19卷4期

• Link 公衛論壇 Public Health Forum
• 由921震災探討公共心理衛生工作的困境由921震災探討公共心理衛生工作的困境
• 吳聰能、賴辛癸
  Trong-Neng Wu, Shin-Kuei Lai
• 無
  none
• 無
  none
• 239 - 243
• 10.6288/CJPH2000-19-04-01

• Link 公衛論壇 Public Health Forum
• 有關「公衛畢業生找不到頭路」的另類觀點有關「公衛畢業生找不到頭路」的另類觀點
• 陳美霞
  Meei-Shia Chen
• 無
  none
• 無
  none
• 244 - 249
• 10.6288/CJPH2000-19-04-02

• Link 綜論 Review Article
• 人芽囊原蟲－一種長期被忽略的腸道寄生蟲Blastocystis Hominis: A long-term Ignored Intestinal Parasite
• 黃尹虹、辛致煒
  Yin-Hung Huang, Jyh-Wei Shin
• 人芽囊原蟲 ； 分類 ； 形態 ； 生活史 ； 流行病學
  Blastocystis hominis ; taxonomy ; morphology ; life cycle ; epidemiology
• 人芽囊原蟲(Blastocystis hominis, Brumpt 1912)是一種寄生於人類消化道中的寄生性原蟲。部分研究結果顯示，不論是在有症狀患者或無症狀帶原者的糞便檢體中，它都是最常見的寄生蟲。人芽囊原蟲最初被歸類於對人體無害的腸道酵母菌的一種，長久以來均未受到重視，甚至被忽，略以致有關人芽囊原的分類、形態、細胞生物學、生活史、致病性等方面也都一直未十分明療。近年來，有些報告指出人芽囊原蟲的感染與腹瀉有關，認為它對人類具有潛在性的致病能力，然而其致病性至今仍倍受爭議，也因此引發許多研究者的注意，進一步對其生物學、流行病學及臨床等方面進行研究。本篇文章僅針對其分類、形態、生活史及流行病學方面做一概述。
  Blastocystis hominis IS a protozoan parasite inhabiting in the intestinal tract of human. A number of studies showed it is often the most frequent protozoan reported in human fecal samples from both symptomatic patients and asymptomatic carriers. This organism was in the first time reported as a harmless yeast, and has been neglected for a long time. The life cycle, mode of transmission, cell biology and pathogenesis of B. hominis are still not well understood. In recent years, numerous reports have suggested that B. hominis is associated with diarrhea and is consid-ered as a potential pathogen in human. However, the pathogenicity of B. hominis is still a contro-versial issue, and it has attracted the attention of researchers to initiate studies On the biology,epidemiology and clinical aspects of this parasite. This article described the taxonomy, morphol-ogy, life cycle, and epidemiology of B. hominis.
• 250 - 260
• 10.6288/CJPH2000-19-04-03

• Link 原著 Original Article
• 職業非死亡意外事故危險因子之病例對照研究A case-control Study of Risk Factors for Unintentional non-fatal Injuries on the Job
• 李中一、陳凱倫、吳家興、宋鴻樟
  Chung-Yi Li, Kai-Ren Chen, Chia-Hsing Wu, Fung-Chang Sung
• 職業意外事故 ； 病例對照研究 ； 相對危險性 ； 運動
  occupational injury ; case-control study ; relative risk ; exercise
• 目標：本研究目的在探討國內某石化製造業員工工作史及工作條件、健康狀態、工作與生活型態等因素對職業非死亡意外事故危險性之影響。方法：本研究設計利用病例對照研究法。病例組個案包括433名於1991年至1997年間發生非死亡意外事故之員工，對照組個案則包括954名匹配年齡、性別、以及工作地點後隨機選取之其他員工。研究對象以自填式問卷提供意外事故相關原因之資料。本研究利用邏輯斯迴歸模式計算勝算比用以估計各意外事故潛在危險因子之相對危險性。結果：造成意外事故發生的顯著危險因子包括平均每週工作超過5.5天(勝算比2.2，95%信賴區間＝1.1-4.7)與必需輪值夜班(勝算比1.2，95%信算區間＝1.1-1.5)。而與發生意外事故危險性呈負相關之因素則包括：飲酒、喝茶、喝咖啡、運動習慣、視力聽力問題、以及看病次數。自覺健康狀況與意外事故之間呈顯著負相關(趨勢檢定p＝0.0001)，自覺健康較差著(後25百分位)發生事故的危險性僅是自覺健康較佳者(前25百分位)之30%。結論：每週工作超過5.5天者以及必須輪值夜班者是未來預防職業非死亡意外事故工作之主要對象。此外，潛在的回憶偏差與分析中未能包括己經離職之意外事故個案所可能造成的選樣偏差問題則是本研究的主要限制。
  Objectives: To investigate associations between occupational non-fatal injury and work histo-ry and condition, lifestyle and perceived health status among petrochemical workers. Methods:We used a case-control design. Cases were 433 workers with non-fatal injury between 1991 and1997 while controls were 954 workers without any injury during the same period. Controls were randomly selected with frequency matching to cases on age, sex and work site. Self-administered questionnaires were used to collect information on various potential risk factors of injury. Adjust-ed relative risk was estimated using a multivariate logistic regression model. Results: ”After adjust-ment for potential confounders, an elevated risk of occupational non-fatal Injury was found for those who had worked for over 5.5 days a week (odds ratio [OR]=2.2, 95% confidence interval [CI]= 1. I -4. 7) and those who had night shift work (OR=1.2, 95% CI= 1.I - 1.5). Multivariate analy-sis also revealed significantly inverse relationships between the risk of injury and factors including consumption of alcohol, tea or coffee, routine exercise, perceived visual or hearing impairment,and clinic visits. A significant reverse dose-response trend was noted between injury and self-rated health conditions. Employees with the poorest self-reported health (lowest quartile) were less like-ly than those in the first quartile 10 have injury (OR==O.3, 95% CI==O.2-0.6). Conclusions: Our study suggests overtime workers and night shift workers are major subjects for receiving preven- tive measures of occupational injuries. The potential selection bias due to exclusion of the retired cases from analyses and the possible recall bias were two methodological drawbacks that might have affected the study results.
• 261 - 271
• 10.6288/CJPH2000-19-04-04

• Link 原著 Original Article
• 牙醫診所醫療物價指數建立之研究A Study on the Establishment of Dental Medical Economic Index
• 劉順仁、林小嫻、李玉春
  Shuen-Zen Liu, Shila Lin, Yue-Chuen Lee
• 牙醫診所醫療經濟指數 ； 總額支付制度 ； 全民健康保險
  Dental Medical Economic Index ; global budget payment system ; National Health Insurance
• 目標：本研究目的在建立兼顧成本控制及行政可行性的牙醫診所醫療經濟指數，以利總額支付制度之推行，並作為未來建構國內其他類型醫療經濟指數之參考。方法：本研究首先調查全民健保實施後牙醫診所之各項執業成本佔總成本之比率(包括人事費用、藥品費用、材料費用、建築物租金、設備折舊、其他費用及雜項支出)，以作為指數計算之權重。其次，本研究利用牙醫診所各執業成本項目，就主計處公佈之各項物價指數中，選擇較能反映牙醫成本項目之指數，並參考主計處及相關政府機構86年至88年公告之相對物價指數進行加權平均，以建立牙醫診所醫療經濟指數。結果：醫師診察費(佔48.96%)為牙醫診所營運成本比重最大的項目，其次為人事費用(佔11.65%)及醫療材料(佔11.29%)。以民國85年為基期，台灣地區86及87年牙醫診所服務物價總指數分別為103.70%及108.93%，年增率分別為3.74%及5.00%。影響牙醫診所醫療經濟指數漲幅最大的成本項目為醫療器材及醫師費，影響率各為1.76%及1.44%。而影響最大的物價指數項目為躉售物價指數－醫療儀器類，影響率為2.59%，主要受到匯率波動之影響。在分類指數方面，若以執業地區分類，則以東部地區分類指數最高。結論：牙醫診所醫療經濟指數之建立及持續修正、改良對牙醫總額支付制度之推行至為重要。鑑於總額支付制度將逐漸推廣至中醫、西醫診所及醫院，衛生署應持續推動各種相關指數之建立。
  ”Objectives: The main purpose of this paper is to establish the Dental Medical Economic Index (OMEI) to facilitate the implementation of global budget payment system of the National Health Insurance. Methods: The paper first surveys the dental clinics to determine their cost structure, as measured by the percentage of personnel, medicine, materials, office rent, equipment depreciation, and other costs to total cost. Then, the cost structure is matched by appropriate price indexes to construct the Dental Medical Economic Index. Results: We found that dentists' consul-tation fee is the main cost item of dental clinics (48.96%), followed by personnel cost (11.65%) and material cost (11.29%). Using 1996 as the base year, the 1997 and 1998 Dental Medical Economic Indexes are 103.70% and 108.93%, representing an annual increase rate of 3.74% and 5.00%, respectively. In addition, the most significant influencing the DMEI are material and den-tists' consultation fee (1.76% and 1.44%, respectively), Among various price indexes, wholesale price index of medical equipment is the most significant influencing the DMEI (2.59%). Conclu-sions: The establishment and continuous refinement of DMEI is crucial to the implementation of global budget payment system for dental clinics. The methodology discussed in this paper can be used to establish similar indexes for other types of clinics and hospitals in the future.
• 272 - 284
• 10.6288/CJPH2000-19-04-05

• Link 原著 Original Article
• 技術學院及專校醫管科系應屆畢業生從事疾病分類工作之相關因素探討Factors Influencing Hospital and Health Care Students' working Willingness in Disease Coding
• 黃慧娜、陳惠芳、林為森、韓揆
  Hui-Na Huang, Hui-Fang Chen, Weir-Sen Lin, Kuei Han
• 疾病分類 ； 課程評價 ； 工作意願
  disease coding ; evaluation of curriculum ; working willingness
• 目標：疾病分類編碼的正確與完整關係到醫療研究、醫療費用的給付和未來實施診斷關係群(DRGs/PPS)的基礎。研究指出，我國疾病分類整體編碼的錯誤率高達52%，其中一個重要的因素是疾病分類人員的素質和人力。故本研究從最根本的學校教育著手，瞭解畢業生未來從事疾病分類工作的意願及其影響因素。方法：以87年度全國醫管科系中有研修疾病分類課程的應屆畢業生為研究對象，採問卷調查法，設計學習成果評量，內容包括課程內容安排、老師影響、同儕影響、自覺課程的重要性、對課程的興趣和未來從事疾病分類工作的意願六項，以分層集群抽樣法抽取樣本，發出821份問卷，回收782份，回收率95.2%，有效樣本780份。結果：六大項評量成果中，老師影響、自覺課程的重要性為較為正面的評價，課程內容安排、對課程的興趣、從事疾病分類工作的意願為較負面的評價。影響未來從事疾病分類工作意願的背景因素是女性、31歲以上、夜二專學生的工作意願較高，學習評量影響因素是對課程的興趣和自覺課程的重要性。結論與建議：性別、年齡、學制、對課程的興趣和自覺課程的重要性會影響學生選擇是否從事疾病分類的工作，建議加強專科生的專業英文能力與醫學專業知識，才能在編碼過程中較為順利，亦可在全國性考試之前予以校內模擬測驗，增加考試動機和信心。
  ”Objectives: Medical research, reimbursement system and classification of DRGs depend on the accuracy and completeness of disease coding. A research showed that the error rate of overall disease coding was 52% in Taiwan,and for which qualification and manpower of coding person-nel are important factors. The purpose of this study was to assess college graduates' willingness to work as disease coding personnel and the influencing factors. The contents of the questionnaire included arrangement of curriculum, teaching methods and attitudes, learning atmosphere of classmates, self-sensed importance of curriculum, interests, and working willingness. Methods: Samples are collected by a stratified-cluster method. Eight hundred and twenty-one questionnaires were dis-tributed and 780 effective cases were returned. Results: The outcome of the instructor's influence and self-sensed importance of curriculum were positive; the attitude toward the arrangement of curriculum,interests and working willingness were negative. Characteristic factors which influ-ence on working willingness found that females, aged over 31, students in night schools contrib-ute to a higher working willingness. Factors which influence on working willingness are interest toward curriculum(major) and self-sensed importance of curriculum(minor). Conclusions and sug-gestions: Sex,age,academic program, interest to curriculum, and self-sensed importance of curric-ulum are the relative factors toward working willingness.We suggested to enhance English ability and professional medical knowledge for coding improvement. A quiz before the national exami-nation is important for increasing the confidence and motivation of the student.
• 285 - 291
• 10.6288/CJPH2000-19-04-06

• Link 原著 Original Article
• 規律經期婦女經期不適與飲食之研究Regular Menstruation Women's menstrual Discomfort and Food Intake
• 張玨、吳佩樺
  Chueh Chang, Pei-Hua Wu
• 經期不適 ； 飲食
  menstrual discomfort ; food intake
• 目標：嘗試瞭解不同飲食型態婦女其經期不適出現之差異，將婦女飲食區分成不足、適量、過量三組，檢視停經不適發生與飲食攝取知情之相關。方法：以1996年8月-1997年4月參與某健檢中心健康檢查之有規律經期25-39歲婦女，依平日飲食狀況填答飲食紀錄者，食物攝取以衛生署所定的每日飲食建議量進行分析。結果：由一般飲食狀況，婦女攝取奶類是明顯不足的；僅有不到三成的女性達到攝取標準；肉魚豆類的攝取也只有四成多的婦女攝取適量，而蔬菜類是大多數婦女皆攝取不足的食物類；雖然女性普遍而言熱量攝取並不高，但是油脂攝取卻遠超過一般建議。飲食攝取與經期不適在水果與蔬菜類的攝取，有較明顯的差異有隨攝取量增加，而明顯減低。結論：針對飲食與全方位生理、心理狀況影響婦女經期的健康，未來需要更多以婦女的經驗為出發的研究。
  Objectives: The purpose of this study attempted to explore the differences in occurrence of uncomfortable situation during menstruation among those regular menstruation women with vari-ous food intake. Women participating in this investigation were divided in to three groups based on their food intake: insufficiency, appropriateness, and overdose. Furthermore, the researcher aimed at examining whether these three types of food intake were related to occurrence of uncom-fortable situations during menstruation. Methods: The study sample included those women who aged from 25-40 and participated in the health examination at one health examination center during August 1996 to April 1997. Participants were asked to record their daily food intake, and the recorded data were analyzed according to the Recommendation Daily Nutrient Allowance suggested by the Department of Health. Results: The data analysis revealed that women in this study obviously have an insufficient intake of milk products, and less than 30% of them actually achieve the intake standard. On the other hand, only about 40% of participating women have the appropriate intake of meat, fish and bean products. Comparing to the intake standard of vegeta-bles, most of women in this study specifically have lack of sufficient intake of vegetables. Al-though women in general do not have the high intake of calorie, the finding showed that partici-pating women if fact overdose themselves with oil and fat intake much more than the suggested standard. Based in the result, a significant difference in experience of discomfort with menstrual situations was also confirmed due to the intake of fruits and vegetables. While increasing the intake of fruits and vegetables, there is an apparent decrease in experience discomfort with men-strual situations. Conclusions: In order to better understand women’s health and the menstrual discomfort from a holistic perspective, we also need to integrate the food intake with psychology and physiology. It is necessary to initiate more future research focusing on exploring women’s personal experiences instead of treating such uncomfortable situations during menstruation as an illness.
• 292 - 302
• 10.6288/CJPH2000-19-04-07

• Link 實務 Public Health Practice
• 醫療廢棄物處理與事業廢棄物政策之檢討Discussion of Medical and Industrial Waste Treatment Policy
• 陳永仁
  Yeong-Ren Chen
• 醫療事業廢棄物 ； 代清除處理業
  medical waste ; private contract operators
• 目標：本文旨在目前醫療事業廢棄物中間處理妥善處理率可達90%以上的過程及原因，做為其他事業廢棄物處理之借鏡。方法：藉整理、分析各階段公民營機構投入醫療廢棄物處理之法令政策與技術管理策略，探討不同階段其處理設施與妥善處理率相關性，以瞭解其中可能的成功因素。結果：發現可能的成功因素包括：(1)目的事業主管機關補助公立醫院興建醫療廢棄物處理設施；(2)國有財產法允許公有設施可以對外營業；(3)主管機關輔導民營代處理業加入營運；(4)主管機關有效的稽查管制；(5)衛生和環保主管機關充分合作；(6)醫界充分配合政府之廢棄物處理政策。結論：台灣地區其他事業廢棄物之妥善處理率偏低，各目的事業主管機關可以參考本地已成功之模式，妥善處理其廢棄物，以改善台灣地區環境品質。
  Objectives: This paper explores industrial waste treatment in light of current successes in the treatment of medical waste. The proper intermediate treatment rate for medical waste has exceed-ed 90%. The reasons and stages behind this achievement provide a possible model for improving treatment for other types of industrial waste. Methods: Regulatory and technical management methods practiced by public institutions at different stages were used to analyze the relationship between treatment facilities and treatment rates at different stages to understand reasons for successful implementation. Results: These reasons include: (1 )subsidies by the competent industrial authority to public hospitals for the construction of medical waste treatment facilities, (2)authorization by the public properties law for public facilities to be run by private operators, (3)government techni-cal assistance to help private contractors undertake such operations, (4)effective controls and au-diting by the competent industrial authority, (5)full cooperation between health and environmental department, (6)full cooperation with government waste treatment policies by the medical sector. Conclusion: Proper waste treatment rates for other industrial sectors tends to be low. All compe-tent industrial authorities should study local successful models, which will help them to treat industrial wastes properly and improve Taiwan's environment.
• 303 - 308
• 10.6288/CJPH2000-19-04-08

• Link 實務 Public Health Practice
• 公衛畢業生的出路愈來愈差了，真的嗎？The Job Opportunity is getting worse for Public Health Graduates. Is that True?
• 鄭守夏、陳珮青、林佳美
  Shou-Hsia Cheng, Pei-Ching Chen, Chia-Mei Lin
• 公共衛生 ； 畢業生 ； 出路 ； 高普考試
  public health ; personnel ; graduate ; job opportunity ; governmental examination
• 目標：本文旨在探討公共衛生學系畢業生的出路問題，尤其著重於衛生行政機關進用專業人員的探討。方法：透過對全國公共衛生學系大四學生進行問卷調查，統計過去十年的高普考錄取情形，以及對全國縣市衛生局調查衛生行政人員的進用管道，用以分析公共衛生畢業生的出路問題。結果：調查發現，公共衛生系大四學生普遍覺得畢業生找工作比其他科系困難，過去十年的高普考「衛生環保行政」職系的錄取名額也逐年減少，而衛生單位現職人員有一半以上都是由相關職系轉任的，值得重視。結論：針對出路問題的瞭解，我們建議公衛界可以朝三方向努力：一為停止其他專業的轉任，二為要求衛生單位優先以高普考進用新人，三為爭取專業證照的設立，希望藉由長期努力來改善公共衛生畢業生的出路問題
  Objectives: This report is to understand the current situation and problems concerning the job opportunity of public health graduates, with focus on the channels to governmental positions. Methods: Several data sources are included to meet our objectives: questionnaires for seniors of departments of public health; statistics on the governmental employment examination in the past 10 years; and statistics on health administration personnel nationwide. Results: We found that senior students in public health departments generally perceived the difficulty in job markets. Statistics also indicate that the opportunity of governmental employment become harder in recent years. Conclusion: There are problems in the job market for public health graduates. Several possible alternatives are discussed in the report.
• 309 - 314
• 10.6288/CJPH2000-19-04-09

• Link  
• 台灣版世界衛生組織生活品質問卷之發展簡介Introduction to the Development of the WHOQOL-Taiwan Version
• 台灣版世界衛生組織生活品質問卷發展小組
  The Whoqol-Taiwan Group
• 世界衛生組織生活品質問卷 ； 簡明版世界衛生組織生活品質問卷 ； 台灣版本
  WHOQOL-100 ; WHOQOL-BREF ; Taiwan-Version
• 無none
  The World Health Organization (WHO) initiated a cross-cultural project on the development of the WHOQOL-1 00 questionnaire in 1991 and finished it in 1995. Later, the questionnaire was simplified to the WHOQOL-BREF containing 26 items. The long form of the questionnaire con-tains 100(cultural1y comparable) generic core questions. However, it allows each nation/culture to add culture-specific questions. We started to develop the questionnaire-Taiwan version in 1997. This paper briefly introduces the development of the WHOQOL-Taiwan Versions. The procedures of translating the questionnaire, selecting the appropriate scale descriptors, and proposing suitable culture-specific items were seriously designed. We collected the data on 1068 subjects from 17 hospitals in Taiwan to conduct reliability and validity analyses. The results showed that the inter-nal consistency (Cronbach's a) and the test-retest reliability coefficients of the questionnaire were 0.97 and 0.86 respectively; the indices of content validity and Concurrence validity achieved statis-tically significant (p < .01); most of the items could discriminate between healthy and unhealthy subjects; Facet-G score (for measuring general QOL and health) was well predicted by the six domain scores and the explained variance was about 64.2%. Moreover, four-factor model (i.e., physical capacity, psychological, social relationship, and environment) was the most plausible model. Based on our data analysis, the psychometric properties of the questionnaire for Taiwan version were convincing and were comparable to the global study.
• 315 - 324
• 10.6288/CJPH2000-19-04-10