19卷2期

• Link 公衛論壇 Public Health Forum
• 水泥中鉻所造成的職業皮膚炎可能為國內最常見之職業皮膚病水泥中鉻所造成的職業皮膚炎可能為國內最常見之職業皮膚病
• 郭育良、 陳秋蓉
  Yue-Liang Leon Guo, Chiou-Jong Chen
• 無
  none
• 無
  none
• 67 - 68
• 10.6288/CJPH2000-19-02-01

• Link 綜論 Review Article
• 由第二屆世界衛生經濟學大會看衛生經濟學之發展The Future of Health economics-Reflections on the Second World Conference of International Health Economics Association
• 紀駿輝
  Chun-Huei Chi
• 衛生經濟學 ； 國際衛生經濟學學會 ； 需求模式
  Health Economics ; International Health Economics Association ; Demand Analysis
• 國際衛生經濟學會iHEA是衛生經濟學界最重要的環球學術團體，其舉辦的世界衛生經濟學大會亦是衛生經濟學的最重要之學術會議。在該大會所發表的論文，可以作為衛生經濟學界發展的指標。本文藉著作者參與該會在1999年6月6日至9日於荷蘭鹿特丹舉行第二屆大會觀察發表論文的數量與種類，來分析衛生經濟學近來與未來之發展。本文分為兩大部份，第一部份藉分析論文的性質可知，與衛生財務或健康保險相關的議題為衛生經濟學最熱門的主題，佔論文總數的30%。其次則為經濟評估相關的研究。文中亦由論文發表者的所屬機構及國家來分析衛生經濟學在各國的發展情況。第二部份則評介二個較重要的論文發表和一場衛生經濟學理論的大辯論。這些論文及辯論的共同主題是對衛生經濟學理論、分析模式與假設，以及研究方法的反省與批判。增進我國在世界衛生經濟學界的學術地位之策略。
  International Health Economics Association (iHEA) is, arguably, the most important international academic association for health economics. This paper summarizes the nature and contents of the Second World Conference of iHEA, held in Rotterdam from June 6 to 9 of 1999. The first part of this paper discussed the number and nature of papers presented at this conference. Results of analysis suggests that the subject related to health care finance and health insurance is the most popular in this conference, with a total of 163 papers, representing 30% of the total number of papers presented. The second most popular research area, with is economic evaluation, 129 papers (23.8%). Furthermore, I also examine the development of health economics in the world, by analyzing the number of papers presented by each country’s delegates. Finally, discussion and comment on two plenary session papers and one debate session on health economics demand theory. A common thread to these sessions is the critical examination of health economics theories, analytical model and its assumptions, and research methods. If this introspection in followed by many health economists, it will have a profound impact on the field of health economics. Finally, I propose several strategies to promote the development of health economics in Taiwan and discussed the global significance of this development.
• 69 - 85
• 10.6288/CJPH2000-19-02-02

• Link 原著 Original Article
• 臺灣地區醫師人力供需預測之情境分析Scenario Analysis of Physician Manpower Supply and Demand in Taiwan
• 藍忠孚、宋文娟、陳琇玲、詹錕鋙
  Chung-Fu Lan, Wen-Chuan Sung, Hsiu-Ling Chen, Kun-Wu Tsan
• 醫師人力供需 ； 情境分析法
  Physician Manpower Supply and Demand ; Scenario Analysis
• 目標：為預測未來短、中、長期醫師人力可能面臨問題。方法：本文以質性研究方式運用情境分析法引入模擬情境。結果：經研究發現未來醫師人力供需：（１）若短、中期內醫師人力政策維持不變，則人力問題需以輔助方案予以緩解；（２）若短、中期內醫師人力政策採調整策略，則人力問題可以獲致適當解決；以及（３）若短、中期內醫師人力政策採開放制度，則人力過剩效應會在長期顯現。結論：最後提出討論，期使我國醫師人力培育制度之發展臻於健全
  Objectives: This study aimed to analyze physician manpower supply and demand. Methods: Using the method of scenario analysis in order to predict possible trends and problems in the future. Results: Our research findings were as follows: (1) If short and mid-term physician manpower policies are fixed, certain supporting plans will be needed. (2) If short and mid-term physician manpower policies are not constant, the manpower problem shall be adjusted with solutions. (3) If short-and mid-term physician manpower policies adopt to an open system, there will be an oversupply of physicians in the long run. Conclusions: Finally, we expect that Taiwan’s physician manpower policies can be improved.
• 86 - 95
• 10.6288/CJPH2000-19-02-03

• Link 原著 Original Article
• 某市立醫院民營規劃之財務影響評估－財務分析之應用Evaluating the Financial Impact of Privatizing a Municipal Hospital: An Application of Financial Analyses
• 張睿詒、侯穎蕙、董鈺琪、楊志良
  Ray-E Chang, Ying-Hui Hou, Yu-Chi Tung, Chin-Liang Yuang
• 財務分析 ； 民營化 ； 公立醫院
  financial analysis ; privatization ; government-owned hospital
• 目標：運用財務分析，探討公立醫院不同經營方式之財務影響，提供決策制定所需之財務訊息。方法：結合財務分析中現金流量預估、收入（成本）習性分析、淨現值法以及敏感度分析做為結構式分析程序，估計不同經營方式之營運成果。資料來自同一醫療區六家市立綜合醫院以及六家財團法人綜合醫院。結果：在任何景況下，半開放模式與合作經營模式均提供較佳之淨現值。半開模式可獲得之淨現值介於３億１千４百餘萬元與９億３千２百餘萬元之間；另一方面，合作經營模式淨值介於５億１千７百餘萬元與８億５千２百餘萬元。但醫院實際提供之財務貢獻，若合作經營模式可分享之經營成果不及６１％，則半開放模式將是較佳之經營選擇。結論：半開放模式與合作經營模式均為財務結果較佳之可行方案，但對個案醫院所提供之實質財務貢獻，方為決策者所應考量之攸關資訊。本研究之財務分析，係建立一系統化之分析架構，提供決策制之定財務攸關資訊。然而，準確的財務估計，除了系統化分析方法，尚需藉由過去預估經驗加以持續改善方可獲得。
  Objectives: This study intends to investigate the financial impacts of different operation alternatives for a government-owned hospital. Through financial analyses, decision-makers can gain financial insight into different alternatives, Methods: Operation results of different alternatives were obtained based on cash flow analysis, revenue/cost behavior analysis, net present value, and sensitivity analysis. Data were obtained from financial statements of six municipal general hospitals and six private not-far-profit genera1 hospita1s in the same medica1 region. Results: In all cases, the semi-open and joint venture models resulted in higher net present values (NPV) than did the other models. While the semi-open model obtained NT $314-$392 million NPV from its operations, the NPV for the joint venture model was NT $517-$852 million. However, if the hospital's share is less than 61 % of its operating result in the joint venture model, the semi-open model is preferred in terms of providing more actual financial contribution to the hospital. Conclusions: The semi-open and joint venture models are superior to other models in terms of financial results. However, for the decision-maker, the net financial contribution to the hospital should be a relevant issue for consideration. This study establishes a systematic approach to decision making by employing financial analyses. Nevertheless, accurate final1cial estimates depend not only on a systematic approach but also on continuous refinement of the analyses based on past estimating experiences.
• 96 - 108
• 10.6288/CJPH2000-19-02-04

• Link 原著 Original Article
• 金門縣金城鎮第二型糖尿病患者視網膜病變盛行率及相關因素Prevalence and Associated Factors of Diabetic Retinopathy among Type 2 Diabetic Subjects in Kin-Chen, Kinmen
• 周碧瑟、曹雪琳、董道興、曾國亮、陳水湖
  Pesus Chou, Hsueh-Lin Tsao, Tao-Hsin Tung, Gou-Liang Zeng, Swei-Hu Chen
• 第二型糖尿病 ； 視網膜病變 ； 盛行率 ； 相關因子
  type 2 diabetes ; diabetic retinopathy ; prevalence ; associated factors
• 目標；探討金城鎮糖尿病患者視網膜病變之盛行率與相關因子。方法：本研究以陽明十字軍於1992至1994年於金城鎮針對30歲以上居民篩選出的糖尿病患360人為研究對象，於1996及1997年由同一位眼科專科醫師以間接眼底鏡進行散瞳眼底檢查來論斷視網膜病變，總共完成237人。完成率65.8%。結果：研究結果發現237名糖尿病患者中，36位有視網膜病變，盛行率為15.2% , 其中背景期糖尿病視網病變7.2%、前增殖期糖尿病視網膜病變7.2%、增殖期糖尿病視網膜病變0.8%。多變項對數迴歸分析結果發現，糖尿病患病期間每增加一年期視網膜病變盛行率增加1.3倍(95%信賴區間為1.2-1.4)，糖化血色素每增加1%其盛行率增加1.3倍(95%信賴區間為1.1-1.5)，微量白蛋白尿≧50 mg/1者的盛行率是微量白蛋白尿＜50 mg/1的3.7倍(95%信賴區間為1.3-10.6)。女性的盛行率是男性的3.8倍(95%信賴區間為1.4-10.1)。結論：本研究發現糖尿病患視網膜病變盛行率為15.2%，糖尿病患病期間長、糖化血色素高、微量白蛋白尿高、以及性別（女性高於男性）均為影響糖尿病視網膜病度的相關因子。
  Objectives: To study the prevalence and associated factors of retinopathy among type 2 diabetics in Kin-Chen. Methods: A cross-sectional study on retinopathy among 360 diabetic subjects, screened by the Yang-Ming Crusade from inhabitants aged 30 and over in Kin-Chen in 1992-1994, was carried out in 1996-1997 by an ophthalmologist using indirect ophyhalmoscopy to examine the fundus after dilating pupils for the diagnosis of diabetic retinopathy. In total, 237 (65.8%) subjects were examined. Results: Thirty-six of 237 diabetics were diagnosed with diabetic retinopathy. The prevalence was 15.2%, including background diabetic retinopathy 7.2%, pre-proliferative diabetic retinopathy 7.2, and proliferative diabetic retinopathy 0.8%. Based on multiple logistic regression analysis, the significant associated factors for diabetic retinopathy were duration of diabetes (OR=1.3, 95% CI: 1.2-1.4), HbA1c (OR=1.3, 95% CI: 1.1-1.5), microalbumin (?50 mg/1 vs. <50 mg/1, OR=3.7, 95% CI: 1.3-10.6), and sex (female vs. male, OR=3.8, 95% CI: 1.4-10.1). Conclusions: This study found that the prevalence of retinopathy among type 2 diabetic subjects was 15.2% The statistically significant associated factors were longer duration of diabetes, higher HbA1c, higher microalbumin, and female sex.
• 109 - 118
• 10.6288/CJPH2000-19-02-05

• Link 原著 Original Article
• 事業廢棄物非法掩埋場周邊民井水質揮發性有機物之調查研究An Investigation on Volatile Organic Compounds in Ground Water at Industrial Waste Dump Sites
• 王正雄、陳麗霞、鄭資英、傅千育
  Cheng-Hsung Wang, Li-Shiar Chen, Tzu-Yin Cheng, Chien-Yu Fu
• 廢棄物污染 ； 地下水 ； 揮發性有機化合物
  industrial waste contamination ; ground water ; volatile organic compounds
• 目標:本研究在探討事業廢棄物非法掩埋場址附近民井水質可能受揮發性有機物(Volatile Organic Compounds，簡稱VOCs)污染之暴露評估。方法:本研究於53處事業廢棄物非法掩埋場址附近l公里範園內，調查344口民井，估算井深，測定水溫，以密閉容器採取水樣，攜回實驗室內以吹氣捕捉毛細管柱氣相層析法／串聯式光離子化偵測器及電解導電感應偵測器檢測法，檢測水樣受揮發性有機物污染之情形。結果：344口民井水樣中，測得69口受七種VOCs污染，包括：42個水樣檢出總三鹵甲烷(0.43~24.88μg/L，平均1.93μg/L)、28個水樣檢出1,1,1-三氯乙烷(0.41~4.03μg/L，平均1.05μg/L)、15個水樣檢出1,1-二氯乙烯(0.88~12.18μg/L，平均2.71μg/L)、8個水樣檢出氯乙烯(0.47~0.66μg/L，平均0.53μg/L)、3個水樣檢出三氯乙烯(0.52~3.45μg/L，平均1.51μg/L)、3個水樣檢出四氯化碳(0.43~1.54μg/L，平均0.69μg/L)及2個水樣檢出1,2-二氧乙烷(1.18和1.28μg/L、平均1.23μg/L)。大部份水樣可檢出一種VOC，但部份水樣可同時檢出4種VOCs。個別水樣之VOCs總濃度多在1.0~5.0μg/L之間，VOCs污染物中除1,1-二氯乙烯在高雄縣有1件12.18μg/L)、屏東縣有2件(7.15μg/L、7.46μg/L)超出飲用水水質標準(7μg/L)外，餘均符合規定。結論：廢棄物不當掩埋可能會對附近民井之水質造成污，建議受VOCs污之井水須經者沸後飲用。
  Objectives: This research was conducted to investigate the contamination of volatile organic compounds (VOCs) in the ground water obtained from wells near illegal dump sites of industrial wastes. Methods: Samples were obtained from 344 wells located within one kilometer in distance from 53 dumping sites identified in 3 counties and cities. The depth of wells and the temperature of samples were measured at the sampling sites and collected using closed containers. VOCs were analyzed at the Environmental Protection Administration Laboratory by purge and trap pretreatment capillary column gas chromatography equipped with photoionization and electrolytic conductivity detectors in series. Results: Among 344 wells, 7 VOCs were quantitated in samples from 69 wells (20.1%). These contaminants included: total trihalomethane (0.43~24.88µg/L, averaged 1.93µg/L) in 42 samples, 1,1,1-trichloroethane(0.41-4.03µg/L, averaged 1.05µg/L) in 28 samples,1,1 –dichloroethene(0.08~12.18µg/L averaged 2.71µg/L) in 15- samples, vinyl chloride(0.47~0.66µg/L, averaged 0.53µg/L) in 8 samples, trichloroethene(0.52~3.45µg/L, averaged 1.51µg/L) in 3 samples, carbon tetrachloride (0.43~1.54µg/L, averaged 0.69µg/L) in samples, and I ,2-dichloroethane ( 1.18 and 1.28µg/L, averaged 1.23µg/L) in 2 samples. Four VOCs have been identified for few samples. The total VOCs concentrations ranged from 1.0 to 5.0µg/L, for most samples. The concentrations of 1-dichloroethene for one sample (12.18µg/L) obtained in Kaoshiung and for two samples. (7.15µg/L,7.46µg/L)obtained in Pingtung were above the government drinking water quality standard. Other pollutants were below the government drinking water quality standard. Conclusions: Improperly dumped waste may contaminate well water. Although contaminated chemicals in well water were not all in high concentrations, it remains a better policy for residents to drink boiled water.
• 119 - 129
• 10.6288/CJPH2000-19-02-06

• Link 原著 Original Article
• 台灣常見市售酒精性飲料嘌呤含量之探討Determination of Purine Contents in Alcoholic Beverages Commonly Retailed in Taiwan
• 黃建財、毛義方、 陳美蓮
  Chien-Tsai Hwang, I-Fang Mao, Mei-Lien Chen
• 酒 ； 嘌呤 ； 高效能液相層析法
  Alcoholic beverages ; purine ; high performance liquid chromatography
• 目標：本研究是為探討國內市售酒精性飲料中嘌呤的含量，藉以了解其可能對高尿酸血症和痛風的影響。方法：以高效能液體層析法分析16種酒，包括8種啤酒及紹興酒、原住民小米酒、米酒、高梁酒和藥酒等嘌呤的含量。結果：本研究顯示僅釀造酒及再製酒有嘌呤存在，蒸餾酒的嘌呤未被檢出。所有測試酒類之嘌呤總含量，以紹興酒最高有13.57 mg/100mL，各別嘌含量則以hypoxanthine最高。所分析8種品牌的啤酒，其嘌呤總含量平均為7.05 mg/100mL，而四種嘌呤分佈則以guanine最高。藥酒中嘌呤總含量，以保力達B的6.80 mg/100mL較高。原住民小米酒嘌呤總含量2.19 mg/100mL，雖然不高，但pH值明顯低於其他酒類。以嘌呤／酒精比來看，則絕大多數的啤酒較高。故若攝取等量酒精時，喝啤酒應會攝取到較多的嘌呤。結論：本研究認為市售酒類雖屬於低嘌呤食品，仍不宜經常大量飲用。尤其啤酒含有7.05 mg/100mL嘌呤，每天飲用6罐以上(354mL/罐)，即同時攝入約150 mg以上的嘌呤，增加了罹患高尿酸血症和痛風的機會。此外，適量飲用酒類時，仍應注意下酒菜的選擇。
  Objectives: The purpose of this study was to determine the purine content in commercial alcoholic beverages retailed in Taiwanese domestic markets. Methods: Sixteen kinds of alcoholic beverages were measured for pufine content using high performance liquid chromatography. Results: We found that fermented liquors and liqueurs contained purines, whereas none were found in distilled liquors. The highest purine content of the alcoholic beverages sampled was found in Shaohsing wine with an average of 13.57 mg/100mL, and hypoxanthine dominated the purine content. Guanine was the highest purin base in eight kinds of beer that had a mean total purine content of 7.05 mg/100mL. The total purine content in Paolyta B liqueur was 6.80mg/100mL, and the total was even lower in Taiwan aborigines' Millet wine with a value of 2.19mg/100mL, but with the lowest pH value of all the sampled alcoholic beverages. The purine/alcohol ratio of most beers was higher than that in other alcoholic beverages sampled. This means that for the same quantity of alcohol ingested, the purine content of beer is higher than other alcoholic beverages. Conclusions: Although alcoholic beverages retailed in Taiwan contain a lower concentration of purine base, drinking six or more cans (354mL/can) of beer with a mean purine content of 7.05 mg/100mL is equal to ingesting 150mg or more of purines. This may increase the risk of suffering from hyperuricemia and gout. This study also suggested that moderate drinkers need to select foods cautiously, choosing those which contain low purines.
• 130 - 137
• 10.6288/CJPH2000-19-02-07

• Link 原著 Original Article
• 香客在寺廟中懸浮微粒曝露濃度之探討Personal Particulate Exposures in Buddhist Temples
• 高玫鍾、龍世俊
  Mei-Chung Kao, Shih-Chun Lung
• PM10&PM2.5 ； 拜香 ； 寺廟 ； 曝露評估
  PM10 and PM2.5 ; incense burning ; temple ; exposure assessment
• 目標：本研究探討香客在寺廟內之PM10及PM2.5曝露濃度,並由廟宇型態上差異及不同拜拜日期等來探討影響香客在寺廟內懸浮微粒曝露濃度之原因。方法：選擇台中市內兩間不同型態之廟宇，在農曆初一、十五及初二、十六，每間廟以四位工作人員配戴採樣器來模擬香客在廟內PM10及PM2.5之曝露。以流量2L/min之SKC採樣幫浦配上個人懸浮微粒採樣頭，用直徑37mm之鐵弗鈑龍濾紙採集廟宇中PM10及PM2.5。結果：香客在廟內之PM10及PM2.5曝露濃度比一般居家環境中曝露濃度高5~16倍，比當時廟外馬路上濃渡平均約高4至5倍。而在初一、十五之懸浮微粒曝露濃度明顯高於初二、十六，PM10濃度約高出230μg/m3，PM2.5濃度則約高出153μg/m3。大型廟宇之香爐數多，香客接觸香爐的時間較長，故其平均曝露濃度較高，而小型廟宇因為空間小，在人潮洶湧、香火卿盛時，香客之懸浮微粒曝露濃度會增加到與在大型廟宇差不多。結論：建議到寺廟內進香之民眾，儘量減少在寺廟中停留之時間，選擇通風較好之寺廟或避開初一、十五到廟內玤。
  Objectives: This study was conducted to assess worshippers' exposure to PM10 and PM2.5 in two different types of Buddhist temples. The exposure factors of worshippers were also evaluated. Methods: Sampling was conducted on the 1st, 2nd, 15th, and 16th days of the lunar month in two Buddhist temples in Tai-Chung. Samples were taken using Personal Environment Monitors (PEMs) connected to personal pumps with 2L/min flow rates. The PEMs were worn by research staff, who mimicked worshippers' activities, to obtain their exposures to PM10 and PM2.5 in both temples. Factors such as construction type of the temples and worshipping dates were evaluated to explore the potential determinants affecting worshippers' exposures to PM10 and PM2.5 in Buddhist temples. Results: Visitors were exposed to aerosol concentrations in temples that were approximately 5 to 16 times the background exposure and nearly 4 to 5 times greater than those measured outside temples. Exposures of about 230µg/m3 more for PM10 and 153µg/m3 more for PM2.5 were observed on the 1st and the 15th than on the 2nd and the 16th of the lunar month. Worshippers were exposed to more PM10 and PM2.5 in the larger temple with more thuribles since they spent more time praying there. The smaller temple had worse ventilation so worshippers’ exposure on crowded day was almost as great as that measured in the larger Buddhist temple. Conclusions: To reduce exposure to PM10 and PPM2.5, people should spend less time in Buddhist temples, choose a well-ventilated temple, or avoid visiting temples on the 1st and 15th days of the lunar month.
• 138 - 143
• 10.6288/CJPH2000-19-02-08

• Link 實務 Public Health Practice
• 天然災害後環境衛生實務Environmental Health Practices for post-disaster
• 林嘉明
  Jia-Ming Lin
• 天然災害 ； 收容收 ； 收給水 ； 收廢棄物處理 ； 收消毒及除蟲
  natural disaster ; shelter ; water supply ; waste disposal ; disinfection and disinfestations
• 目標；集集大地震為台灣帶來百年罕見的大災難，此天然災害中斷平日建立的環境衛生保護網，為避免災後環境衛生的惡化，落實環境衛生實務是當務之急，亦是國家規劃未來防災計畫的重要課題，故欲對當前及未來提出實用性的建議，作為決策者及現場工作者，為解決災後環境衛生問題方便參考之用。方法：本報告收集曾經受災國家的經驗以及台灣921集集大地震之後數度進出災區之見聞，對於可能遭遇的環境衛生問題提出討論及應對措施。結果與結論：這些措施包括災前的準備及災後人口遷徙及／或人口臨時集中收容所的下列環境衛生措施：給水、廢棄物處理包括水肥處理、固體廢棄物處理等；收容所之雜項衛生措施，包括沐浴、洗衣、消毒及除蟲等；災區受難者之衛生教育原則等，這些側重傳統鄉村環境衛生的做法，亦然可以適用於都市受災後的情況。此外，都市受災後特有的環境衛生問題如建築物頹廢物的清理、臨時廁所、公共給水系統的恢復，則可同時借鏡於近代曾出現大規模天災的都市經驗如阪神地震經驗之防災計畫。
  Objectives: The destructive Chichi earthquake in Taiwan obliterated the environmental health protective network which people were used to. In order to avoid degradation of environmental health in the stricken area and to prepare for future natural disasters, it has become urgent and important to discuss and fulfil environmental health practices. Thus, this report is intended to suggest some practical measures to counter post-disaster disorder in environmental health, for use by decision-makers and field workers as references. Methods: Upon reviewing the experiences of countries suffering repeated disasters and the information coming from the massive 21 Sept. 1999 Chichi earthquake in Taiwan (at 7.3 on the Richter scale), potential post-disaster problems in environmental health and practical countermeasures are discussed. Results and Conclusions: In addition to pre-disaster preparation, required practices for shelters and/or for the informal camping areas after disaster include water supply, waste disposal for garbage as well as nightsoil, laundries, disinfection and disifestation, and health education. Although most of these practical measures employ the principles for rural environmental health, they are also applicable to post-disaster situations in urban areas. In addition, it is worthwhile reviewing those lessons from the Osaka and Kobe earthquakes because of the problems such as handling the rubbish from the demolition of buildings, setting up mobile latrines, recovering the water supply system, and so on.
• 144 - 158
• 10.6288/CJPH2000-19-02-09