16卷4期

• Link 綜論 Review Article
• 非胰島素依賴型糖尿病病人死亡狀況及預後因子Mortality and Prognostic Factors for Non-Insulin-Dependent Diabetes Mellitus
• 陳國東、陳建仁
  Kow-Tong Chen, Chien-Jen Chen
• 非胰島素依賴型糖尿病 ； 死亡率 ； 預後因子
  non-insulin-dependent diabetes mellitus ; mortality ; prognostic factors
• 本文收集已發表有關非胰島素依賴型糖尿病(non-insulin-dependent diabetes mellitus, NIDDM)病人死亡率以及預後因子的文獻，綜述整合以往研究結果。糖尿病病人死亡率較一般人增加的理由尚不是很清楚。在台灣，有關引起非胰島素依賴型糖尿病病人死亡率及預測因子的研究仍非常少。文獻顯示，NIDDM病人的死亡率是一般人口的2-6倍。越年輕其增加的死亡率越高。非胰島素依賴型糖病病人的主要死亡原因是心血管疾病、糖尿病、腦血管疾病、腎臟病變、惡性腫瘤。首次診斷為糖尿病的年齡、空腹血糖、高膽固醇血症、高血壓、蛋白尿、肥胖是非胰島素依賴型糖尿病病人死亡率的預後因子。台灣地區自1993年以來，糖尿病已躍居台灣地區十大死亡原因的第五位。它是慢性病死亡原因中增加人數最快的疾病。雖然NIDDM病人的預後因人而異，不過對於NIDDM病程的瞭解不僅可以改善病人的健康，也可以作為NIDDM治療策略的基礎，減少NIDDM病人死亡率。
  Research on mortality and prognostic factors of non-insulin-dependent diabetes mellitus (NIDDM) were reviewed in detail. The reasons for the excess mortality in diabetes remain ill-defined at present. It is not clear to what extent this excess is attributable to an increased prevalence or force of established risk factors for morbidity and mortality in non-diabetic populations and to what extent specifically diabetes related-factors may play a role. Few studies have examined their relationship between risk factors and mortality in people with NIDDM in Taiwan. There are 2-6 times excess mortality in people with NIDDM compare with the general population. The excess mortality was greater among young adults and lowest among elderly. Death from cardiovascular disease, diabetes, cerebrovascular disease, nephropathy, and cancer account for the larger proportion of this excess. Age at initial diagnosis, fasting blood sugar, hypercholesterolemia, hypertension, proteinuria, obesity were the main prognostic factors for the mortality of NIDDM. Since 1993, diabetes is the fifth leading cause of death in Taiwan. It is the chronic disease with marked increasing rate of death numbers in Taiwan. A major challenge in diabetes management is reducing unfavorable risk factors to ameliorate the high rates of morbidity and mortality.
• 281 - 290
• 10.6288/CJPH1997-16-04-01

• Link 綜論 Review Article
• 非胰島素依賴型糖尿病盛行率與危險因子Prevalence and Risk Factors of Non-Insulin-Dependent Diabetes Mellitus
• 陳國東、 陳建仁
  Kow-Tong Chen, Chien-Jen Chen
• 非胰島素依賴型糖尿病 ； 盛行率 ； 危險因子
  non-insulin-dependent diabetes mellitus ; prevalence ; risk factor
• 本文是要對世界各地非胰島素依賴型糖尿病盛行率及危險因子做一文獻探討。已有許多研究証明糖尿病的盛行率因人群年齡結構、地域、種族之不同而有很大的差異，即使是同一種族，生活型態不同，其盛行率也不同。在傳統生活型態的社會非胰島素依賴型糖尿病的盛行率很低，隨著現代化生活的演進，盛行率隨著提高；1940年以前，美國Pima印地安人，太平洋島嶼的Micronesian及Polynesian很少被發現有糖尿病，不過現在已有相當高的糖尿病盛行率。引發糖尿病的危險因子包括遺傳因素、肥胖、老化、高胰島素血症、飲食、運動過少、血脂異常、懷孕胎數、蛋白尿及高尿酸血症等。 台灣地區近年來由於社會經濟的發展，生活型態及飲食習慣的改變，糖尿病已逐漸變為威脅國人健康的主要疾病。目前國內這方面的研究還不多，期待更多的投入，找出國人引起非胰島素依賴型糖尿病之危險因子，使國人免於罹患非胰島素依賴型糖尿病。
  Research on prevalence and risk factors of non-insulin-dependent-diabetes (NIDDM) were reviewed in detail. There is clear evidence that prevalence rates of NIDDM varying from country to country, between ethnic groups within the same country, and within the same ethnic group living under different conditions. In particular, populations undergoing rapid westernization or which have migrated to more westernized countries have tended to develop higher prevalence of NIDDM. Prior to 1940, diabetes was rarely seen in the populations of Pima Indians, Micronesia, Polyneasia. However, high prevalence rates have been reported from urbanized area of Micronesia and Polynesia. Genetic factor, obesity, aging, hyperinsulinemia, diet, physical activity, dyslipidemia, parity, proteinuria, and uric acid have been found to be correlated with prevalence of NIDDM. It is the chronic disease which has the marked increasing rate of death numbers in Taiwan. The purpose of this paper is to review the prevalence and risk factors of NIDDM in different studies and provide for prevention and intervention efforts.
• 291 - 308
• 10.6288/CJPH1997-16-04-02

• Link 原著 Original Article
• 產婦特性與採用剖腹產：以台大醫院為例Maternal Factors Associated with the Use of Cesarean Section: A Case Study of the National Taiwan University Hospital
• 黃俊元、楊銘欽、陳維昭
  Chun-Yuan Huang, Ming-Chin Yang, Wei-Jao Chen
• 剖腹產 ； 保險身份 ； 非醫療因素
  cesarean section ; insurance status ; non-medical factors
• 為探討產婦人口學因素及非醫療因素對產婦採用剖腹產利用的影響，本研究於1994年12月至1995年2月針對台大醫院全部527位產婦施以以自填式結構化問卷普查，問卷回收率為92.41%。研究結果顯示：研究樣本中採用剖腹產的產婦共有202位(41.5%)，其中除了部份確實因為醫療因素而採用剖腹產以外，其餘產婦則受到非醫療因素影響，按其重要性百分比排序依序為：1．選擇良辰吉時、2．比較容易安排生產時間、3．怕生產疼痛，自己提出要求、4．害怕生產過程沒有丈夫親友陪伴、5．擔心自然產後會導致陰道裂傷鬆弛影響性生活、6．親友丈夫建議、7．利用假期安排剖腹產、8．保險有給付。而在對數複迴歸分析結果中，對產婦採用剖腹產有影響之相關因素包括：產婦的保險身份、年齡、居住地、生產胎次、教育程度及有剖腹產主要診斷等。
  The objective of the study is to investigate the impact of maternal characteristics, non-medical factors on the use of cesarean section. Questionnaires were sent to 527 childbearing women in National Taiwan University Hospital from December 1994 to February 1995. Four hundred eighty seven responses were received. Response rate was 92.41%. Totally there were 202 cesarean cases (41.5%). The reasons of having cesarean section were due to medical and non-medical reasons. The women of cesarean delivery ranked the importance of the non-medical factors as follows: 1. to choose a good delivery time, 2. to arrange delivery time easily, 3. to avoid delivery pain, 4. to worry about that her husband and relatives can not keep company, 5. to worry about that vaginal delivery would influence the sexual life, 6. her husband and relatives suggested to take cesarean section, 7. utilizing vacations to arrange cesarean delivery, 8. since payment will be covered by insurance. According to the result of the logistic regression analysis, variables significantly associated with the use of cesarean section included: maternal insurance status, age, residence, education level, parity of childbearing women and having indications for cesarean section.
• 309 - 318
• 10.6288/CJPH1997-16-04-03

• Link 原著 Original Article
• 時間成本對某一醫學中心門診病人利用量之影響The Influence of Time Cost on the Utilization of Ambulatory Care among Patients in a Medical Center
• 林素真、楊志良、黃文鴻
  Swu-Jane Lin, Chih-Liang Yaung, Weng-Foung Huang
• 時間成本；價格彈性；醫學中心
  time cost ; price elasticity ; medical center
• 無
  The objects of the study are to determine the influence of time cost and monetary cost on the utilization of the outpatient service in a medical center, and to estimate the elasticities of both costs. Systemic sampling was used to obtain 10% sample patients in the outpatient department during the survey period. With the survey and the extraction of data from the hospital computer file, information about each patient's utilization amount in the latest six months, diagnosis, demographic characteristics, individual wage, family income, health condition, monetary cost and time cost needed for the latest visit is collected. Results of multiple regression analysis, using utilization amount as the dependent variable, indicate that patients who are older, have worse self-evaluated health status, have appointments in advance, have preferences for the doctors or services of this hospital, and paid less time cost, tend to use more of the ambulatory care in this hospital (p<0.05). Despite that time cost is a significant factor, its elasticity is quite low (0.05). On the other hand, both income and monetary costs do not significantly influence the utilization of outpatient services.
• 319 - 328
• 10.6288/CJPH1997-16-04-04

• Link 原著 Original Article
• 蘭嶼雅美人求醫行為之研究A Study of Medical Care Seeking Behavior of the Yami on Botel Tobago
• 吳炳輝、季瑋珠、洪其璧
  Ping-Fuai Wu, Wei-Chu Chie, Chi-Byi Horng
• 蘭嶼 ； 雅美人 ； 求醫行為
  Orchid Island ; Yami tribe ; health care seeking behavior
• 蘭嶼雅美人的經濟及健康條件低落、文化特殊、地形隔絕，往往使衛生及醫療政策在當地的執行成果不彰。緣此，本研究之研究目的在於瞭解蘭嶼雅美人的求醫行為，包括影響健康的風俗習慣、醫療信仰和疾病的處理方式，並探討影響雅美人求醫行為的因素，據以提出政策改善的建議。本研究以蘭嶼鄉年滿20歲及以上的成年人為對象、戶為單位，用Kish表家戶內隨機抽樣的方式，每戶抽一人，總計樣本數為712人，由公共衛生護士以結構式問卷進行家戶面訪。調查內容包括：傾向、能力、需要因素、醫療服務的可用性與滿意度、與文化相關的健康信念，及腹瀉與關節痛發生時的求醫行為。扣除空戶及拒訪，共得有效樣本701人。分析結果發現：雅美人的經濟能力低落、健康保險比率偏低、蘭嶼的醫療資源缺乏、滿意度普遍不佳。雖然目前蘭嶼雅美人生病是以現代醫學療法為主，但是受訪者中尚有半數以上民眾在腹瀉及關節痛時使用傳統醫療。年齡在中年、職業非軍、公、學生、對現代醫療的滿意度低、以及現代健康信念低者，腹瀉時傾向於使用傳統醫療；關節痛時使用傳統醫療的相關因素，除年齡無顯著相關外均與腹瀉時相同。據此，吾人建議：政府相關機構應適量增加當地的醫療資源，提升民眾健康教育，使能融合傳統與現代，並重塑正確的文化與健康信念。
  The Yami tribe on the Orchid Island (Botel Tobago) have been suffering from poor economic and health condition for decades because of their culture background and geographic isolation. Past health policy had only limited achievements. The aims of this study were to understand the medical care seeking behavior and associated factors of this tribe and to make policy suggestions accordingly. Based on the records of the Orchid Island household registry office, we did random sampling to select 712 family units and one person aged 20 and above in each family with the Kish Table. Trained public health nurses did home visit and face-to-face interview with a structured questionnaire. The questionnaire covered predisposing, enabling, need factors, availability of and satisfaction with medical services, culture-related health beliefs, and health care utilization when having diarrhea and joint pain. Multiple logistic regression were used to study the effects of the possible associated factors. A total of 701 completed the interview. We found that Yami people had low income and coverage of health insurance, inadequate medical resources and low satisfaction. Although modern medicine was the major source of care, more than half of the subjects used traditional treatment. Middle-aged, those whose occupation were not government employee, military, and students, those who were unsatisfied with modern medicine, and had low modern health beliefs, tended to use traditional medicine when having diarrhea. The result of joint pain was the same except that the age had no significant association. In conclusion, we suggested the government to enrich local medical resources, improve health education, and incorporate the modern health beliefs and practice with the traditional one.
• 329 - 338
• 10.6288/CJPH1997-16-04-05

• Link 原著 Original Article
• 台灣外籍勞工工作滿意度與生活適應性之探討Minvestigation of Foreign Labors' Job Satisfaction and Life Adjustment in Taiwan Satisfaction and Life Adjustment in Taiwan
• 謝臥龍、楊奕馨、陳秋蓉、 陳九五、駱慧文、 許嘉和
  Vinceng Shieh, Yi-Hsin Yang, Chiou-Jong Chen, Jew-Wu Chen, Angela Lo, Chia-Ho Hsu
• 外籍勞工；工作滿意度；生活調適；文化調適
  foreign labor ; job satisfaction ; life adjustment ; culture adjustment
• 本文的主要目的是要：1)了解外勞工作滿意度與個人的因素、性生活調適及文化適應性之關係；2)了解工作滿意度與身心健康狀況之相關性；3)探討影響生理及心理異常的因素。 本研究採德懷技巧(Delphi technigue)經過開放式問卷匯集研究工具所需的資料，在經專家檢試之後發展成「外籍勞工生活適應調查表」，並經過第二階段緊湊的施測與面訪，收集到99個外勞的資料並藉以計算問卷之信度。而所得的研究資料發現受訪的外勞在台期間，就其性生活方面，曾發生性衛動者占54.2%，而有發生性關係者(30.1%)，本研究亦發現外籍勞工其中僅53.6%在其性行為中曾採取防治措施，且有21.4%的外勞染上性病。這些資料顯示外勞的性教育與性生活是有關管理與衛生單位急需密切注意的地方；休閒與文化適應性是影響勞動條件滿意度、人際關係與身心健康狀況的重要項目。文化適應度的提高有助於提高工作滿意度及減少身心異常現象；而勞動條件滿意度的增加則有助於生理及身心異常現象的減少；對於外勞政策的不了解並沒有影響到工作滿意度及身心健康狀況。
  Since Taiwanese government legalized foreign labors, the society has faced lots of challenge. Policy makers, researchers as well as ordinary people in our society all concerned about unemployment rate, public safety, foreign labors' life adjustment and economic impact. In this research, we used a three facet model to discuss foreign labors life adjustment form personal, organizational and contextual points of view. This study consisted two parts. First, the Delphi technique was used to collect important items associated with foreign labors' job satisfaction and life adjustment. Then, based on the collected information, a questionnaire was designed to investigate their life adjustment. The purposes of this study are to: 1) investigate foreign labors' physical and psychological conditions, understanding of policy, job satisfaction, sex life, and culture adjustment, 2) investigate whether job satisfaction is affected by personal factors, understanding of policy, sex life and culture adjustment, 3) investigate whether job satisfaction is associated with physical or psychological illness, and 4) discuss the factors for psychological and physical illness. From the results, one can conclude that foreign labors' culture adjustment is associated with job satisfaction and psychological and physical illness. Other important factors include nationality, education, type of job, number of friends and relatives in Taiwan, etc. We suggested that foreign labors' living and working conditions need to be improved to increase their job satisfaction and life adjustment.
• 339 - 354
• 10.6288/CJPH1997-16-04-06

• Link 實務 Public Health Practice
• 醫院醫材存貨管理之實證研究An Empirical Study on the Inventory Management System of Medical Dispensable Materials for a Medical Center Hospital
• 蘇喜、莊逸洲、林曉薇、 劉嘉玲
  Syi Su, Yi-Chou Chuang, Hsiao-Wei Lin, Chia-Ling Liu
• 經濟訂購量 ； 醫院存貨管理系統 ； 存貨管理績效 ； 存貨成本 ； 前置時間
  economic order quantity ; hospital inventory management system ; inventory performance ; inventory cost ; lead time
• 本研究係以一醫學中心為研究對象，研究資料包括醫材之請購、入庫資料、相關人事薪資、樓地板面積、折舊金額及水電費等。研究期間為81/7/1~82/6/30。首先將醫材，依ABC分析法分為A、B及C類，依據過去一年之使用量建立各項醫材之需求預測模式，再將屬於A及B類之每一項醫材分別依據經濟訂購量模式，求算其經濟訂購量及再訂購點，並制定適於各類存貨之管理方式，最後分析個案醫院存貨管理問題。 研究結果為A、B類醫材佔醫材總出庫金額的91.03%，但僅佔17.96%的項目，所以必需以重點觀念來管理。A、B類存貨適用於經濟訂購量結合再訂購點的模式，C類存貨則以最大－最小法結合定期訂購法管理。針對控制前置日數而研擬的四方案，以結合經濟訂購量模式並控制前置日數變異之方案管理績效最佳。歸納個案醫院之存貨管理問題，主要為未依重點管理原則分類、醫材項目太多且合約太少、出庫後實際耗用量之資訊不足、年存貨週轉率太低及請購流程關卡太多等。
  This study explores the inventory management system of a medical center hospital. ABC analysis method was utilized to classify the subject items into A?B and C categories. Demand forecasting model was built based on half to one year's actual usage data. Continuous inventory monitoring system versus periodic inventory monitoring system were selected to regulate three category items' inventory level independently. A and B categories of medical dispensable materials took 91.03% monetary value, but only explain 17.96% stocking units. In order to fulfill more efficient inventory management system, class A and B items were suggested to apply Economic Order of Quantity with reorder point model (continuous monitoring system), Class C subject items were recommended to use maximum-minimum method combine with fixed interval ordering system (periodic monitoring system). Four alternatives concerning with improving current inventory management system were proposed. Based on those four alternatives the total inventory cost was evaluated independently. The results showed that combining E.O.Q. method with lead time variation control (alternative 4) had best performance using the minimum total inventory cost as indicator.
• 355 - 364
• 10.6288/CJPH1997-16-04-07

• Link 實務 Public Health Practice
• 彰化縣和美鎮居民懷疑爆發皮膚病流行原因調查An Outbreak Investigation of Dermatoses among People Living in Homei, Changhua County
• 湯豐誠、朱有仁、王莉芳、王榮德
  Feng-Cheng Tang, Yu-Jen Chu, Li-Fang Wang, Jung-Der Wang
• 紅疹 ； 蟲咬症 ； 空氣污染
  erythematous lesion ; insect bite ; air pollution
• 本研究之目的在調查八十二年九月份彰化縣和美鎮犁盛里的居民皮膚紅疹病變明顯增加的致病原因。本研究以皮膚紅疹病變較集中之地區的居民為研究族群。衛生單位人員首先對該地區的居民之居家環境與皮膚病況實地查訪；然後由各皮膚科專科醫師及職業病醫師對有皮膚病變之居民進行會診。結果共有78位有皮膚症狀之居民主動前來被診視；其中有51名確定有皮膚病診斷。這其中又以蟲咬的患者最多（36例）。蟲咬的患者當中成人多於小孩(7:2)，男女相同，發病日期以八月份最多，並有顯著家中聚集的現象。彰化縣環保局亦對該鎮焚化爐、當地露天燃燒及里內29家工廠特性進行了解，發現垃圾焚化爐其煙?僅約35公尺高，且距離犁盛里有二公里之遠，附近工廠之作業特性又似乎無可能導致附近居民皮膚紅疹病變的情形。經請病媒昆蟲學者前往調查並進行環境衛生整理後，此病即不再出現。因此我們推論此次爆發居民皮膚紅疹病變，和空氣污染並無相關連，而可能主要和蟲咬有關。
  The objective of this study is to determine the cause of an endemic outbreak of erythematous lesions of skin among people living in Ho-Mei, Chang-Hua county. Inhabitants with skin lesions who lived in the prevalent area were asked to come for dermatological examination. All volunteered subjects were examined by at least one dermatologist and one occupational physician and interviewed with a structured questionnaire. 51 subjects with skin lesions were diagnosed among 78 subjects who came. 36 cases with insect bite was the most prevalent diagnosis. Adults with insect bites were found to be more frequent more than children (7:2), and female and male were equal in numbers. Victims usually developed the lesions of insect bites in August and there was a significant high tendency of family clusters. In the walk-through survey to the surrounding environment, we found that there were one refuse incinerator and some factories surrounding the prevalent area. However, the furnace of the incinerator was about two kilometers far from the endemic area and its chimney was only 35 meters high. The operations of all the other local factories generally did not produce toxic air pollutants. After implementing environmental sanitation procedures to eradicate local insects including mosquitoes, the skin lesions disappeared and never recurred. We concluded the endemic outbreak of the skin lesions was not associated with air pollution, but probably caused by insect bites.
• 365 - 373
• 10.6288/CJPH1997-16-04-08