17卷1期

• Link 綜論 Review Article
• 脊柱側彎症Scoliosis
• 李碧霞、 陳靜敏
  Pi-Hsia Lee, Ching-Min Chen
• 脊柱側彎 ； 脊柱側彎篩檢
  scoliosis ; scoliosis screening
• 利用學校進行篩檢，以早期偵測脊柱側彎和變形的情況，在美國及加拿大均已非常普遍，臺灣地區因對於脊柱側彎篩檢的起步較晚，相關知識及研究仍付之闕如，故本文回顧整理相關文獻，綜述脊柱側彎的定義、原因、徵象及症狀、流行病學、治療等，並介紹學校脊柱側彎篩檢計畫，俾提供學校進行脊柱側彎篩檢之參考。重點包含：脊柱側彎症以原發性型態居多；盛行率大約在0.3~19%，容易發生在有脊柱側彎的家族史、女生、9~15歲之間。大部分的脊椎彎曲是輕微的，僅需由醫師密切觀察，其他的治療包括運動、穿背架與手術等。最後建議政府相關單位，未來宜針對10~16歲學生進行篩檢，每年檢查一次，並有完整的轉介、追蹤計畫。
  The use of school screening for the early detection of scoliosis and spinal deformities has become widespread in the United States and Canada. Since scoliosis screening is not mandated in Taiwan, knowledge and research about scoliosis in school-age children are relatively lacking. The purpose of this paper is to review relevant literature to summarize its definition, etiology, symptoms and signs, epidemiological data, various screening and treatment methods etc. School scoliosis screening plans are also introduced in this paper. Important points considered include the prevalence rates of 0.3~19%, the majority of which is of the idiopathic type, and the risk factors of family history, being female, and the rapid development stage between the ages of 9 to 15 years. In most cases the curvature of the spine is so mild that the only treatment needed is close observation by a physician. Other forms of treatment may include exercises, a brace, surgery, or a combination of these. Finally, recommendation is made to target 10-16 year old students for yearly screening; and further referral and follow-up processes are planned in this paper.
• 2-9
• 10.6288/CJPH1998-17-01-01

• Link 原著 Original Article
• 民衆對醫藥分業執行方案意見調查Public Opinion Survey of Separation of Physician's Dispensing Practice from Medical Practice
• 季瑋珠、 陳善音、陳建煒
  Wei-Chu Chie, Kin-Wei A. Chan, Shan-Yin Chen
• 醫藥分業
  separation of physician's dispensing practice from medical practice
• 根據全民健保法與藥事法，醫藥分業訂於1997年三月一日起實施，為瞭解國人對醫藥分業的認知，及所偏好的方案，本研究自1997年一月六日至九日，採用結構式問卷，以電腦輔助隨機抽樣進行電話訪問，有效樣本為1568名台灣地區二十歲以上成人。結果發現有58.2%的受訪者不知道1997年三月將實施醫藥分業。在實施方法上，72.1%贊同雙軌制，即就醫時除了拿處方簽前往有藥師的藥局，或大型醫院的藥劑科調劑外，如果就醫的醫院或診所也有合格的藥師，也可以在就醫的醫院或診所請藥師調劑：只有24.0%贊成單軌制，即只能持處方至有藥師的藥局，或大型醫院的藥劑科，由藥師調劑。中年、教育程度較高、職業為軍公教、住南部者、過去就醫藥物知識較多者較知道1997年三月將實施醫藥分業。中年、教育程度較高、住南部者、過去看病用藥知識較多者，於調整其他變項後較贊同單軌制。根據上述結果，本研究建議：在推行醫藥分業時，應加強對民眾，特別是社會經濟地位較低，資訊較不充足者的教育與溝通，並採行漸進的方法，兼顧理想與現實，才能使整個醫藥分業的制度順利進行。
  In the practice of medicine, utilization of prescription drugs comprises of two components: a physician prescribes the drug(s), and a pharmacist dispenses the drug(s). However, in Taiwan these two professional activities have not been clearly separated. According to the Pharmaceutical Affairs Act and National Health Insurance Act of Republic of China, prescription and dispensing should be carried out by different professionals, starting from March 1, 1997. The specific aim of this study was to assess the knowledge and attitude of the general public toward the implementation the regulation of the ”separation of physician's dispensing practice from medical practice”. A random digit dialing telephone interview as conducted in the evenings of January 6 through 9, 1997, a total of 1568 Taiwan residents aged 20 and above were interviewed. 58.2% of them did not know the date that the regulation was supposed to become effective. 72.1% preferred a dual-track system (both pharmacies and hospitals or clinics with licensed pharmacists could dispense prescription drugs) and 24.0% preferred a single track system (all medications dispensed in pharmacies). In general, middle-aged, better educated, military or civil personnel, teachers, residents in southern Taiwan, and those with better knowledge about drugs were more likely to know the date that the regulation was supposed to become effective, and to prefer the single-track method. Based on these results, we suggest that better public education and communication, directed especially to people with lower socioeconomic status and limited information are practical ways to implement the regulation.
• 10-18
• 10.6288/CJPH1998-17-01-02

• Link 原著 Original Article
• 全民健保實施後住院病患復健治療利用分析The Utilization Analysis of Rehabilitative Therapies in Inpatients under the National Health Insurance Scheme
• 吳肖琪、吳義勇、熊嘉玲、藍忠孚
  Shiao-Chi Wu, Yee-Yung Ng, Chia-Ling Hsiung, Chung-Fu Lan
• 健康保險 ； 復健醫療 ； 住院醫療 ； 復健治療
  Health Insurance ; Rehabilitation Medicine ; Inpatient Care ; Rehabilitative Therapy
• 全民健保開放骨科、神經科、神經外科、整型外科四個急性醫療專科可直接施行復健治療，與全民健保依醫院評鑑層級給付復健治療部分費用後，各科復健治療利用的情形是本研究之目的。本研究利用民國84年7至12月全民健保住院申報資料進行分析，結果顯示健保實施後，復健治療使用率為6.2%，復健科的復健治療使用率最高(90.7%)，但骨科由於病忠多，其復健治療使用次數最多（佔總復健使用人次25.1%），其次是神經科（佔6.4%），再其次才是復健科（佔6.3%），以醫院層級區分，醫院層級愈高則復健治療使用率愈高，各醫療專科絕大部份的復健治療利用，是在醫學中心及區域醫院；開放的四個醫療專科，其復健治療利用共佔總復健治療利用40.3%。隨著人口之老化，建議在實施第三期醫療網計畫時，在加強復健醫療及長期照護部份，要強化提供急性醫療專科復健治療之功能，並考慮地區醫院之定位。
  The National Health Insurance implemented in 1995 opened the direct access of rehabilitative therapies to four specialties including orthopedic, Nneurology, Nneurological surgery, and plastic surgery, and revised the payment method of rehabilitative therapies according to the levels of hospitals. The purpose of the study concerns the utilization of rehabilitative therapies in inpatients under the National Health Insurance Scheme. We made descriptive analysis for the computerized data of the Inpatient reimbursement claim of the National Health Insurance during July and December in 1995. The result showed that the total utilization rate of inpatient rehabilitative therapies was 6.2%. The highest utilization rate of inpatient rehabilitative therapies was in department of rehabilitation(90.7%). The most utilization frequency of inpatient rehabilitative therapies was orthopedic (25.1% of the total utilization rate), followed by neurology(6.4%) and rehabilitation medicine (6.3%). The upper level of hospitals, the higher of utilization rate of inpatient rehabilitative therapies. The use of inpatient rehabilitative therapies occurred mostly in medical centers and area hospitals among these specialties. The use of inpatient rehabilitative therapies among these four specialties was 40.3% of the total use. Therefore, we suggested to enforce providing rehabilitative therapies of specialties for improving the rehabilitation medicine and long term care system in the third planning of Medical Care Network and to reevaluate the role of community hospitals for the rehabilitative therapies especially for the growing population of aging.
• 19 - 27
• 10.6288/CJPH1998-17-01-03

• Link 原著 Original Article
• 全民健康保險子宮頸抹片檢查之利用度研究The Utilization of Pap Smear Services Provided by the National Health Insurance
• 黃月桂、葉明義、林勤豐
  Yueh-Guey Huang, Min-Yih Yeh, Chin-Feng Lin
• 全民健康保險 ； 子宮頸抹片 ； 利用率 ； 認知率 ； 滿意度
  national health insurance ; Pap smear ; utilization rate ; recognition rate ; degree of satisfaction
• 本研究在了解全民健保開辦後，滿三十歲以上台灣婦女「全民健保子宮頸抹片檢查」的利用率，偏好的受檢院所及受檢時段，選擇受檢院所的考慮因素，一般婦女對子宮頸癌及抹片檢查的認知情形，受檢與不曾受檢的原因，及對本項健檢的滿意程度。 本研究以縣市比例分層隨機抽樣，於1996年四月間電訪1063位台灣地區滿三十歲以上之婦女。結果顯示利用率為26.1%。一般而言，低年齡、家庭主婦及及教育程度在高中、國中畢業者的利用率較高，高齡、農林漁牧工作者、教育程度為國小（含）以下者之利用率較低。另外，約50%的受訪者選擇基層院所受檢，其主要考慮因素為醫療院所離家近、習慣性以及親友介紹等，而職業婦女較偏好非上班時段受檢。此外，子宮頸癌及抹片檢查認知率約52%，整體之受檢滿意度為3.6分（總分範圍為1~5分）。
  The purpose of this study is to investigate, after the implementation of the National Health Insurance (NHI) Program in Taiwan, the utilization rate of Pap smear provided by the NHI for women over 30, the preferred providers and exam time for Pap smear, the criteria of choosing providers, women's knowledge about cervical cancer and Pap smear, reasons of examination or non-examination, the degree of satisfaction for Pop smear services. Using stratified random sampling, this study telephone interviewed 1063 women above 30 years old in Taiwan in April, 1996. The results found 26.1% of utilization rate. Generally, older women, women workers in agriculture, forestry, farming and fishery, and less educated women had lower utilization rate, while younger women, housewives, and high school graduate showed higher utilization. Approximately 50% respondents choose clinics for their Pap smear examination. Main reasons for women's choices of medical providers are the vicinity, past experience, and others' recommendations. Besides, the recognition rate of cervical cancer and Pap smear is 52%, the career women prefer off-duty hours for Pap smear services. The overall satisfaction score is 3.6 on a scale of 1 to 5.
• 28 - 35
• 10.6288/CJPH1998-17-01-04

• Link 原著 Original Article
• 台灣中醫師與中藥商對保育動物入藥現況之調查研究A Study of Traditional Pyysicians and Pharmacists on Use of Endangered Animals in Traditional Medicine in Taiwan
• 張鴻仁、陳志強、曹偉、郭旭崧、蕭美玲、周碧瑟
  Hong-Jen Chang, Chih-Chiang Chen, Wei Tsauer, Hsu-Sung Kuo, Mei-Ling Hsiao, Pesus Chou
• 中醫師；中藥商；保育動物；中藥材
  TCM doctors ; Chinese herbal medicine dealer ; endangered species ; Chinese herbal materials
• 本研究主要目的是針對衛生署列為涉及野生動物保育類之十四種中藥進行研究，以結構性問卷進行資料收集，藉以了解國內中醫師及中藥商對其療效、替代品、市場流量以及禁用後可能的損失等的看法與現況。 本研究是以分層隨機取樣的方式，從全國二千六百多位中醫師及八千餘家中藥商中分別抽出兩百名中醫師及四百家中藥商，由國立陽明大學醫學系五年級六位學生，分駛兩部汽車於1995年暑假期間走訪全省，按抽出的樣本，逐一拜訪。 本研究各縣市的平均受訪率，中醫師為75.4%，中藥商為71.4%。在各藥材的使用率方面，中醫師已由原先的20.9%降至8.9%，而中藥商對各藥材的平均使用率也由尚未禁用前的34.0%降至目前的9.2%。在是否贊成禁用方面，平均有69.5%的中醫師及58.9%的中藥商贊成禁用這些藥材。而在禁用後的影響方面，平均有90.4%的中醫師及70.1%的中藥商認為對收入沒有影響。此外，在替代品方面，平均有16.8%的中醫師及14.1%的中藥商認為這些藥材有替代品。禁用後的近兩年，中醫師與中藥商對各藥材的使用率與其年齡與教育程度並未呈現顯著意義的相關。 本研究的結果可作為將來主法及擬定政策的參考，也可以使國際保育團體對於國內目前野生動物入藥之真實情況有所了解，不為片面之見所誤導。
  The main goal of this study is to analyze the use of 14 types of traditional Chinese medicines (TCMs) made from endangered animal species in Taiwan. A structured questionnaire survey of TCM doctors and Chinese herbal dealer was used to determine 1) the perceived effectiveness of the drugs, 2) substitute drug options, 3) amount of sales, and 4) financial losses due to the drugs being made illegal. The study population, 200 TCM doctors and 400 Chinese herbal medicine dealers, was determined by stratified random sampling from 2,600 registered TCM doctors and over 8,000 Chinese herbal medicine dealers registered in Taiwan. During the summer of 1995, six 5th-year medical students (National Yang-Ming University, Taipei, Taiwan) traveled throughout Taiwan to interview the subjects. The average response rates were 71.4% for Chinese herbal medicine dealers and 75.4% for doctors. Before prohibition, an average of 34.0% of Chinese herbal medicine dealers and 20.9% of doctors sold or prescribed one or more of the 14 drugs. At the time of the survey, only 9.2% of Chinese herbal medicine dealers and 8.9% of doctors continued to make use of any of the drugs on a regular basis. Though many of them had not used many of the drugs for some time, only 58.9% of Chinese herbal medicine dealers and 69.5% of doctors agreed to prohibition. 70.1% of Chinese herbal medicine dealers said they did not suffer financial losses, as opposed to 90.4% of the doctors. Both age and education level were factors for use of the 14 drugs before prohibition, but not in 1995 after at least 2 years of prohibition. The results of the study may clarify some of those misunderstandings about the progress of endangered species protection in Taiwan.
• 36 - 47
• 10.6288/CJPH1998-17-01-05

• Link 原著 Original Article
• 醫院護理人員之工作特性、成就動機對工作投入、工作滿足、與留職意願之影響A Survey of the Relationship among Job Characteristics, Achievement Motivation, Job Involvement, Job Satisfaction, and Retention of the Hospital Nurses
• 潘依琳、張媚
  I-Lin Pan, Chang-Mei Yeh
• 工作特性 ； 成就動機 ； 工作投入 ； 工作滿足 ； 留職意願
  job characteristics ; achievement motivation ; job involvement ; job satisfaction ; retention
• 本研究是探討醫院基層護理人員之工作特性、成就動機與工作投入、工作滿足、留職意願之關係。研究對象是以等距抽樣法從三家教學醫院中抽選出162位的臨床基層護理人員，問卷回收率為82%。資料的收集是採用結構式問卷，並用描述性分析、變異數分析、薛費氏事後比較、皮爾森積差相關、及逐步迥歸來進行資料的分析。研究結果發現：從事符合自己工作興趣的工作，工作特性中較高之工作自主性、工作完整性、工作回饋性、與他人回饋性，直屬上司有效的工作指導，以及明確的工作結構，皆可促進醫院護理人員的工作投入，提高工作滿足感，以及降低離職率。而具有高成就動機的護理人員，其工作投入與工作滿足感皆較高。此外，輪上夜班的頻率與在職教育的機會，會影響工作滿足與留職意願，其中以不用上夜班者、及在職教育機會很多者的滿足感與留職意願最高。而工作時間的固定性，亦會影響醫院護理人員的工作滿足感，以工作時間固定者的滿足感最高。因此，研究者根據以上研究結果，提出護理實務上的建議。
  The purpose of this research is to understand the relationship among job characteristics, achievement motivation, job involvement, job satisfaction, and retention of the hospital nurses. The subjects were 162 nurses who worked in the three teaching hospitals. Structural questionnaires were used to collect data and the response rate of questionnaires was 82%. Descriptive statistics, one-way ANOVA, Scheffe's posteriori comparison, Pearson's pro-ductmoment correlation, and Stepwise multiple regression were utilized in data analysis. The results indicated that: match subjects' work interest, high job autonomy, high task identity, high feedback from the job itself and others, good leadership and clear work structure can improve the hospital nurses' job involvement, job satisfaction, and retention. The nurses who have higher achievement motivation can elevate the subjects' job involvement and job satisfaction. The frequency of night duty and the opportunity of in-service education were significantly associated with job satisfaction and retention. Moreover, the fixation of work time has significant effects on the subjects' job satisfaction, the workers who have fixed work time have higher job satisfaction than the others. To sum up the results, this study provides some suggestions about nursing administration.
• 48 - 58
• 10.6288/CJPH1998-17-01-06

• Link 原著 Original Article
• 台北市衛生局急救與心肺復甦術訓練班學員成果評估Evaluation on the Trainees of the First Aid and CPR Training Course Offered by Taipei Municipal Department of Health
• 楊銘欽、范靜媛、 黃久美
  Ming-Chin Yang, Ching-Yuan Fann, Chiu-Mieh Huang
• 急救訓練；計畫評估；心肺復甦術
  nfirst aid training ; program evaluation ; cardio-pulmonary resuscitation CPR
• 本研究之目的在評估台北市政府衛生局及其所屬十二區衛生所、三家市立醫院於84年度所舉辦之急救與心肺復甦術訓練班之成果。研究對象為參加該(84)年度八小時課程的所有學員，使用團體施測的方式，進行前到及後測，共有599位學員參與前後測。主要發現如下：(1)受訪學員在受訓前後對急救知識的答題正確率均有顯著的進步，至於最常答錯的題目為執行心肺復甦術(CPR)時各步驟的排序。(2)學員認為最適宜的課程長度為4~6或7~8小時；對上課內容多感到適中、容易。(3)學員知道開班的訊息的主要來源為公司（如計程車行）、學校。(4)參加的動機中，最多的是為防患未然的心理。(5)初訓學員、參加動機偏主動者、年齡小於等於45歲者、或男性學員在需要時採用CPR的可能性較高。(6)學員自覺最需要課程的前幾項依次為：心肺復甦術、創傷和止血包紮、燒燙傷處理、異物梗塞處理等。
  The purpose of this study was to evaluate the effect of first aid and cardiopulmonary resuscitation (CPR) training course offered by Taipei Municipal Department of Health, its 12 district health stations and 3 municipal hospitals. Data were collected by using questionnaires on all the trainees attending the complete 8-hour training courses in 1995. Tests were conducted before and after the training. Totally there were 599 valid trainees who took both pre and post tests. Major findings are as follows: (l) After taking the training course, the rate of correct answers for knowledge questions was significantly improved. However, most of the trainees answered incorrectly on the procedure of cardiopulmonary resuscitation (CPR) skills. (2)Trainees preferred 4-6 or 7-8 hour course and considered the content of the course appropriate. (3)The primary source of information regarding training course was from company and school. (4)The motivation for participating in the course for the majority of trainees was to learn useful skill in case of facing an accident. (5)Those trainees who were the first time learners, having more active motivation, younger than 45 years old and being male had higher probability of using CPR skill in an accident situation. (6)The most needed topics were CPR, management of trauma, stop bleeding, swathing, burning and choking.
• 59 - 69
• 10.6288/CJPH1998-17-01-07

• Link 原著 Original Article
• 以濾紙乾血及唾液作HIV-1抗體篩檢之效度評估Validity of Filter Paper Dried Blood Method and Saliva Test for the Detection of HIV-1 Infection
• 涂醒哲、鄭玉娟、 顏似綾、張安隆、林瓊照、 林瑞宜
  Shiing-Jer Twu, Yu-Juen Cheng, Szu-Lin Yen, An-Lung Chang, Chiung-Chao Lin, Ruey-Yi Lin
• HIV-1抗體 ； 愛滋病毒感染 ； AIDS ； 濾紙乾血法 ； 唾液檢查法
  HIV-1 antibodies ; HIV infection ; AIDS ; filter paper dried blood ; saliva
• 本研究利用濾紙乾血及唾液配合Wellcozyme HIV 1+2 GACELISA (Immunoglobulin G antibody capture enzyme-linked immunosorbent assay)試劑做HIV-1抗體檢查，並且和兩次EIA檢驗血清檢體後的確認結果比較，以評估濾紙乾血法及唾液檢查法的效度。結果發現，濾紙乾血法的敏感度(sensitivity)為93.55%(58/62)，特異度(specificity)為98.72%(77/78)。但與經Western Blot確認的個案比較，敏感度則達到100%。唾液檢查法的敏感度及特異度也均為100%。此外，經過六個月的室溫置放，濾紙乾血仍可有效檢測出HIV-1抗體。Omni-Sal唾液收集器中的唾液置於室溫下經過一個月後也可有效到出HIV-1抗體。由本研究的效度評估結果顯示，濾紙乾血法及唾液檢查法皆具有相當的可信度。在室溫下，檢體的保存期限也可達至少一個月的時間，其中濾紙乾血法在儲存六個月後再測，仍可百分之百測出HIV-1抗體。這兩種方法將可作為大規模篩檢及匿名篩選可行的工具。
  We evaluated the validity of the filter paper dried blood method and saliva test for detecting HIV-1 antibodies. Specimens of filter paper dried blood and saliva were tested with IgG-capture enzyme-linked immunosorbent assay (GACELISA). HIV-1 antibody results on dried blood and saliva were compared with the HIV-l serostatus determined by EIA (Enzyme immunoassay). The overall sensitivity and specificity of the filter paper dried blood method were 93.55%(58/62) and 98.72%(77/78), respectively. However, the filter paper dried blood was 100% sensitive if compared with Western Blot. The saliva test was 100% sensitive on 110 specimens collected from anti-HIV-1 positive patients. The specificity of the saliva test was also 100% on 109 specimens collected from anti-HIV negative individuals. In addition, storing dried blood specimens at room temperature for up to 6 months did not affect the results of the GACELISA test. The saliva test also detected HIV-1 antibody correctly after the saliva specimens had been stored at room temperature for 1 month. These results demonstrate that GACELISA tests on saliva or on filter paper dried blood are accurate alternatives to the conventional blood test for HIV-1 antibodies. These two methods are suitable for large-scale screening and for epidemiological studies.
• 70 - 75
• 10.6288/CJPH1998-17-01-08