17卷2期

• Link 公衛論壇 Public Health Forum
• 期待更多有關醫學中心“體制外”的研究期待更多有關醫學中心“體制外”的研究
• 陳美霞
  Meei-Shia Chen
• 無
  none
• 無
  none
• 77 - 79
• 10.6288/CJPH1998-17-02-01

• Link 原著 Original Article
• 台北市北投區居民對中醫醫療的知識、信念與行為意向及其對醫療利用型態之影響The Knowledge, Belief, and Behavioral Intention of Traditional Chinese Medicine in Peitou District, Taipei
• 康翠秀、陳介甫、周碧瑟
  Tsui-Hesiu Kang, Chieh-Fu Chen, Pesus Chou
• 知識 ； 信念 ； 行為意向 ； 中醫醫療
  knowledge ; belief ; behavioral intention ; traditional Chinese medicine
• 本研究目的為探討社區民眾對中醫醫療的知識、信念與行為意向。本研究於民國84年8~12月以台北市北投區四十個里三十歲以上居民為母體群，抽樣2961人，實訪2328人，得有效問卷1085份（回收率47%），結果顯示：(1)對中醫醫療的知識方面：認知比率最高以『中醫因為藥物的性質和治療需要，常製成各種不同劑型』答對率最高。對中醫醫療的信念方面：一般大都採中立，以『吃中藥，有病可以治病沒病可以補身』同意的人數最多。對中醫醫療的行為意向方面：大那份仍較傾向西醫，而以『嬰幼兒疾病』傾向西醫的比率最高；而關於『肌肉扭傷、關節脫臼』以及『產後保養』則較傾向中醫。(2)年紀越輕，對中醫醫療的知識越高，且其行為意向越偏向中醫醫療，但在信念上並無顯著差異。教育程度越高，對中醫醫療的知識越高，但相反的對中醫醫療的信念卻越負向，而對行為意向卻無顯著差異。以本省客家人對中醫醫療的知識最高，且其信念及行為意向亦是最偏向中醫醫療。在宗教方面以信仰西洋京教者對中醫醫療的知識最高，但其意向卻是最不偏向中醫醫療。在職業方面以軍公教警對中醫醫療的知識最高，但其信念與行為意向卻是以工者為最偏向中醫醫療。(3)在醫療利用型態方面，只用西醫佔68%，只用中醫佔29%，中西醫合併佔29.1%。
  The main goal of this study was to explore knowledge, belief, and behavior towards traditional Chinese medicine (TCM) among one community in Taipei. A questionnaire was used to survey residents over 30 years of age in 40 sections of Peitou district, Taipei City from August to December, 1995. A total of 2328 subjects were interviewed, and 1085 (47%) interviews were completed. The results of this study revealed: (1) Regarding knowledge about TCM, the most agreed to answer concerning the 15 statements about knowledge was “Herbal drugs are made in different forms according to drugs character and effect”. Regarding beliefs about the effectiveness of TCM, most people agreed that ”Taking herbal medicine not only can cure disease but also improve health”. Regarding behavior intention towards TCM, the majority of subjects were inclined to use medicine, particularly in pediatric illness. The most frequent situations in which the subjects were inclined to use TCM were ”Muscle sprain”, ”Joint dislocation” and ”Care of puerperium” (2) Younger people had a profound insight about the value of TCM and were more likely to favor its use. Those with higher education levels were more likely to be familiar with TCM, but were also more likely to present a negative attitude toward its effectiveness. Hakka people had the best knowledge of TCM, and their beliefs and behavioral intention were in favor of it, too. TCM is thoroughly perceived by many western-religious believers, but their beliefs and behavior intention were less likely to be amenable to its use. Public-servants (i.e. soldiers, teachers, officers and police) were knowledgeable about TCM as well, while the beliefs and behavior intention towards TCM were positive (3) Of the types of medical services utilized, 68% used western medicine only, 2,9% use TCM only, and 29.1% used both western medicine and TCM.
• 80 - 92
• 10.6288/CJPH1998-17-02-02

• Link 原著 Original Article
• 醫療作業環境空氣中生物性及化學性因子暴露評估－以一大型教學醫院之調查為例Airborne Microbial and Chemical Exposure Assessment in a Hospital Environment
• 吳佩芝、蘇慧貞、黃金鳳、林佳瑩、李俊璋
  Pey-Chih Wu, Huey-Jen Su, Chin-Feng Huang, Chia-Ying Lin, Ching-Chang Lee
• 醫療作業環境 ； 生物性氣膠 ； 化學性因子 ； 暴露評估
  hospital environment ; bioaerosols ; chemicals ; exposure assessment
• 不同環境污染物，因其特性不同及人體對其暴露時間之長短，故而所引致之健康影響亦可能有別。本研究以一使用中央空調系統之大型醫院為對象，針對院內醫療從業人員可能暴露的生物性及化學性因子進行偵測及調查，以了解其在工作環境中之成分含量及分佈，以進一步探討從業人員之暴露程度與健康影響之可能相關。 在生物性因子暴露評估上，主要以一階空氣採樣器(Andersen sampler)銜接培養皿直接採集空氣中之真菌及細菌，另外以濾紙匣銜接幫浦採樣器，採集空氣中細菌內毒素之濃度。在化學性因子評估方法上，針對本類型作業環境空氣中之乙醇、甲基異丁酮及二甲苯，以標準方法利用活性碳管採樣，再經氣相層析儀／火焰離子化分析儀(GC/FID)加以分析。此外，另以Bruel &Kjar之毒性氣體監測儀，以定點方式，監測作業環境中甲?之含量，每30秒監測一次。 分析結果發現，空氣中生物性氣膠的濃度，以院內之洗縫組、急診處較高。至於空氣中之乙醇、甲基異丁酮及二甲苯時量平均濃度均較勞委會規定之容許濃度標準100DPPm、50PPm、100Ppm低。然而病理部標本室中所測得之甲?濃度卻較規定之容許濃度1PPm，高出2~3倍。由於甲?為動物性致癌物，建議應加號改善通風設施及個人防護措施。 本暴露評估調查結果發現，以中央空調系統為主之現代化醫院，除少數特殊地點外，應較無產生高濃度生物氣膠危害之可能，但應以改善區域性通風設施及配戴個人防護器具來加強對特殊化學暴露之防護。
  The characteristics of a hospital environment easily potentiate health hazards resulting from microbial and chemical air pollution. This project was conducted to evaluate the airborne microbial and chemical concentrations in a modern hospital environment with central air-conditioning. The bioaerosol exposure was assessed by sampling viable fungi and bacteria using a single stage/N6 Andersen impactor with Malt and Nutrient agar. After incubation and morphological identification, concentrations of airborne fungi and bacteria were expressed as CFU/m^3 (colony forming units/m^3). Airborne endotoxin was collected by filter cassettes connected with personal pump. Limulus amebocyte lysate test and KLARE method was applied for analysis calculation of concentrations. Airborne chemical concentrations were examined according to the SOP (Standard Operating Procedures) published by the Council of Labor Affairs, Taiwan, ROC. Ethanol, MIBK, and xylene were analyzed by GCJFID. Formaldehyde was measured by a Bruel & Kjar Toxic Gas Monitor with data taken every 30 seconds. The preliminary data analyses showed that there was no particularly high bioaerosol concentrations observed in the modern hospital environment in this study other than the Washing Department and the Emergency Room. Most of the chemical exposure did not appear to be of concern. However, the formaldehyde concentration was about 2 to 3 times above the Permissible Exposure Level (1ppm). Considering the animal carcinogenicity of formaldehyde, special improvement of local ventilation and enforcement of personal respiratory protection is highly recommended
• 93 - 102
• 10.6288/CJPH1998-17-02-03

• Link 原著 Original Article
• 實驗室測量血中鉛含量一致性的評估：國人血中鉛濃度調查研究的經驗Assessment of Test Consistency of Blood Lead Levels: The Experience from a Study on Blood Lead Levels in Taiwanese Population
• 孫建安、張玉坤、賴錦皇、吳德敏、 劉紹興
  Chien-An Sun, Yue-Cune Chang, Ching-Huang Lai, Der-Min Wu, Saou-Hsing Liou
• 血中鉛含量 ； 測試一致性
  blood lead levels ; test consistency
• 本研究藉由國內七家實驗室參與「國人血中鉛濃度調查研究」的機會，評估實驗室間與實驗室內測試低血鉛含量的一致性。測試樣本由本研究之中心實驗室所在之總醫院的血庫中隨機選取五名沒有職業性鉛暴露的捐血袋（每袋為250毫升），然後每位捐血者之捐血袋分裝成每管5毫升（共50管）的測試樣本，並冰存於4℃的冰箱中。研究人員於三次不同的時間點（每次間隔兩星期），從五名捐血者血袋所建構成的到試樣本群中，隨機選取每位捐血者之兩管測試樣本，以乾冰保存的方式送至受測實驗室。每個受到實驗室參考標準的樣本處理分析程序，以石墨爐原子吸收光譜儀來測試血液樣本中的鉛含量，並需於收到測試樣本兩個星期內完成測試工作。評估結果發現，各實驗室在測試同一時間送至實驗室之同一個案的第一管樣本時的變異係數（〔標率差÷平均數〕×100%）介於0.7%到58.9%之間，而在測試第二管樣本時的變異係數則為2.7%~102.6%。另外，以中心實驗室為比較基準，使用GEE(generalized estimating equation)分析模式發現各實驗室與中心實驗室之間亦存在有實驗室間的測試變異。這些結果顯示，血中鉛含量的測定存在有顯著性之實驗室間的測量差異。因此，在以血中鉛含量為生物標記的調查研究中應包含監測實驗室測試血中鉛品質的品管程序。本研究提供了評估實驗室測試血中鉛檢驗品質的模式，也提出了實證的數據來驗證實驗室測量血中鉛含量所面臨測試穩定性的實質困難。
  A proficiency study was done to assess the consistency of analyses for blood lead levels (BLLs) when performed by different laboratories. Specimens of blood were aliquoted into a series of test samples from five healthy blood donors and were sent to each laboratory on three separate occasions with two-week interval between each occasion. All test samples were handled identically during processing, storage, and retrieval, and were labeled in ways which would preclude their identification by the receiving laboratory. Blood lead concentrations were analyzed by seven participating laboratories, each used flameless atomic absorption spectrophotometry (FAAS) and followed the same protocols for BLL measurements. Statistical analysis of the data showed that the coefficients of variation (CVs) of laboratory performance on the first replicate of each subject were between 0.7% and 58.9% and the corresponding CVs for assays on the second replicate were in the range of 2.7% to 102.6%. In addition, results from the analysis based on generalized estimating equation (GEE) revealed a statistically significant variation in interlaboratory measurements of BLLs. These study results emphasized the need for rigorous evaluation and increased monitoring of laboratory performance in epidemiological studies using BLLs as biomarkers.
• 103 - 110
• 10.6288/CJPH1998-17-02-04

• Link 原著 Original Article
• 醫院形象定位之研究－以台北市六家醫學中心的家醫科就診民衆為例A Study on the Hospital Image Positioning-Outpatient Visits in Six Medical Centers' Family Medicine Department
• 張櫻淳、黃文鴻、蘇喜
  Ying-Chun Chang, Weng F. Huang, Syi Su
• 醫院形象 ； 定位 ； 行銷策略
  hospital image ; positioning ; marketing strategy
• 本研究的主要目的在於膫解消費者心目中所認知的各醫院的形象定位。首先從文獻中歸納出26項屬性，將其設計為五點式的李克特氏量表，經施測及因素分析後，共得五個形象構面。設計問卷測量消費者認知的形象定位，以台北市六家醫院的家醫科就診民眾為研究對象，發出問卷共1519份。有效問卷回收612份（回收率40.3%）經分析後，主要結果為： 一五個形象構面，(1)等候時間的長短；(2)醫院的整體觀感；(3)門診的醫療品質；(4)就醫的便利性；(5)醫院和醫師的名聲。且就本研究而言，醫療品質與整體觀感是民眾認為較重要的兩項。 二、樣本人口所認知的醫院形象定位為：A、B、C醫院目前的定位明確，分別為醫院及醫師的名聲、整體觀感及就醫的便利性；D、E、F醫院則不明確且同質性高：而等候時間與醫療品質則是尚未被佔據的開放位置，係可今展行銷策略的足位點。
  he main purpose of this study was to investigate the current hospital image positioning cognized by consumers. 26 attributes from literature review were constructed with five- point Likert Scale in the survey questionnaire. Five hospital image dimensions were obtained from factor analysis, and further self-administered questionnaires were designed to measure consumers' image positioning among study subjects. With convenience sampling method, questionnaires were administered to 1519 outpatients visiting six medical centers' family medicine department during March and April 1996 in Taipei. There were 612 questionnaires completed, which represents 40.3% responses rate. After data analysis, the major findings were: 1. Five image dimensions cognized by consumers of this study were the length of waiting time, the holistic impression of the hospital, the quality of outpatient services, the accessibility to visits, and the reputation of the hospital and doctors. 2. The consumers' hospital image positioning in this study was described as follows: Hospital A, B and C had specific positions in the market, hospital A was the reputation, hospital B was the holistic impression, and hospital C was the accessibility. However, hospital D, E and F had no specific positions, but bore the same nature with one another, which means they were more competitive. The quality of outpatient services and waiting time were two open positions unoccupied by any of the six hospitals, it could be developed for the marketing strategy.
• 111 - 124
• 10.6288/CJPH1998-17-02-05

• Link 原著 Original Article
• 某醫學中心專任主治醫師薪資滿足感、離職傾向與影響因素關係之研究－線性結構模式分析之應用The Association of the Satisfaction with Compensation, Propensity to Leave, and Their Related Factors of Fulltime Visiting Staff in a Medical Center-Application of Linear Structural Equation Model
• 羅萱、楊志良
  (Hsuan Lo, Chih-Liang Yaung
• 薪資滿足感 ； 離職傾向 ； 線性結構模式分析
  ?satisfaction with pay?;?intention to leave?;?linear structural
• 國立醫學中心級醫院的薪資制度受限於政府機關法今的規範，薪資制度採年資制及職級制造成不同工同酬的現象，致使績效好的醫師無法在薪酬上得到適度的回饋，因此可能影響其薪資滿足感因而降低服務意願致離職。 本研究假設薪資滿足感受到個人特性、對組織期望因素、及工作績效的影響；離職傾向受到組織期望因素及薪資滿足感的影響。利用線性結構模式分析方法來探討醫師薪資態度及相關行為間的關係。 研究對象為以某國立醫學中心級醫院專任主治醫師388人（回卷率為58.5%）。研究結果發現：影響離職傾向的直接因素：薪資滿足感、「家庭因素」、臨床績效、年薪所得。影響薪資滿足感的因素：「組織氣氛因素」、「薪資因素』、年薪所得、臨床及研究績效。顯示該個案醫院管理者在提高主治醫師留任意願的?多措施之一，以改善目前薪資制度的缺失，維持及增進組織支持的氣氛，增加工作設計上的彈性，及改善工作量不平均的現象有助淤醫師的留任。
  The case hospital, a public university medical center, has a rigid payroll system due to tight governmental regulation. The pay is based on a physicians tenure and hierarchy which may lead to the physician' low job satisfaction, and consequently high propensity to leave the hospital. Therefore, the purpose of this study is to explore the factors influencing the propensity of full-time physicians to leave. Based on literature review, we hypothesized that the physicians' satisfaction with pay will be affected by personality, expectation to work environment, and work performance, and that physician's intention to leave the job will be influenced by the expectation to work environment and satisfaction with pay. The survey consisted of, 388 visiting staffs being selected from this case hospital, of which 227 sample cases responded to this questionnaire (58.5%). Using the Linear Structural Equation modeling, we analyzed the association between the satisfaction with pay and their propensity to leave. The main study results were that the factors directly affected the intention to leave were the satisfaction with compensation, family factor, clinical performance, and research performance. Based on our study results, we suggest that the case hospital should improve the physician payroll system, facilitate the organization supporting mechanism, increase the flexibility of job design, and correct the unbalanced work load.
• 125 - 138
• 10.6288/CJPH1998-17-02-06

• Link 原著 Original Article
• 全民健保實施後急性病床住院病患超長住院情形之分析Analysis of Overstay in Acute Beds in Hospitals under the National Health Insurance Program in Taiwan
• 吳肖琪、林麗嬋、藍忠孚、吳義勇
  hiao-Chi Wu, Li-Chan Lin, Lan-Chung Fu, Yee-Yung Ng
• 健康保險 ； 住院日 ； 醫療服務利用 ； 住院病患 ； 佔床情形
  health insurance ; length of stay ; health services utilization ; inpatients ; bed occupancy
• 全民健保實施後，陸續有些醫院反應急性病床一床難求，部份慢性病患佔用急性病床。為能瞭解此一情形，本研究以全民健保84年7至12月急性病床住院中報資料進行分析，以住院超過30日定義為超長住院，則超長住院息者的比率為4.0%，超長住院人日佔總住院人日24.4%，若能避免超過30日的住院，則估計可空出10.1%之病床，估計此部份費用佔健保住院費用13.1%。以公私立別區分，公立醫院超長住院率7.5%遠較私立27%高，公立超長住院人日為35.1%，和立為18.2%。以層級別區分，醫院層級愈高超長住院愈嚴重，公立與和立醫學中心的超長住院率分別為8.9%與5.6%；其超長住院人日分別為39.6%與27.9%。依專科別區分，內科病床超長部份利用率10.4%，雖遠較復健科32.9%為低，但由於內科病患最多，故超長住院人次居最冠。由前述分析，可以發現超長住院是迫切需要被正視的問題，建議未來應朝落實出院計畫、鼓勵驕展各類長期照護服務、提高住院部份負擔比例、拉大醫院層級部份負擔差距、提高自行負擔金額上限等方向努力。
  Following implementation of Taiwan's National Health Insurance (NHI) some hospitals have reported a shortage of acute beds as a result of long hospital stays by some patients. To study this situation, we analyzed inpatient data (n=930, 751) in acute hospitals covered by NHI from July-December, 1995. Overstay was defined as a hospital stay of over 30 days. The overstay rate was 4.0%. The days of care taken by overstay patients accounted for 24.4% of all days of care in the hospital. Thus, if overstay could be prevented, NHI could conserve 10.1% of total hospital beds and 13.1% of inpatient expenditures. Overstay has different effects in public and private hospitals; the overstay rate in public hospitals exceeded that in private hospitals (7.5% vs. 2.7%). The days of care for overstay patients in public and private hospitals were 35.1% and 18.2% of all days of care, respectively. Differences were also found by rating level of accredited hospitals-those with higher ratings had higher overstay rates. Overstay in medical centers also differed by the nature of the center; the overstay rate for public and private medical centers was 8.9% and 5.6%, respectively. For days of care for overstay patients, again, public outweighs private at 39.6% vs. 27.9% of all days of care. Although the occupancy rate of acute beds for patients in internal medicine is significantly lower than rehabilitation medicine (10.4% vs. 32.9%), the number of occupied acute beds is higher because there are more patients in internal medicine. We recommend that in order to effectuate discharge planning, the government and hospitals develop a long term care delivery system and raise inpatient co-payments.
• 139 - 147
• 10.6288/CJPH1998-17-02-07

• Link 原著 Original Article
• 肝癌患者罹病成本與其相關因子之探討：以某醫學中心患者為例Morbidity Costs and Associated Factors of Patients with Hepatocellular Carcinoma from a Medical Center
• 吳季倫、楊銘欽
  Chi-Lun Wu, Ming-Chin Yang
• 肝癌 ； 罹病成本 ； 直接成本 ； 間接成本
  hepatocellular carcinoma ; morbidity cost ; direct cost ; indirect cost
• 肝癌為台灣十種常見惡性腫瘤之一，於近年來已成為癌症死因之首位。罹患肝癌後，各種醫療費用與相關支出，以及患者與親友潛在的生產力損失，對個人、家庭乃至社會之經濟影響甚鉅。 本研究以社會觀點估計某醫學中心229位受訪肝癌患者自確診後至受訪日期或死亡日期之罹病成本（包括直接成本與間接成本）。直接成本包括患者自付及保險支付之相關醫療費用；而間接成本則包括交通費用、時間成本與其他支出。研究結果發現罹病成本、直接成本與間接成本之總平均值分別為450,000元、250,000元及210,000元；肝癌第二期患者之平均值分別為430,000元、250,000元及180,000元；而肝癌第三期以上患者之平均值分別為510,000元、230,000元及280,000元。間接成本視患者期別不同，約佔罹病成本之40%至50%，並且時間成本部份即佔間接成本之90%左右。而無論是直接成本、間接成本或罹病成本，醫療服務利用情形皆與各項成本成正相關。此外，確診前薪資較高之患者，其間接成本與罹病成本亦較高。
  Hepatocellular carcinoma (HCC) is one of ten common cancers in Taiwan and has been the leading cause of death among cancer patients in recent years. Once contracted with HCC, enormous cost of medical care, such as expenditures associated with care seeking and the potential loss in productivity, will have tremendous economic impact on the patient, his/her family and the society. Based on social perspective, this study estimated morbidity costs (including direct costs and indirect costs) of 229 HCC patients from a medical center. The costs estimated were occurred from the diagnosis date to the date of responding our questionnaire or the death date. Direct costs refer to medical care expenditures, and indirect costs include transportation fee, time cost and others. Disregard patients stages of HCC, the average direct, indirect and morbidity costs were about NT $250,000, NT $210,000, and NT $450,000, respectively. For patients of HCC stage ?, the average direct, indirect and morbidity costs were about NT $250,000, NT $180,000, and NT $430,000, and for patients over HCC stage ? were about NT $230,000, NT $280,000, and NT $510,000, respectively. About 40% to 50% of morbidity costs were attributable to indirect costs, and 90% of indirect costs were attributable to time cost. The direct, indirect and morbidity costs were positively associated with medical care utilized. Furthermore, the indirect and morbidity costs were associated with the salaries of the patients before the diagnoses were confirmed.
• 148 - 157
• 10.6288/CJPH1998-17-02-08

• Link 原著 Original Article
• 使用貝氏因子與變異項比值進行氣喘死亡率地理空間資料模型之選擇Spatial Model Selection Using Bayes Factor and Ratio of Variabilities for Asthma Mortality Data
• 曾仲瑩、蕭朱杏、 陳建仁
  Jung-Ying Tzeng, Chuhsing Kate Hsiao, Chien-Jen Chen
• 貝氏因子；條件式自我相容模式；可交換模式；地理空間資料模型選擇
  Bayes factor ; CAR model ; EX model ; spatial modelselection
• 以階層式模型分析空間地理資料，除了可考慮有規則性的變異量之外，亦可針對隨機變異量加以處理。在認為各地死亡率係受另一隨機分佈（即事前分佈）支配的前提下，階層式模型透過所假設的隨機分配以解釋隨機變異，其中最常用的兩種模式即為conditional autoregressive(CAR)模式與exchangeable(EX)模式。然而，欲在這兩種代表不同意義的模式間進行選擇，卻往往欠缺判斷的準則。本研究以台北地區氣喘死亡率資料為例，在面對兩種不同死亡原因的假說的情況下，我們兼採CAR模式與EX模式來探討氣喘死亡率的地理趨勢，並利用Fully Bayesian方法與Monte Carlo Markov Chain原理（如Gibbs sampling）來估計參數。除了須選出一適當的模式來描述其地理分佈狀況外，更希望透過所選用模式的意義來了解氣喘死亡的可能成因。我們選採兩個指標－貝氏因子與局部作用之變異量與整體作用之變異量比值－作為模式選擇的依據。研究結果發現：(1)由貝氏因子可直接看出資料較支持何種模式；而變異量比值則顯示資料本身的性質與是否應將局部作用放入模式中加以考慮，在模式的選擇上，二者應相互配合使用。(2)由指標來判斷，對氣喘死亡率資料而言，以EX模式較為適恰。由此亦推論內湖區、南港區有較高死亡率；而仍存在於地區間的變異則較可能由地區間彼此獨立的因素所引起。
  Hierarchical models are commonly used in analyzing geographical data. They take account of the random variation in addition to the systematic variability among observations. Through specifying a distribution for rates at different areas, various kinds of random mechanism for variability can be considered. The exchangeable (EX) priors and conditional autoregressive (CAR) priors are the two most common approaches. However, it is unclear about how to choose between these two mechanisms. In this study, motivated by looking for the true pattern of the asthma mortality data for Taipei City, we adopt the two competing EX and CAR models to investigate the spatial pattern. With the two hypotheses (the EX or CAR model), we not only need to obtain estimates of quantities of interest but also need to choose an appropriate model since the final decision may result in different etiologic studies. In this paper, we use the fully Bayesian approach with the Monte Carlo Markov Chain to obtain estimates. Then, we focus on two model selection indices-the Bayes factor and the ratio of the variances (the local effect to the global effect) for the asthma study. Based on the study results, we conclude: (1) Both the Bayes factor and the ratio of the local variance to the global variance should be used together for choosing an appropriate model. The Bayes factor offers a direct answer for which model is favored by the data, while the ratio of variances reflects the characteristic of the data and provides a way to evaluate whether it is necessary to consider the area-specific effect. (2)According to the two indices, the EX model is considered more appropriate for the asthma mortality data, and the rates at Neihu and Nankang are higher than other areas. The remaining variation among areas for the EX model may be caused by some spatial-independent variables rather than spatial-correlated variables.
• 158 - 169
• 10.6288/CJPH1998-17-02-09