21卷4期

• Link 綜論 Review Article
• 有效解決河川水質污染之認知─以新竹茄苳溪為例Effective Solutions for the Pollution of River Water Quality-Chei-Tong River at Shin-Chu As an Example
• 莊德豐、高滄君、林佳宏、陳佩足、鄭雅愛
  Der-Fong Juang, Tsang-Jiun Kao, Lia-Hong Lin, Pei-Chu Chen, Ya-Ai Cheng
• 茄苳溪 ； 灌溉用水水質標準 ； 鈉吸收率 ； 電導度
  Chei-Tong River ; irrigation water quality standards ; sodium absorption rate ; conductivity
• 國內部分河川水質污染嚴重，不僅影響飲用水水源水質、公共衛生及環境品質，對兼具灌溉用途之河川，可能危害農作物之成長並造成土壤污染問題，更甚者會因污染物累積於農作物間接影響人健康。本文將以新竹茄苳溪流域為探討對象，彙整過去相關計畫及筆者參與其一計畫等之成果作一綜合討論，以瞭解該河川水質污染之種類與來源及作為農作物灌溉使用之適當性等，並提供有效解決河川水質污染之認知等。 由於茄苳溪源頭長期呈無水狀態，流域內之水源主要來自於新竹工業區污水處理廠之放流水及沿岸工廠之排放水，也受到生活、事業廢水等持續不斷排入之影響，其河川水質遭受嚴重污染，河水水體呈暗紅色，主要為新竹工業區污水處理廠排放具色度之放流水所致，而水質中SO4-2、CI-、鈉吸收率及電導度均超出灌溉用水水質標準，尤其是鈉吸收率及電導度兩項超出標準甚多，並不適於供農作物灌溉使用。因此，針對改善茄苳溪水質色度、鹽類等問題及檢討其灌溉用途而言，除建議可提昇新竹工業區污水處理廠處理能力並以灌溉用水水質標準為處理目標外，亦可由修改河川水體水質標準或灌溉用水水質標準著手，同時相關主管單位亦應積極協調尋求替代灌溉水源之可能性。
  The pollution of rivers will affect not only the quality of drinking water sources, public health, and environmental quality, but for those with an irrigation purpose, it may also endanger the growth of crops and cause soil contamination problems. Furthermore, the pollutants accumulated in crops may possibly influence human health. With the Chei- Tong River at Shin Chu as an example, the authors collected data from relevant past research, discussed the water quality pol1ution problem of the river, and finally provided effective solutions for the problems. The water in this river mostly came from the discharge of some plants along the river and the wastewater treatment plant of Shin-Chu Industrial Park. It was found that the river water appeared dark red. This was primarily due to the discharge from the treatment plant and the SO4-2 and Cl- in the water. The conductivity and SAR (Sodium Absorption Rate) of the water, in particular, were much higher than irrigation water quality standards. Therefore, it was concluded that the water of Chei- Tong River was not appropriate for irrigation purposes. To solve these problems, the authors suggested that the treatment capability of the wastewater treatment plant should be improved, the water quality standards of the river or for irrigation usage should be revised, and the relevant governmental institutions should actively look for other alternative irrigation water sources.
• 223 - 234
• 10.6288/TJPH2002-21-04-01

• Link 綜論 Review Article
• 臺灣原住民醫療衛生政策之回顧A Review of Aboriginal Health Policy in Taiwan
• 鴻義章、林慶豐、彭玉章、呂淑妤
  Antonio I.C. Hong, Chin-Feng Lin, Eugene Yu-Chang Peng, Shu-Yu Lyu
• 原住民 ； 醫療服務 ； 衛生政策
  aborigines ; medical services ; health policy
• 我國原住民雖然只佔全國人口約2％，但近年來隨著社會變遷與憲法修正條文對於原住民族地位與多元文化發展之肯定與保障，許多與原住民有關之健康議題亦被納入國家重要衛生政策中。本文之主要目的在於探討我國原住民衛生政策之過去發展歷程。結果發現臺灣先後歷經荷蘭統治時期、西班牙統治時期、鄭成功時代、滿清統治時期與日領時代等幾個殖民統治階與光復後或民政府時期，依照其不同時代背景與特性，可將原住民衛生政策之發展為傳統醫療期、萌芽期、鄭基期、建立期、發展期、茁壯期及永續經營期等七個時期。自民國七O年代開始，山地鄉居民的健康狀況漸受重視，而一直到民國八十七年衛生署醫政處正式成立「山地離島醫療科」開始，原住民醫療衛生政策更邁入一個新的里程碑，屬於成長茁壯的時期，而現階段在邁入新世紀後，則希望朝永續發展的目標精進。
  The aboriginal people comprise approximately 2% of the total population in Taiwan. Aboriginal health related issues have become one of the most important national health policies in recent years due to the transition of society and the modification of the Constitution in order to respect and ensure aboriginal status that is based on multiple cultural perspectives. The major purpose of this paper is to review the policy which relates to aboriginal health. This review will include several periods: Dutch, Spanish, Cheng's, Ching Dynasty and Japanese periods. The development of aboriginal health policies may be divided into seven stages according to different time periods and their characteristics. They are: traditional medicine, budding, founding, establishing, developing, mature, and sustainable management stages. The health status of residents in mountain areas had been ignored until the 1980s. It was noted that a specific administrative department which is in charge of the health programs of”mountain areas and off-shore islands” was established in 1998 by the Bureau of Medical Affairs, Department of Health, the Executive Yuan, Taiwan, R.O.C. Therefore, the development of aboriginal health policies is a new development which has remained and constant since 1998. It is hoped that aboriginal health policies will develop into a sustainable management stage in the new century.
• 235 - 242
• 10.6288/TJPH2002-21-04-02

• Link 原著 Original Article
• 臺灣地區不同行政區域主要死因之累積死亡與潛在生命損失累積率Cumulative Mortality Rates and Cumulative Rates of Potential Life Lost For Main Causes of Death in Different Administrative Areas in Taiwan
• 張晉豪、梁燕青、廖勇柏、李文宗
  Chin-Hao Chang, Yan-Ching Liang, Yung-Po Liaw, Wen-Chung Lee
• 十大死因 ； 累積死亡率 ； 潛在生命損失累積率 ； 城鄉差異
  ten leading causes of death ; cumulative mortality rate ; cumulative rate of potential life lost ; urban and rural differential
• 目標：本研究比較不同地區主要死因，及各死因對社會衝擊的程度。方法：將民國80至89年臺灣地區的死亡及人口資料予以合併，計算不同區域之死因別累積死亡率(CR)與潛在生命損失累積率(CRPLL)。結果：不同行政區域中，男女性CR多以「惡性腫瘤」為首，男性約32％，女性約19％(山地鄉女性以「腦血管疾病」為首，21％)。CR隨著行政位階的降低增加。不同行政區域中，男性CRPLL皆以「意外事故」為首。其中以山地鄉最高，達1,773天。女性CRPLL在院轄市、省轄市及縣轄市以「惡性腫瘤」為最高(約190天)，然而在平地鄉及山地鄉以「意外事故」最高(平地鄉210天，山地鄉558天)。CRPLL在各行行政區域之排序大致相似。但在山地鄉，「慢性肝病及肝硬化」由第五升至第二；「結核病」由第九升至第六。結論：本研究結果可供中央及各地衛生機關擬定衛生政策之參考。潛在生命損失累積率以及累積死亡率之計算簡單且含意清楚，往後衛生統計應可將其計算及呈現列為例行常規之一。
  Objectives: This paper compares the main causes of death in different administrative areas in Taiwan using indices of cumulative mortality rate (CR) and cumulative rate of potential life lost (CRPLL). Methods: Age-specific population numbers and death numbers were abstracted from Vital statistics in Taiwan, 1991-2000. CRs and CRPLLs in different administrative areas in Taiwan were calculated. Results: Among the causes of death that were studied, malignant neoplasm was the highest CR for males (~32%) and for females (~19%) in most administrative areas. (Cerebrovascular disease was the highest CR [~21 %] for females in aboriginal townships.) CRs are higher as the level of the administrative area becomes lower. For males, accidents and adverse effects were the highest CRPLL in every administrative area. This figure amounted up to 1,733 days in aboriginal townships. For females, malignant neoplasm was the highest CRPLL (~190 days) in metropolitan clues, provincial cities, and urban townships, whereas accidents and adverse effects was the highest CRPLL in rural (210 days) and aboriginal (558 days) townships. The ranking of the various causes of death using the CRPLL indices was similar in most administrative areas, but it changed Tram fifth to second and the ranking of tuberculosis climbed from ninth to sixth. Conclusions: The results of this study could be a reference for health agencies, central or local, inorder to make policies. CR and CRPLL can be simply calculated and their meanings are transparent. It is recommended that they be routinely compiled in official vital statistics.
• 243 - 252
• 10.6288/TJPH2002-21-04-03

• Link 原著 Original Article
• 飲用水經電解處理後之水質變化Changes on Drinking Water Quality After Electrolysis Treatment
• 王根樹、陳祈森、陳進傳
  Gen-Shuh Wang, Chi-Shen Chen, Chin-Chuan Chen
• 電解水 ； 金屬離子 ； 陰離子 ； 總菌落數 ； 大腸桿菌
  electrolyzed water ; metal ions ; inorganic ions ; total bacteria counts ; coliforms
• 目標：將電解水生成器視為一個「淨水單元」，探討一般飲用水經電解水生成器電解後之水質變化。方法：以市售某廠牌電解水生成器為對象，以純水添加微生物或無機鹽類作為人工合成進流水，在不同電解條件下進行測試，探討所生成電解水的水質特性。結果：進流水通過電解糟後，水體的pH值、氧化還原位(ORP)及電導即發生顯著之變化，同時酸性水及鹼性水之水質特性趨勢亦相反。測試結果顯示電解水生成器可去除部分砷及鉛，對總菌落數及大腸桿菌群也有部分去除效果；但使用純水為進流水之試驗結果顯示生成之電解水水質並無明顯變化。結論：經電解作用所生成電解水水質成分。但進流水水質隨地理環境及使用原水之不同而有所不同，必須注意如何控制電解質之添加劑以維持電解功能之充分發揮。
  Objective: An electrolyzed-water treatment device was used as a ”water purification unit” to evaluate the changes on the characteristics of drinking water quality after electrolysis. Methods: The characteristics of the electrolyzed water were studied using a commercial electrolyzed-water treatment device. Laboratory spiked water with various compositions of inorganic and microbial was used as the input water. Water quality parameters before and after different electrolysis conditions were compared. Results: After electrolysis, major differences were observed on the pH, oxidation-reduction potential (ORP) and conductivity between the electrolyzed water and the input water. An opposite trend was observed between the electrolyzed acidic and alkaline water. The electrolysis process was able to remove part of lead and arsenic, partial removal was also obtained for coliform groups and total bacteria counts. However, no apparent change was observed after electrolysis when pure water was used as the input. Conclusion: The change in pH, ORP and conductivity in electrolyzed water was due to the presence of the electrolytes in water. In some cases it is necessary to add some electrolytes in input water to enhance the electrolysis processes. However, since the input water quality varies with geographic locations, one should carefully control the amounts of the electrolytes in input water for the optimum performance of the electrolysis process.
• 253 - 265
• 10.6288/TJPH2002-21-04-04

• Link 原著 Original Article
• 台北市產後護理機構之照護品質調查Quality of Care in Postpartum Care Organizations in Taipei
• 蘇喜、蕭世槐、湯靜怡
  Syi Su, Shih-Huai Hsiao, Tang ; Jing-Yi
• 產後護理 ； 坐月子 ； 照護品質
  Postpartum care organization ; Postpartum care ; Quality of care
• 目標：本研究主旨在瞭解產後護理機構(坐月子中心)之照護品質現況。方法：本研究為一橫斷性研究，使用二份具有信、效度之問卷，以非隨機取樣方式，分別實地訪查位台北市內的9家產後護理機構之設施／設備及服務提供狀況，及以面訪方式調查居住於內之258位產婦之照護滿意度。結果：(1)利用產後護理機構之產婦以30~34歲最多，約佔50.8%，平均年齡為32.7歲；產婦及其配偶之學歷在大學以上者最多，分別佔51.4%及65.2%，產婦與配偶之職業分類亦以專業性及技術性相關工作、自營事業者及經理主管居多；(2)坐月子中心中立案者僅1家，平均成立時間為7.8年，平均床數為16.4床，每床平均可使用為32.06平方公尺。收費金額每日平均為3,008元，產婦利用前需要繳交保證金及預約床位金；(3)產婦對整體坐月子服務滿意度感到滿意者有57%。感覺尚可的有40％。在對托育服務之整體性滿意度，有61.3%感到滿意，感覺尚可有35％；其他各方面的滿意度皆比產婦對自己的服務滿意度要高。(4)選擇接受機構式照護之原因以專業化照護、家中沒人可以幫忙坐月子、同事朋友建議等等為主。(5)有關與產後護理機構之資訊來源以曾經利用者或其親屬介紹者、及媒體宣傳為主。(6)選擇產後護理機構的考量因素以照顧品質較佳、扽嬰設備很好、居住環境良窳為要，且保證金收取與否會影響其坐月子及托育服務滿意度。結論：綜而言之，產後護理機構其照護品質，在結果上，不論在產婦之坐月子服務滿意度、抑或托育服務滿意亦達六成；在結構面上，仍以機構未經政府單位立案之問題居首，此值得衛生主管機關注意。
  Objective: This research is aimed to explore the current quality situation of postpartum care organizations (PCO) and the degree of satisfaction the residing postpartum women hold. Method: This study design is a cross-sectional study. Two questionnaires which were reliable and valid were utilized to explore both the postpartum care organizations and the residents' opinion of the quality of care. Census survey of the nine PCOs and 258 nonrandomly sampling subjects among their residents, were subjects of organizations and residents respectively. Results: The following results were found: (l) 50.8% of residents of PCOs are aged 30-34 years old, 51.4% and 65.2% of residing postpartum women and their husbands' education level was bachelor's level. Their occupational status were mostly professional and skilled related jobs, a self-run business or manager. This shows that the socio-economic status of the subjects were relatively high. (2)Among the nine organizations, only one is legally registered. The average daily expense is 3,008 NT dollars. Besides that, most organizations require the residents to submit 10,000 NT dollars as a deposit or reservation right for a bed. (3) 57% of the subjects feel satisfied with the overall services, 40% feel they are acceptable. 61.3% of the subject feel satisfied with the baby care services, 35% feel they are acceptable. The other perceived satisfaction of baby-sister services were assessed higher than postpartum women.(4) the main reasons for utilizing institutionalized postpartum care are believed to be that the PCOs provided professional postpartum care, no relative can provide postpartum care services, and colleagues' and friends' advice. (5) the postpartum women were informed by other users' suggestions, relatives, and the mass media. (6) the factors for choice consideration were quality of care, a lot of good baby care facilities and equipment, and a comfortable residential environment. Conclusion: As to the outcome Quality of PCOs, the satisfaction proportion toward postpartum care and baby care are both above 60%. The illeqal nature of the PCOs is a most important issue and deserves more attention from the authorities.
• 266 - 277
• 10.6288/TJPH2002-21-04-05

• Link 原著 Original Article
• 癌症住院病人精神醫療照護服務之醫療利用研究The Utilization of Psychiatric Services in Cancer Inpatients
• 李宣緯、葉玲玲、王金龍、徐聖輝、黃達夫
  Hsuan-Wei Li, Ling-Ling Yeh, Ging-Long Wang, Sheng-Hue Hsu, Andrew T. Huang
• 癌症病人 ； 醫療利用 ； 精神醫療服務 ； 精神科照會
  cancer patients ; medical utilization ; psychiatric service ; psychiatric consultation-liaison service
• 目標：檢視國內癌症病人於住院期間精神醫療利用情形及其影響因素。方法：分析國內某癌症專科醫院2001年癌症住院病人的精神醫療利用情形及影響其精神醫療利用的因素。並與1999年全國癌症住院病人的精神醫療利用比率進行比較。結果：根據某癌症專科醫院的資料分析結果發現，病人的年齡、住院日數和病人於該次住院合併精神疾病診斷碼的數目均會影響癌症住院病人是否接受精神醫療照護服務。且接受精神醫療照護服務癌症住院病人，其精神疾病診斷分布以適應障礙比率最高。在精神醫療用比率方面，國內癌症住院病人接受精神醫療照護服務的比普遍偏低，某癌症專科醫院癌症住院病人精神醫療利用比率4.1%，其他院則介於0％~2.2%之間。不同癌症類別病人接受精神醫療利用比率偏低，因此未來應積極探討腫瘤病人精神層面的需要。此外，未來健保支付制度調整時，亦需特別關注癌症病人精神醫療照護服務相關議題。
  Objectives: This study attempts to examine the utilization and factors affecting the utilization of psychiatric services of cancer inpatients in Taiwan. Methods: The study was conducted by analyzing the utilization and factors affecting the utilization of the cancer inpatients in a cancer center in Taiwan in 2001. Results were then compared with the utilization rate of the psychiatric care of all cancer inpatients throughout Taiwan in 1999. Results: Age, length of hospital stay and the number of psychiatric diagnosis were the factors that affect the utilization of psychiatric care. Of the psychiatric diagnosis of these patients, adjustment disorders were by far the most common. The utilization of psychiatric services for cancer inpatients was generally very low in Taiwan. It was 4.1 % in the cancer center and between 0% and 2.2% in general hospitals in Taiwan. Among cancer inpatients with different cancer sites, the utilization rate of the psychiatric care was higher in patients with central nervous system cancer. Conclusion: The low utilization rate of psychiatric services by cancer inpatients in Taiwan calls for an in-depth review of the necessity of psychiatric support in oncology patients. Furthermore, the appropriate utilization rate of psychiatric care for cancer patients should also be considered as an important issue in future restructuring of the reimbursement programs by the national health insurance.
• 278 - 288
• 10.6288/TJPH2002-21-04-06

• Link 原著 Original Article
• 臺灣的社會資本與自評健康Social Capital and Self-Rated Health in Taiwan
• 鄭惠玲、江東亮
  Hui-Ling Cheng, Tung-Liang Chiang
• 社會資本 ； 自評健康
  Social Capital ; Self-Rated Health
• 目標：本研究旨在採討臺灣社會資本成人自評健康的關係。方法：橫斷性次級資料分析，分析單位為個人。研究資料來自1996年的「台灣社會變遷調查」，為全國性代表樣本，共2,385名成人。社會資本指標由社會信任及社會參與兩個面向組成，共有五道測量題目。本研究利用對數迴歸分析檢視社會資本是否與自評健康有關。結果：整體而言，84.2%的受訪者自述身體狀況為好或很好，87.6％的受訪者自述目前生活快樂或很樂。社會資本越高，越容易自述身體健康和生活快樂。在控制性別、年齡、教育程度和個人收入等級後，自述身體健康的勝算比為1.2(95%信賴區間1.1-1.3)，自述生活快樂的勝算比為1.3(95%信賴區間1.2-1.5)。結論：社會資本是台灣成人自評健康的重要影響因素。
  Objectives: To examine the relationship between social capital and self-rated health among adults in Taiwan. Methods: Cross-sectional and individual-level secondary data analysis. Data for the analysis came from the 1996 Taiwan Social Chang Survey with a nationally representative sample of 2,385 adults. Social capital was measured using a 5-item scale covering social trust and social involvement. Logistic regression was applied to explore whether social capital was associated with self-rated health. Results: Overall, 84.2% reported their physical health as being good or excellent, and 87.6% living happily or very happily. High social capital was significantly associated with self-rated good physical health and happy life. The odds ratio for good physical health and happy life were 1.2 (95%CI 1.l-1.3) and 1.3 (95%CI 1.2-1.5) after controlling for sex, age, education and individual income class. Conclusions: Social capital was very significant in determining self-rated health among adults in Taiwan.
• 289 - 295
• 10.6288/TJPH2002-21-04-07

• Link 實務 Public Health Practice
• 探討台灣地區醫院品質報告卡之可行指標Exploring the Applicable Quality Indictors on Hospital Report Cards in Taiwan
• 陳楚杰、林恆慶、勞寬
  Chu-Chienh Chen, Herng-Ching Lin, Kuan Lao
• 醫院品質報告卡 ； 醫療照護市場 ； 品質指標
  hospital report cards ; medical care market ; quality indicators
• 目標：本研究之目的為探討台灣地區醫院認為適當的主導推行醫院品質報告卡之組織及其公佈品質資訊的意願狀況和願意公佈的指標。方法：本研究以495家地區級(含)以上醫院為研究對象，採取郵寄問卷的方式蒐集所需的資料。結果：問卷回收183份，總回收率為37%，其中地區教學級(含)以上醫院的回收率為68.75%，但地區醫院回收率僅有25.9%。有57.7%的樣本醫院認為由財團法人醫院評鑑醫療品質策進會主導進行較適當。有52％的樣本醫院願意公佈其品質資訊。有50％以上樣本醫院願意公佈品質資訊，平均住院日及病人滿意度等10項。結論：有52％的樣本醫院願意公佈品質資訊，衛生主管機關可考慮推動醫院品質報告卡，促使醫院提升醫療服務品質。以保障民眾就醫權益及增進醫療照護市場的效率。
  Objectives: The purposes of this study are to explore the appropriate organization to initiate hospital report cards and to understand hospitals’ willingness to use report cards and publishable quality indicators. Methods: The study used 495 hospitals including medical centers, regional hospitals, teaching district hospitals, and district hospitals as the study sample. A mailing survey was performed to collect applicable data. Results: There were 183 questionnaires returned. This equaled a response rate of 37%. The response rate for medical centers, regional hospitals, and district teaching hospitals was as high as 68.75%. However, the response rate for district hospitals was only 25.9%. Among the sampled hospitals, 57.7% chose the Taiwan Joint Commission on Hospital Accreditation as the most appropriate organization to initiate hospital report cards. Over 50% of hospitals are willing to publish 10 quality indicators including physician specialty and practice experience, average length of stay, and patient satisfaction. Conclusions: In total, 52% of the sampled hospitals are willing to publish performance information. It is recommended that policy makers consider initiating hospital report cards. The report cards could help hospitals improve quality of services in order to protect consumers’ rights and enhance the efficiency of the health market.
• 296 - 304
• 10.6288/TJPH2002-21-04-08