32卷2期

• Link 綜論 Review Article
• 肥胖的環境與生活型態因素Environmental and Lifestyle Factors of Obesity
• 簡義紋、吳岱穎、林光洋、吳逸帆、郭冠良、季瑋珠
  Yi-Wen Chien, Tai-Yin Wu, Kuang-Yang Lin, Yi-Fan Wu, Kuan-Liang Kuo, Wei-Chu Chie
• 肥胖 ； 環境 ； 生活型態 ； 成因
  obesity ; environment ; lifestyle ; contributing factors
• 肥胖是全球引起死亡的第五大風險因子，並造成個人代謝相關疾病及國家醫療財政負擔。造成肥胖的因素很多，可分為遺傳及基因因素、環境因素、生活型態因素、內分泌或藥物因素，本文旨在以三個層面來探討環境及生活型態因素對台灣近年來肥胖率增加的影響。（1）家庭層面：探討家庭社經地位、家庭生活品質、父母體型、飲食習慣變遷及靜態活動增長和肥胖的關係。（2）學校層面：探討運動時間減少及升學壓力造成睡眠時間減少和肥胖的關係。（3）社會層面：探討西式速食、含糖飲料、媒體廣告影響及肥胖稅和肥胖的關係。本文回顧現有文獻及統計資料並提出可行的解決方案，以期政府能透過政策執行來改善影響國民健康甚鉅的肥胖問題。
  Obesity is the fifth leading risk factor of death globally. Obesity causes diseases related to metabolic syndrome individually and creates medical and financial burdens nationally. Many factors contribute to obesity including factors classified as hereditary or genetic, environmental, lifestyle, and endocrine or medical in nature.The aim of this paper is to explore the effects of environmental and lifestyle factors on the increasing obesity rates in Taiwan in recent years using three components. (1) Family component: to discuss the relationship between family socioeconomic status, quality of family life, parental body stature, changes in dietary habits and increased sedentary activity and obesity. (2) School component: to explore the relationship between decreased exercise and sleep deprivation due to academic pressure and obesity. (3) Societal component: to explore the relationship between Western-style fast food, sugar-sweetened beverages, the impact of mass media, fat tax and obesity. In this paper, we review existing literature and available statistics and propose potentially feasible solutions to the issue of obesity in hopes that through governmental policy implementation, this significant health problem in the people of Taiwan can be ameliorated.
• 101 - 113
• 10.6288/TJPH2013-32-02-01

• Link 評論 Commentary
• 評論：肥胖的環境與生活型態因素Commentary to Environmental and Lifestyle Factors of Obesity
• 吳至行
  Chih-Hsing Wu
• 無
  none
• 無
  none
• 114 - 115
• 10.6288/TJPH2013-32-02-02

• Link 綜論 Review Article
• 照護連續性之文獻回顧A Literature Review of Continuity of Care
• 陳啟禎、 鄭守夏
  Chi-Chen Chen, Shou-Hsia Cheng
• 無
  continuity of care ; healthcare outcome ; review
• 照護連續性為初級照護的重要基礎。台灣全民健保實施後，高度就醫可近性和缺乏轉診機制，可能不利於照護連續性的提升。本文回顧照護連續性的概念、測量指標的演進和照護連續性與照護結果實證研究議題。我們搜尋MEDLINE及CEPS中文電子期刊服務之資料庫於1950年至2012年之研究，同時採用逐篇審視被引用文獻的方式定義出照護連續性相關的文獻，共計納入61篇文章。整體而言，照護連續性概念的定義已漸趨一致，人際面和資訊面為照護連續性兩個核心面向；由於行政資料庫的發展，照護連續性測量多以標準量化的指標為主。相較於早期的實證研究無一致性的結論，近期多數研究支持照護連續性可帶來較佳的照護結果和較低的醫療費用。本文建議未來的相關研究在方法學上，對於研究設計與處理時序性的議題、照護連續性測量指標的選擇等，應依研究目的考量其適用性。其次，有關照護連續性對照護結果的作用機轉，以及照護連續性各面向對於照護結果的相對影響力等議題，皆值得後續研究。
  Continuity of care (COC) is an essential issue in primary healthcare. Under the national health insurance (NHI) program in Taiwan, easy access to care and lack of referral may hamper the improvement of COC. This study reviews the evolution of the concept and measurement of COC, empirical studies concerning the relationship between COC and healthcare outcomes, and methodological issues. We retrieved studies from MEDLINE and Chinese Electronic Periodical Services databases from 1950 to 2012 and completed a manual review of cited articles to identify studies related to COC. A total of 61 studies were included in this review. In summary, there is emerging consensus on the concept of COC. ”Interpersonal” and ”information” are two essential dimensions of the concept of COC. Due to the increasing availability of administrative data, quantitative measures of COC have been commonly employed in recent studies. Compared to earlier studies with no consistent findings, the majority of recent studies have reported that better COC was associated with favorable healthcare outcomes and reduced healthcare expenses. We suggest that researchers consider the study design, handle temporal relationships between COC and healthcare outcome, and choose appropriate measures for determining COC according to their research objectives. In addition, future studies might focus on the mechanism between COC and healthcare outcomes, and the relative importance of various COC dimensions on healthcare outcomes. This review may be of interest to researchers in Taiwan.
• 116 - 128
• 10.6288/TJPH2013-32-02-03

• Link 原著 Original Article
• 兒童與青少年長期追蹤研究之未回應趨勢及其社會人口學因素Factors Related to Non-Response Trajectories of Children and Adolescents in a Long Term Follow-Up Study
• 陸玓玲、吳文琪、吳其臻、李蘭、 張新儀
  Dih-Ling Luh, Wen-Chi Wu, Chi-Chen Wu, Lee-Lan Yen, Hsing-Yi Chang
• 長期追蹤 ； 未回應趨勢 ； 群體軌跡分析
  Long term follow-up study ; Non-response trajectory ; Group-based trajectory model
• 目標：兒童與青少年行為之長期發展研究（簡稱CABLE計畫）因面臨研究樣本隨教育階段改變（國小、國中、高中、大學）而調整資料收集方法，本研究目的為描述兒童與青少年長期追蹤未回應之趨勢及原因，並分析其相關社會人口學因素。方法：CABLE計畫自2001年起針對台北及新竹國小一年級（世代一）和四年級學童（世代二）進行追蹤，以獲有父母同意書之學童為研究樣本（分別為2,852、2,663人）。未回應係指每年追蹤調查的應施測名單中未能回收問卷者。以世代分層Group-based Trajectory Model探討未回應趨勢及相關社會人口學因素。結果：經軌跡分析，世代一、二均呈現四個未回應軌跡：持續回應（世代一、二之百分比分別為73.4%、76.0%）、後期未回應（11.2%、5.4%）、漸增持續未回應（9.3%、8.2%）、及早期未回應後期回應（6.1%、9.7%）。相對於持續回應者，居住於台北、父母教育為高中及以下、父母婚姻為非結婚者，分別有較高之機會屬於不同狀況之未回應軌跡。結論：以CABLE持續追蹤資料進行推論時宜處理未回應之社會人口學差異。
  Objectives: The Child and Adolescent Behaviors in Long-term Evolution (abbreviated as CABLE) project had to change data collection methods for these subjects as they advanced to higher level schools including elementary school, junior high school, senior high school, and college or university. The purpose of this study was to describe the trajectories of non-response during the 9 year follow-up and to analyze the socio-demographic factors related to those trajectories. Methods: CABLE commenced in 2001 and subjects were followed every year. They were 1st and 4th grade students (sample sizes were 2853 and 2663 respectively) with parental consent in Taipei City and Hsin-Chu County. Non-response was defined as not responding to a questionnaire every year. We used the Group-based Trajectory Model to find non-response trajectories and related factors as stratified by cohorts. Results: Both cohorts showed four trajectories: continuing response (percentages in cohort 1 and cohort 2 were 73.4% and 76.0%, respectively), late non-response (11.2% and 5.4%), increasing non-response (9.3% and 8.2%), and early non-response but late response (6.1% and 9.7%). With continuing response as the reference group, those who lived in Taipei City, those whose parental education was lower than senior high school, and those whose parents were not married were more likely to be non-responsive. Conclusions: Using CABLE long term data to make implication should consider these socio-demographic differences with non-response trajectories.
• 129 - 139
• 10.6288/TJPH2013-32-02-04

• Link 原著 Original Article
• 台灣天主教醫院護理人員情緒勞務及心理健康之關係The Relationship between Emotional Labor and Mental Health among Nurses in Catholic Hospitals in Taiwan
• 李卿雲、謝碧晴、 蘇慧芳
  Ching-Youn Lee, Pi-Ching Hsieh, Hui-Fang Su
• 天主教醫院 ； 護理人員 ； 情緒勞務 ； 心理健康
  Catholic hospitals ; nursing staff ; emotional labor ; mental health
• 目標：探討台灣天主教醫院護理人員情緒勞務和心理健康之間的關係。方法：橫斷式、相關性研究，研究對象為6家天主教醫院。以林尚平之情緒勞務量表與世界衛生組織發展的心理健康自評問卷Self Reporting Questionnaire 20（SRQ-20），於2010年7月1日到2010年10月30日蒐集資料。結果：共有653位護理人員進入研究，其中有效問卷624份（95.56%）。以SPSS 18.0之描述性、變異數分析、相關及迴歸等統計檢測後發現：（1）護理人員情緒勞務負擔程度偏高（M±SD=5.41±1.19）；心理健康狀況不理想（M±SD=2.81±1.05），SRQ-20 50.4分；（2）情緒勞務的基 本情緒表達、表層情緒控制及心理健康會因教育程度、職務與科別之不同而呈現統計上顯著差異；（3）年齡、年資與基本情緒表達、表層情緒控制及心理健康呈顯著高度正相關；年齡與深層情緒偽裝呈顯著低度正相關；（4）基本情緒表達、表層情緒控制、互動程度、深層情緒偽裝與心理健康呈顯著高度正相關；（5）情緒勞務可解釋心理健康狀況21%變異量。結論：護理人員情緒勞務負擔程度偏高、心理健康狀況不理想。所以，醫療產業對此應加以重視。
  Objectives: The present study evaluated the relationship between emotional labor and mental health among nurses in Catholic hospitals in Taiwan. Methods: Based on a cross-sectional and correctional study design, the researcher invited nurses from six Catholic hospitals to participate between July 1 and October 30, 2010. Instruments were the Emotional Labor Scale developed by Shang Ping Lin and the Self Reporting Questionnaire 20 (SRQ-20) developed by the World Health Organization. Results: A total of 653 subjects were invited to participate, and 624 completed questionnaires were returned for an effective response rate of 95.56%. By using descriptive statistics, ANOVA, correlation, and regression analysis in SPSS 18.0, we found that: (1) Subjects had a relative higher degree of emotional labor (M ± SD = 5.41± 1.19) and poorer mental health status (M ± SD = 2.81 ±1.05) as measured by the SRQ-20; of 50.4; (2) There were significant differences in rules for emotional display, superficial acting, and mental health among different groups based on educational level, position, and working department; (3) Age and service seniority had a highly positive correlation with rules for emotional display, superficial acting, and mental health, whereas age was positively associated with deep acting; (4) Rules for emotional display rule, superficial acting, frequency and duration of interaction, and deep acting were highly correlated with mental health; (5) Emotional labor accounted for 21% of the variance in mental health. Conclusions: Nursing staff bear a high level of emotional labor with unsatisfactory mental health status. Administrators should pay close attention to these issues.
• 140 - 154
• 10.6288/TJPH2013-32-02-05

• Link 原著 Original Article
• 企業組織健康文化與組織健康促進效能之關係The Relationship between Organizational Health Culture and the Effectiveness of Health Promotion Activities in Organizations
• 林雅雯
  Yea-Wen Lin
• 組織健康文化 ； 健康促進效能 ； 職場健康促進
  organizational health culture?;?health promotion effectiveness?;?workplace health promotion
• 目標：本研究從組織理論的角度切入，探討組織健康文化與企業主所關心之健康促進效能的關係，此效能包括健康促進規劃成效、產出、成果與品質四個面向。方法：以立意抽樣法選取了55家台灣企業，由企業中負責職場健康促進業務的人員填寫測量組織健康促進效能的組織問卷，並自每家企業中選取20位專職員工，共1,100人，填寫測量組織健康文化知覺的員工問卷。再將同一組織內員工的知覺得分透過聚合程序進行加總平均，產生各企業組織的組織健康文化得分。回收之有效問卷包含54份組織問卷與1,011份員工問卷，有效問卷回收率為91.91%。研究資料以SPSS 17.0進行描述性統計、相關分析與層級迴歸分析。結果：組織健康文化只有對健康促進規劃成效、健康促進產出等過程面指標及健康諮詢率有所影響。而對於病假率、意外事件發生率、健康促進活動出席率與滿意度等指標則無顯著影響。結論：組織健康文化對於公司的健康促進規劃與產出等成效有正向影響，表示組織健康文化是影響職場健康促進計畫成功的關鍵因素，透過組織健康文化的形塑，才能將健康促進的理念深耕於組織與部門之中。
  Objectives: From the perspective of organizational theory, this study explored the relationship between organizational health culture and the effectiveness of health promotion activities of those organizations in four areas: planning effectiveness, production, outcome, and quality. Methods: Using purposive sampling, we selected 55 enterprises across Taiwan and asked service personnel who were responsible for workplace health promotion (WHP) to fill out a questionnaire that was designed to collect information about the effectiveness of their WHP. In addition, a sample of employee surveys (filled out by 20 full-time employees) was collected from each enterprise. These contained information about personal perceptions of organizational health culture. This information was provided by individual employees and aggregated into organizational-level data. Results: The results showed that organizational health culture had a significant impact on the effectiveness of the planning for and the production of health promotion activities; however, organizational health culture had no significant impact on indicators such as the rates of sick leave and accidents or on the level of satisfaction with and attendance at health promotion activities that served to evaluated both the outcome and quality of health promotion activities. Conclusions: Organizational health culture has made a positive impact on the planning and production of health promotion activities in organizations. This suggests that organizational health culture was a critical factor in the success of WHP. If there is a positive view of health culture in an organization, then the concept of health promotion will be deeply embedded in that organization and its departments.
• 155 - 169
• 10.6288/TJPH2013-32-02-06

• Link 原著 Original Article
• 蔬果攝取頻率與中老年人認知惡化的關聯性探討Association of the Frequency of Fruit and Vegetable Consumption with Cognitive Status and Subsequent Cognitive Decline in Older Taiwanese
• 陳正美、蔡仲弘
  Cheng-Mei Chen, Alan C. Tsai
• 認知惡化 ； 蔬果攝取頻率 ； 飲食 ； 老人
  cognitive deterioration ; fruit and vegetable consumption frequency ; diet ; elderly
• 無
  Objectives: This study aimed to determine the association between the frequency of fruit and vegetable consumption and cognitive function in older Taiwanese. Methods: We analyzed the 1999 and 2003 datasets of the ”Survey of Health and Living Status of the Elderly in Taiwan”. Subjects were 4440 ?53-year-old Taiwanese men and women. The frequency of consumption of fruits and vegetables in 1999 was examined for its possible cross-sectional association with cognitive status and for a possible association with the risk of cognitive decline four years later. Cognitive status and cognitive decline were rated with the SPMSQ scale. A reduction of 2 SPMSQ points was designated as a decline. Results: In a regression model that controlled for gender, age, years of education, smoking, drinking, betel quid chewing, physical activity, leisure activity, intake of nutritional supplements (fish oil & lecithin), and illness (hypertension, diabetes, heart disease, stroke) and other possible confounders, the cross sectional analysis showed that more frequent consumption of fruits and vegetables (?5 times/wk) was associated with a 31% reduction in cognitive impairment (OR = 0.69, 95 CI = 0.57-0.84, p = 0.001); the longitudinal analysis showed that those who consumed fruits and vegetables ?5 times/wk had a 23% reduction in cognitive decline 4-years later when compared to those who consumed fruits and vegetables ?4 times/wk (0.77, 0.59-0.99, p = 0.048). Other food categories such as meat and poultry, fish, seafood and dairy showed no significant associations. Conclusions: More frequent fruit and vegetable consumption was associated with a reduction in cognitive impairment and can protect against future cognitive decline. These results suggest that the intake of fruits and vegetables may offer protection against cognitive decline. The study also highlights the importance of diet in delaying aging-associated memory deterioration; however, these findings should be confirmed with more robust studies.
• 170 - 178
• 10.6288/TJPH2013-32-02-07

• Link 原著 Original Article
• 印尼居家看護自覺所需照顧支持之問卷發展與驗證Development and Validation of a Questionnaire to Measure Self-Perceived Needs for Care Supportive among Indonesian Home Care Aides
• 王琪珍、楊雅萍、陳俞成、王靜枝
  Chi-Jane Wang, Ya-Ping Yang, Yu-Cheng Chen, Jing-Jy Wang
• 居家印尼籍看護 ； 照顧支持 ； 問卷發展 ； 驗證性因素分析
  Indonesian home care aides ; care support ; questionnaire development ; confirmatory factor analysis
• 目標：發展與驗證印尼居家看護自覺所需照顧支持問卷之信效度。方法：三階段進行，第一階段為問卷發展及內容效度檢定，第二階段為印尼文翻譯及效度檢定，第三階段則邀請120位印尼籍居家看護進行印尼版問卷信效度檢定。參考House所提工具、資訊、情緒及評價等四種社會支持資源為架構，來擬定照顧支持問卷。以內在一致性檢定信度，以探索性因素分析及驗證性因素分析（結構方程模式）檢定建構效度，並以皮爾森相關係數檢定同時效度。結果：照顧支持問卷起初擬22題，經探索性因素分析縮減至11題，依題意亦歸為情緒、資訊、工具與評價支持等四個因素，各因素負荷量0.63～0.82，總解釋變異量61.74%，經結構方程模式驗證，顯示此四個因素之模式適配度、收歛及區別效度是良好，具有效度。題數縮減後，內在一致性KR-20為0.53～0.65，顯示具可信度。各因素與研究對象之人口學特徵達顯著相關，顯示具同時效度。結論：本研究所發展之照顧支持問卷，經檢驗具良好的信效度，並能有效供評估印尼籍居家看護照顧所需之支持參考。
  Objectives: The purpose of this study was to develop and validate a questionnaire to measure self-perceived needs for supportive care among Indonesian home care aides. Methods: This study was conducted in three phases: Phase one covered the development of the questionnaire items and the evaluation of content validity by experts. In Phase 2, the questionnaire was translated into Indonesian and the validity of the translated version was determined. In the final phase, 120 Indonesian home care aides were recruited in order to establish the reliability and validity of the questionnaire. Items on the questionnaire were designed based on House's social support model which includes four types of resources: instruments, information, emotion and evaluation. Data were analyzed using KR-20 for internal consistency of the items, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) using a structural equation model (SEM) for construct validity, and Pearson's correlation coefficient for concurrent validity. Results: Eleven of the original 22 items were retained through EFA; four factors were categorized as emotion, information, instruments, and evaluation. The factor loading of the four factors ranged from 0.63 to 0.82 and accounted for 61.74% of the total variance. The SEM approach indicated a satisfactory model-fit and convergent and discriminant validity. The item consistency reliability was 0.53- 0.65 for the 11 items, indicating good reliability. Conclusions: This measurement of self-perceived need for social support was valid and reliable. It can be an effective assessment tool with Indonesian home care aides.
• 179 - 191
• 10.6288/TJPH2013-32-02-08

• Link 原著 Original Article
• 台灣醫院門診降血壓處方品質之多層次分析A Multilevel Analysis of Quality of Outpatient Prescriptions to Treat Hypertension in Taiwan Hospitals
• 汪秀玲
  Hsiu-Ling Wang
• 降血壓藥物 ； 處方品質 ； 醫院 ； 門診 ； 多層次邏吉斯迴歸
  anti-hypertension agents ; prescriptions quality ; hospital ; outpatient ; multi-level logistic regression
• 無
  Objectives: To analyze inappropriate prescriptions at the market and hospital levels by examining antihypertensive medication ordering quality in out-patient departments (OPD) in Taiwan hospitals. Methods: Our sample included 398 accredited acute hospitals located in 23 regions. Information about hospital's ownership, rank, teaching status, OPD visits and hospital number published by the Department of Health (DOH) and information from the 2009-2011 Quality Database of Medications Indicators published by National Health Insurance were collected. The population density (PD) and physician density per 10000 population (PDPP) in the 23 regions were generated from DOH data. Two inappropriate prescription indicators were defined as duplicate medications of oral blood pressure-lowering agents or hypertension patients with a history of hyperkalemia using PSD or AA. We used MLLR models to assess multilevel effects on the probability of good or bad hospital quality for medications. The market concentration in the 23 regions was calculated by Herfindahl-Hirschman Index (H) using OPD visits to measure hospital competition. Results: Our study showed that higher H and PD led to greater probability of low duplicate medications. A higher PDPP led to lower probability of low duplicate medications. When compared to hospitals located in the Eastern region, the probability of low duplicate medications in Taipei, Southern, Kaohsiung-Pingtung areas is lower. The probability of low duplicate medications in teaching hospitals is lower than non-teaching hospitals and medical centers are higher than local hospitals. The probability of appropriately treating patients with hyperkalemia in Taipei, Northern, Southern, and Kaohsiung-Pingtung areas was higher than that of Eastern areas. Overall, the variation of medication quality can be explained 10.25%-17.63% by hospital-level variables and 73.40%-82.52% by market-level variables. Conclusions: Hospital and market characteristics impacted inappropriate prescriptions of anti-hypertensive drugs in the OPD setting over the past 3 years.
• 192 - 204
• 10.6288/TJPH2013-32-02-09