17卷3期

• Link 公衛論壇 Public Health Forum
• 引言引言
• 郭育良 ； 王榮德
  Leon Yue-Liang Guo, Jung-Der Wang
• 無
  none
• 無
  none
• 171 - 171
• 10.6288/CJPH1998-17-03-01

• Link 公衛論壇 Public Health Forum
• 新興傳染病所需的防疫體系新興傳染病所需的防疫體系
• 何美鄉
  Mei-Shang Ho
• 無
  none
• 無
  none
• 171 - 172
• 10.6288/CJPH1998-17-03-02

• Link 公衛論壇 Public Health Forum
• 從腸病毒的流行談台灣病毒監測體系的再造從腸病毒的流行談台灣病毒監測體系的再造
• 劉清泉
  劉清泉
• 無
  none
• 無
  none
• 173 - 174
• 10.6288/CJPH1998-17-03-03

• Link 公衛論壇 Public Health Forum
• 走過C型肝炎鄕走過C型肝炎鄕
• 盧勝男
  Sheng-Nan Lu
• 無
  none
• 無
  none
• 175 - 181
• 10.6288/CJPH1998-17-03-04

• Link 公衛論壇 Public Health Forum
• 醫療廢棄物的處理與病毒性肝炎醫療廢棄物的處理與病毒性肝炎
• 宋鴻樟 ； 陳永仁
  Fung-Chang Sung, Yeong-Ren Chen
• 無
  none
• 無
  none
• 182 - 185
• 10.6288/CJPH1998-17-03-05

• Link 公衛論壇 Public Health Forum
• 氣喘(Asthma)的篩檢定義與診斷氣喘(Asthma)的篩檢定義與診斷
• 葛應欽
  葛應欽
• 無
  none
• 無
  none
• 185 - 190
• 10.6288/CJPH1998-17-03-06

• Link 綜論 Review Article
• C型肝炎在台灣Hepatitis C Virus Infection in Taiwan
• 高嘉宏、陳定信
  Jia-Horng Kao, Ding-Shinn Chen
• 無
  none
• C型肝炎病毒感染是本地慢性肝病的第二大原因，B肝表面抗原陰性的慢性肝炎息者中，70~80%為C肝抗體陽性，且多數體內存有病毒。一般健康成人的C肝抗體盛行率為1~2%，但隨年齡增加而上昇。台灣地區C型肝炎病毒感染以水平傳染為主要的傳染遼徑，其中因輸血而感染者約佔慢性C型肝炎的30~40%。垂直傳染或周產期傳染的效率不高，在10%以下，且和母體之高病毒濃度及生產方式有關。自民國81年7月進行捐血者C肝抗體篩檢後，輸血後急性C型肝炎的發生率已大幅降低，幾不復見。
  Hepatitis B virus (HBV) has long been known to be the major etiologic factor of chronic liver diseases and hepatocellular carcinoma (HCC), and in Taiwan 80-90% of chronic liver diseases and HCC are caused by HBV. Cloning of hepatitis C virus (HCV) genome and subsequent development of assays for antibodies against HCV have revealed HCV as the next most common cause of these diseases in Taiwan. The prevalence of antibodies against HCV (anti-HCV) in hepatitis B surface antigen (HBsAg)-negative patients is around 70-80%, and most of them are viremic. Anti-HCV is found in 1-2% of healthy adults, and increases in parallel with age. The epidemiology of HCV infection in Taiwan is similar to other areas of the world, with horizontal transmission as the major route of infection. Blood transfusion was an important route of transmission, accounting for 30-40% of chronic HCV infection. After screening for anti-HCV in blood donors was instituted in July 1992, this infection route was effectively controlled. In contrast, vertical or perinatal transmission plays a minimal role in the spread of HCV.
• 191 - 197
• 10.6288/CJPH1998-17-03-07

• Link 綜論 Review Article
• 我國全民健康保險體制的改革理念An Economic Perspective on Reforming the National Health Insurance Program
• 盧端芬、湯明哲
  Jui-Fen Rachel Lu, Ming-Je Tang
• 合辦民營 ； 健康維護組織 ； 承保機構之屬性 ； 民營化
  quasi-governmental agency ; HMO ; privatization ; National Health Insurance NHI
• 政府公共服務民營化可謂是全球趨勢。自民國82年國內決策者及學者和國外的醫療顧問，即紛紛提出將全民健保承保機關定位為「公辦民營」的觀念，然而終因缺乏具體實施方案，及全民健保相關條件未臻完備的情況下，在立法過程終遭否決。但是全民健保法中亦規定，全民健保實施期滿兩年須提出執行評估及全民健保改制方案。目前全民健保已開辦近兩年，各界的討論改革方案亦紛紛出籠。可見改革一案，如箭在弦上，不得不發。本文將從管制經濟學及公共行政學的學理出發，探究政府管制／市場機制與醫療經營的關係，並提出具體的改革方案。全民健保宜部分開放民營，以引進市場機制，提昇經營效率。顧及民意及全民健保具社會福利的意義，宜採「公辦民營」的方式進行。由中央健保局繼續辦理原先的保險型態，此外開放民間經營的健康維護組織(Health Maintenance Organization, HMO)，使民眾有選擇的機會。
  Privatization of government services has been a popular trend around the world. Since the inception of National Health Insurance (NHI) in 1993, health policy-makers as well as domestic and foreign consultants have advocated a fundamental change in the administration of NHI Program, namely, toward a quasigovernmental agency program. The concept, however, was not accepted by legislators due to a lack of a concrete implementation proposal and a suitable environment. Nonetheless, the NHI law required that the NHI program would be closely evaluated and proposal for new systems would be presented two years after its implementation. This paper proposes a public-owned private-run system based on the theories on regulatory economics and public administration. We suggest that the NHI program should be partially privatized to introduce market mechanisms, promote competition and to improve the efficiency further. However, the government involvement should be maintained, since the general public prefers the government as a fallback for fear of bankruptcy; and the NHI program has social welfare implications. It is therefore to recommend that Bureau of NHI runs a comprehensive insurance program and call for private HMOs.
• 198 - 205
• 10.6288/CJPH1998-17-03-08

• Link 原著 Original Article
• 社區精神分裂病患家庭功能與自我照顧之相關性Relation between Self-Care and Family Functioning Among Schizophrenic Patients in the Community
• 邱淑貞、蕭淑貞
  Shu-Jen Chiou, Shu-Jen Shiau
• 社區心理衛生 ； 精神分裂病患 ； 家庭功能 ； 自我照顧
  Community Mental Health ; Schizophrenic Patients ; Self-Care ; Family Functioning
• 無
  The purpose of this study was to explore the relation between self-care performance and family functioning among the schizophrenic patients in the community. A convenience sampling was used to recruit subjects from the Taipei City Psychiatric Center. A structured questionnaire was used to interview qualified subjects at their home. Both descriptive statistics and Pearson correlation was used to analyze data. There were seventy-six subjects completed the questionnaires. The result showed that patients' self-care performance was postitively correlated with the level of family functioning, which included problem solving, role, affection, communication, decision-making, independence and health-care. The results are valuable for the nursing professional in providing comprehensive and long-term community care for schizophrenic patients.
• 206 - 213
• 10.6288/CJPH1998-17-03-09

• Link 原著 Original Article
• 台灣北部國中學生氣喘盛行率調查Adolescent Asthma in Northern Taiwan
• 吳家興、林瑞雄、謝貴雄、邱文達、陳麗美、邱淑媞、黃國晉、劉文良、邱宏毅、蕭慧娟、方淑慧
  Jia-Hsing Wu, Ruey S Lin, Kue-Hsiung Hsieh, Wen-Ta Chiu, Li-Mei Chiu, Shu-Ti Chiou, Kuo-Chin Huang, Wen-Liang Liu, Hung I Chiu, Hui-Chiu Hsiao, Shu-Hwei Fan
• 氣喘盛行率 ； 空氣污染 ； 國民中學生 ； 台灣北部
  asthma ; air pollution ; junior high school ; Northern Taiwan
• 行政院環境保護署基於改善空氣品質之訴求，委請國立台灣大學公共衛生研究所等10所學術機構，進行國民中學學生氣喘篩檢及肺功能檢查，以探索與空氣污染的關係，作為空氣污染防制措施之參考。分北一、北二、中、南、高屏及東區進行。本文的目的在報告北一區，即台北市、台北縣、基隆市及宜蘭縣，國中學生氣喘的盛行狀況，並分析學生氣喘盛行的地區差異，探討生活型態、空氣污染、季節等因素的相關程度。氣喘篩檢是使用兩種標準問卷，包括由父母回答的新英格蘭問卷及由學生看錄影帶回答的問卷。問卷內容包括學生的基本資料、居家的環境條件、父母親對兒女的過敏性疾病認知等部份。本分區共回收313，199名(87.9%)學生的資料。 結果：全北一區的國中學生氣喘盛行率為10.2%（男生11.6%、女生8.2%）。其中以台北市的盛行率最高為13.0%，疑似氣喘率則為19.3%，宜蘭縣最低（分別為5.9%和17.9%）。本文除對各種與氣喘可能相關的因子作雙向分析之外，並使用複邏輯迴歸分析，以氣喘的有無當作依變項，性別、年級別、空氣污染程度、燒香、縣市別、學生運動情況、家中抽菸人數及家人抽菸數量為自變項。大多與氣喘呈現統計學上有意義的正相關；唯燒香和運動都呈現負相關。居住在空氣污染較嚴重的地區、男性、父母的高教育程度、低年級、很少運動及暴露在么手菸下均會有較高的氣喘罹病勝算比。複運輯迴歸的結果顯示空氣污染的氣喘勝算比污染嚴重地區對沒污染為1.8（95%信賴區間1.73~1.95）。
  An asthma mass screening study was conducted among all middle school students in Taiwan in 1995-1996. The screening activities were performed simultaneously in six regions: North-1, North-2, Center, South, KauPin and East regions. Investigators also selected 20 percent of the students undergo lung function tests. Data collected for asthma screening in North-1 region, including Taipei metropolitan, Taipei County, Keelung City and Ilan County, were utilized for this report. With the assistance of the local Educational Bureau, school administrations, and teachers, the trained study teams distributed the adapted Chinese version of New England Core questionnaires to students for completion by their parents. Students themselves responded to a Chinese version of the video questionnaire developed by the International Study of Asthma and Allergies in Children. The current study attempts to investigate which of the factors, such as age, gender, parental education, passive smoking, exercise, burning of Chinese incense, and air pollution have significant associations with children's asthma. A total of 158,330 boys and 154,760 girls were included in the analyses. For the whole North-I region, the asthma prevalence was 10.2%, higher in boys (11.6%) than in girls (8.2%), and the suspected asthma prevalence was 19.3%. Among the four subareas in North-1 region, the highest prevalence rate (13.0%) was in metropolitan Taipei and the lowest (5.9%) was in Ilan. Results of multiple logistic regression analysis indicated that factors significantly associated with asthma included living in areas with heavy air pollution, being a boy, higher parental education and being younger. No consistent patterns were observed for passive smoking unless more than 60 cigarettes were smoked daily by household members. Students who lived in areas of parents-reported heavy air pollution were 1.8 times more likely (95% confidence interval 1.73-1.95) to have a history of asthma than students who lived in area with no pollution. This study showed a detrimental relationship between asthma and parent-reported air pollution level.
• 214 - 225
• 10.6288/CJPH1998-17-03-10