對外部知識來源使用度由高而低順序分別為：專業化知識來源、其他知識來源、機構知識來源、市場知識來源。在影響因素方面，醫院規模越大、正式化程度越高、學校附設醫院在進行創新時，對外部知識使用程度較高。
  Objectives: The use of external knowledge is a principal factor in hospital innovation. This research explored the use of external sources of knowledge for hospital innovation. Methods: We employed a self-administered mail survey to collect data and selected top managers in hospitals accredited as district hospitals and above as key informants. We then utilized multiple regression and logistic regression methods to analyze our data. Results: Among the external sources of knowledge, hospital accreditation standards, National Health Insurance regulations, and health policy regulations were the most frequently cited. Pharmaceutical laboratory or company data, consultants or consultancy firms, and profit-making institutions were the least used sources for hospital innovation. In addition, hospital size, hospital formalization, and hospitals affiliated with medical schools were factors which significantly affected the use of external sources of knowledge. Conclusions: The ranking of the kind of external knowledge important for hospital innovation was: specialized knowledge, other knowledge, institutional knowledge and market knowledge. In terms of influencing factors, this study found that hospitals with larger size and a higher degree of formalization or hospitals affiliated with medical schools were more likely to use external sources of knowledge for hospital innovation.
• 460 - 472
• 10.6288/TJPH2012-31-05-07

• Link 原著 Original Article
• "SAFE"教育方案對居家護理個案用藥安全之成效The Effect of the "SAFE" Education Protocol on the Facilitation of Safe Medication Administration for Home Healthcare Clients
• 許淑敏、賈佩芳、陳淑娟、杜淑雲、高寶蓮、陳美芳
  Shwu-Miin Hsu, Pei-Fang Chia, Shu-Chuan Chen, Shu-Yun Tu, Pao-Lien Kao, Mei-Fang Chen
• 衛生教育 ； 居家護理個案 ； 用藥安全
  health education ; home healthcare clients ; safety medication
• 目標：本研究主要目的是發展“SAFE”教育方案並評估對居家護理個案用藥安全之成效。方法：採單組前後測類實驗設計，立意取樣南部某醫院附設居家護理所34位個案與其主要照顧者為研究對象，接受團隊研擬“SAFE”教育方案，包括標準化安全用藥衛生教育流程（Standardizing health education about safe medication administration; S）、評估用藥適當性（Assessing medication adequacy ; A）、促進一個用藥安全的環境（Facilitating a safety medication environment; F）與評值是否執行安全用藥（Evaluating whether practicing safety medication; E）等四項過程，每個月一次，為期三個月。並在教育方案介入前與介入完成後一個月，分別進行前測及後測評量。結果：34位個案用藥安全問題於衛生教育前件數7件，經介入完成後一個月降至1件，McNemar檢定達顯著下降（X^2 =4.17, p＜0.05）。介入完成後一個月，主要照顧者的用藥安全認知由介入前的6.7分提升至8.4分，成對樣本檢定達顯著上升（t= -5.5, p＜0.01）。結論：“SAFE”教育方案確實顯著降低居家護理個案的用藥安全問題，並有助於主要照顧者對個案用藥安全認知程度之提升，其可作為居家護理實務的參考。
  Objectives: The purpose of this article was to examine the effect of the ”SAFE” education protocol on improving safe medication administration for home healthcare clients. Methods: We used a quasi-experimental design and subjects were a convenience sample of thirty-four home healthcare clients recruited from a homecare center in a hospital in southern Taiwan. The group received the ”SAFE” education protocol, including Standardizing health education about safe medication administration, Assessing medication adequacy, Facilitating a safe medication environment, and Evaluating medication safety (acronym: SAFE). The program was held once a month, for 3 months. The outcomes were measured before intervention and 1 month post-intervention. Results: The results showed an average of 7 medication problems in home healthcare clients before intervention and one, 1 month post-intervention (X^2 =4.17, p<0.05). The scores for perception of medication safety by caregivers increased from 6.7 before intervention to 8.4 at 1 month post-intervention (t= -5.5, p<0.01). Conclusions: The ”SAFE” education protocol may effectively decrease the medication problems experienced by home healthcare clients and increase the perception of medication safety by caregivers.
• 473 - 484
• 10.6288/TJPH2012-31-05-08

• Link 實務 Public Health Practice
• 台灣地區出監毒癮者接受美沙酮替代療法18個月之再犯率追蹤Evaluation of Recidivism in Addicts who Received Methadone Maintenance Treatment in Taiwan for 18 Months
• 陳泉錫、季延平、詹中原
  Chuan-Hsi Chen, Yan-Pin Chi, Chung-Yuang Jan
• 美沙酮替代療法 ； 減害 ； 毒品危害防制中心 ； 再犯率 ； 資料探勘
  Methadone Maintenance Treatment ; Harm Reduction ; Drug Abuse Prevention Center ; Recidivism ; Data Mining
• 目標：台灣地區於2005年8月引進美沙酮替代療法（Methadone Maintenance Treatment, MMT），目前是我國防制一級毒品之重要策略。但在引進替代療法後，截至2010底毒品人口並未明顯降低，再犯率亦未有效改善。原因究竟是替代療法療效不佳？或推行仍不普遍？本研究進行大範圍實證研究，以事實數據作為毒品政策成效檢驗之客觀參考。方法：本研究採非實驗設計研究方法，以2009年上半年出監的一級毒品毒癮者3343人為研究對象，以實際資料庫比對分析之計量方法為主，文獻探討為輔。樣本分為持續接受MMT療法與未接受MMT療法2組，分別追蹤18個月。結果：研究發現持續接受MMT療法組再涉毒品案件比率為30.57%。未使用MMT組為42.03%，效果顯著（P值為0.0084）。在降低財產、暴力再犯率亦呈現效果。惟樣本中替代療法涵蓋率僅19.86%，參加替代療法者在18個月後維持率僅23.64%，對整體再犯率改善之影響有限。結論：MMT療法經證實具有降低再犯毒品效果但留置率低，且在治療初期降低再犯毒品之效果並不顯著，其執行方式之妥適性待進一步探究。
  Objectives: In August 2005, the Taiwanese government introduced Methadone Maintenance Treatment (MMT), one of the major strategies in fighting drug abuse; however, as of 2010, the MMT strategy still had not demonstrated effectiveness in reducing the addicted population or the recidivism rate. The aims of this study were to determine whether MMT was effective in Taiwan and to provide objective evidence to authorities before more resources were invested in this protocol. Methods: This study used a non-experimental design approach. A total of 3343 drug abusers released from correctional facilities during the first half of 2009 were divided into adaptive and non-adaptive MMT groups. Follow-up observation was done over 18 months and included drug recidivism and both property and violent crimes for each group. Results: The drug recidivism rate for the MMT group was 30.57%, whereas that for the non-MMT group was 42.03%. The lower rate of the MMT group was expected, but the efficacy of MMT was not evident at the 6- and 12-month observational periods. Only 23.64% of the addicts remained in MMT therapy. Conclusions: The adequacy of MMT implementation and its supporting measures in Taiwan must be further examined.
• 485 - 497
• 10.6288/TJPH2012-31-05-09