15卷3期

• Link 原著 Original Article
• 以健康行為型態分類台灣地區之成年人口群－群聚分析之應用A Typology of Adult Population in Taiwan Based on Health Behavior Pattern-An Application of Cluster Analysis
• 丁志音、江東亮
  Chih-Yin Lew-Ting, Tung-Liang Chiang
• 健康行為型態 ； 群眾分析 ； 社會人口學特質
  health behavioral patterns ; cluster analysis ; socio-demographic characteristics
• 本研究乃利用1990年國民健康調查資料，應用群眾分析法，以十二項健康行為組合所呈現整體型態的差異，對2782名18歲以上國人進行分類，結果共得出七組健康行為群體。根據對香菸、酒、及檳榔三項成癮物質之使用，此七組群體又可區分為三大類型：(1)少癮型，包括循規保健組、多運動及零食組，以及無早養多咖啡組，(2)雙癮型：包括多菸多檳榔組及多菸多酒組，以及(3)多癮型：包括正負混合組以及自我摧殘組。進一步之信度及效度檢驗支持此一分類之適切性。大體而言，相對於少癮型，雙癮型及多癮型以男性佔絕大多數，平均年齡較低，教育程度以小學國中居多，且職業則以從事半技術之藍領工人所佔比例最高。而進一步分析則發現不同類型之各組間亦存有相當大的差異。此一群體間之差異的現象可以Max Weber的地位群體(status group)及次文化理論加以詮釋，即健康行為型態乃個人與社會環境及次文化不斷交互作用下的產物。因此本研究建議：當前之健康促進研究與實務，不該將行為視為獨立的、個別的危險因子，而應強調全貌性整合性的行為概念化，如此才更具有理論與政策意義。
  Using data from a 1990 national household health survey, a typology of 2782 adults 18 years of age and above was developed by a cluster analysis of 12 health-related behaviors. The analysis generated seven distinct health behavioral groups, which were further classified into three major types based on the use of three addctive substances: cigarette, alcohol, and betal nuts: (1) limited-addiction type, including three groups: Health-promotive, Exercise and snack, and Coffee but no breakfast, (2) double-addiction type, including two groups: Smoking and drinking, and Smoking and betal-nuts chewing, and (3) multiple-addiction type, including two groups: Mixed and Self-destructive. Reliability and validity of this classification were examined and the results supported this seven-group solution. The health behavioral profile of these seven types was presented. Overall, in comparison with the limited-addiction group, both double-addition group and multiple-addiction group were characterized by younger male populations, with a lower educational attainment, and were employed in blue collar, semi-manual occupations. Further analyses indicated that considerable variation in sociodemographic characteristics might exist among different types of the same groups. The findings of this study can be well understood within the framework of Max Weber's ”status group” and ”subculture” theory, i.e., health behavioral pattern was a product of continuous interactions between individuals and their social environment and subculture. It is suggested that rather than treating various behaviors as discrete and independent entities as it is in current health promotion research and practice, a holistic conceptualization of health behavior should be adopted for greater theoretical and policy implications.
• 175 - 187
• 10.6288/CJPH1996-15-03-01

• Link 原著 Original Article
• 個別衛生教育介入對高脂血個案知識、健康信念、自我效能、行為的影響Effects of an Individual Health Education Program on Hyperlipidemia Clients' Knowledge, Health Belief, Self-Efficacy and Behavior
• 張淑紅、黃璉華、李源德
  Shu-Hung Chang, Lian-Hua Huang, Yuan-Teh Lee
• 高脂血 ； 個別衛教 ； 健康信念 ； 自我效能 ； 行為
  hyperlipidemia ; individual health education ; health beliefs ; self-efficacy ; behavior
• 本研究採準實驗研究法，目的在探討個別衛生教育介入對高脂血個案知識、健康信念、自我效能、行為及生化指數的影響。選取某教學醫院內科病人依週次隨機分派為兩組。控制組有62人；實驗組有70人。結果發現實驗組經過個別衛教介入後在知識、健康信念（包括罹患性、嚴重性、有效性、障礙性知覺）、自我效能（飲食控制、運動）、行為（飲食、運動）皆比前測時有顯著進步且與控制組達到顯著差異，而生化指數方面TC減少50.22mg/dl、LDL-C減少45.82mg/dl、TG減少63.61mg/dl，比前測時有顯著進步且與控制組達到顯著差異。此衛教明顯地使實驗組有進步，故值得推廣此衛教。
  he purpose of this research was to examine the effects of an individual health education program to the OPD hyperlipidemia clients in relations to knowledge, health beliefs, self-efficacy, diet-control behavior, exercise, and blood cholesterol level. In addition, this research identified the factors associated with diet-control behavior, exercise, and blood cholesterol level. A quasi-experimental design was used in this research. Each subject was randomly assigned to one of the two groups. The control group, which had a total of 62 subjects, read the leaflet by themselves. The experimental group, which consisted of 70 subjects, received a consultation from the researcher pertaining to health education program. The results showed that the experimental group had significant improvements in knowledge, health beliefs (including perceived susceptibility, perceived severity, perceived benefits of taking action and perceived barrier of taking action), self-efficacy (including diet-control, exercise), diet-control behavior, exercise, TC, LDL-C, and TG level. However, the control group had improvements only in knowledge, health belief (perceived barrier of taking action), diet-control behavior, and TC level. The individual health education program is extremely effective and thus, should be seriously considered an option for the future.
• 188 - 196
• 10.6288/CJPH1996-15-03-02

• Link 原著 Original Article
• 社區老人用藥團體教育之成效Effectiveness of the Group Education on Drug Use for the Elderly in Community
• 黃璉華
  Lian-Hua Huang
• 老人 ； 用藥團體教育 ； 成效
  elderly ; group medication education ; effectiveness
• 老年人尚於較高的罹病率對藥物使用需求較高，使老人面臨較多的用藥問題。相關研究文獻顯示，適當的護理指導、用藥教育介入對老人用藥常識和用藥行為有正面影響，因此實需針對社區老人用藥的問題設計護理指導教育，以增進老人用藥常識，改善用藥行為。 本研究採前實驗設計，以團體方式進行護理指導，提供老人一般性用藥教育，評估對老人用藥知識及行為的成效。研究對象為台灣北區65歲以上自願參與之老人127人，於護理指導前後進行測試，所得資料以SPSS電腦軟體進行統計分析處理。 研究結果顯示參與者的教育程度比一般老人高，其用藥常識的前測總平約分為12.88±2.25，為總分15分的85±15%，經團體護理指導介入後測進步為13.54±1.54。用藥行為的前測總平約分為51.07±6.20，為總分64分的80±9%，後測改善為54.02±5.68，配對t檢定呈現顯著的差異。可見團體護理指導能增進老人用藥常識，並改善用藥行為。其中以老人遵從用藥常識效果較佳。五個不同地區學習效果亦不同，鄉村老人遵從用藥常識接受護理指導後呈現統計上的顯著差異，而鄉村及城市參與衛教的老人用藥行為皆得到改善。建議可對類似疾病老人予以省時省力的團體用藥指導。
  Due to a higher morbidity rate and a greater need for medications, the elderly are at a high risk for problems with medications. Literature on intervention strategies related to the medication problems of the elderly proved that education for the elderly does make a significant effect. The elderly who received this education had a greater knowledge of medication and made fewer medication errors. Medication education for the elderly in the community is an urgent need. The purpose of this study was to evaluate the effectiveness of a nursing intervention via group teaching strategy for the elderly in the community. The pre-experimental design was chosen for this study. The subjects included 127 volunteers over 65 years of age in Northern Taiwan. Data from pre-and post-teaching were collected and analyzed via SPSS computer software. The research findings revealed that the participants' education level were higher than general elderly. The mean score of medication knowledge in pre-test was 12.88±2.25 (85 ± 15% of the total scores). It was improved to 13.54± 1.54 in post-test. The mean score of medication behavior in pre-test was 51.07 ± 6.20 (80±9% of the total scores). After group teaching, it was improved to 54.02± 5.68 and paired t-test had significant differences. Group teaching can improve the elderly's medication knowledge and medication behavior. The effectiveness of group medication education in the five areas was different. Group medication education was effective for both rural and urban elderly people, elderly people in the rural area had significant differences in comply with taking medicine. It is recommended that group teaching could be provided for the elderly with similar disease in a more systematic way.
• 197 - 207
• 10.6288/CJPH1996-15-03-03

• Link 原著 Original Article
• 貝氏憂鬱量表應用於國人周產期憂鬱症篩選之適用性Beck Depression Inventory as a Screening Tool for Pre- and Postpartum Depression among Chinese Women
• 柯慧貞、黃耿妍、李毅達、莊麗珍
  Huei-Chen Ko, Keng-Yien Huang, Yih-Dar Lee, Li-Chen Chuang
• 無
  none
• 本研究旨在評估貝氏憂鬱量表(BDI)用在篩選周產期憂鬱症的信效度及不同分割點之適用性。在某醫學中心取樣135個產前與132個?後歸女，先以貝氏憂鬱表10分為篩選工具篩選出可能為憂鬱組的個案與非憂鬱組的個案，再向其中各取樣部分樣本以半結構化晤談表進行診斷晤談，以確立診斷；結果發現貝氏憂鬱表具有滿意的內部一致性信度，且能區分出嚴重型憂鬱症與未達嚴重型憂鬱症之輕型憂鬱症者。應用於篩選時，以10分篩選嚴重型憂鬱症，可達100%敏感度，但特異性只達78%；若篩選憂鬱程度較輕之憂鬱者，10分之敏感度為83%，特異性為86%。本研究另外建立了不同分割點之敏感度、特異性及正確率等值以供不同篩選目的時之參考。
  This study was designed to evaluate the appropriateness of BDI as a screening tool for detecting pre- and postpartum depression. One hundred and thirty-five pregnant women and 132 postpartum women were screened for major depression by BDI using cut-off point of 10. Two samples of possible cases and non-cases completed further diagnostic interviews using SADS-L and SADS. Using a cut-off point of 10, the BDI showed sensitivity of 100% and specificity of 78% in prospectively detecting major depression and sensitivity of 83% and specificity of 86% in minor depression. The appropriateness of various cut-off score of BDI was also evaluated in this study.
• 208 - 219
• 10.6288/CJPH1996-15-03-04

• Link 原著 Original Article
• 影響開業牙醫師訂價策略之因素分析Factors Affecting the Pricing Strategy of Dentists in Taiwan
• 鄭守夏、江東亮
  Shou-Hsia Cheng, Tung-Liang Chiang
• 訂價 ； 收費 ； 牙醫
  fee level ; pricing strategy ; dentist
• 本研究以開業牙醫診所為例，探討臺灣醫療服務提供者的訂價策略及其影響因素。資料取自民國78年經建會全民健保規劃小組對臺灣地區牙醫師所做的問卷調查，共得有效樣本1063人。結果發現：(1)將近60%的牙醫師向病人收取費用時，會考慮到的因素之一是病人的經濟狀況，顯示醫師有差別訂價(price discrimination)的能力與事實：相對的也分別有大約58%和56%的醫師會考慮到治療過程的投入成本以及專業技術；只有43%的醫師會考慮其它診所的收費行情。如此看來，向病人收費時，對淤市場價格的考量仍不及醫師個人的訂價判斷。(2)複迴歸分析診所的一般訂價策略時，我們發現牙醫師的執業投入，如助理人員數及每位病人的平約治療分鐘數，是影響訂價的主要因素，投入較多則訂價較高。另外，地區性的生活消費水準和執業競爭，如牙醫人口比及牙醫師感受到的競爭壓力，也是明顯的影響因素。區域性與個人的訂價差異及其政策上的應用也將加以討論。
  Using information from clinic dentists, this study examines the pricing strategy and its influencing factors of health care providers in Taiwan. Data are obtained from a national dentist survey on practice characteristics and opinions on national health insurance designed in late 1989. A total of 1063 dentists with completed information are included in the analysis. The results show that the most important factors dentists would consider when they charge a patient are patients income (60%), cost of treatment (58%), professional skill (56%), and their peers' rate (43%).The multiple regression analyses indicate that practice inputs, i.e. number of assistant and treatment time spent per patient, are important factors associate with dentist's charge level. Local living cost and perceived competition are also significant influencing factors. The findings suggest that the behavior of price discrimination exists though it's magnitude may be limited. Geographical and personal differences in fee levels are also discussed.
• 220 - 227
• 10.6288/CJPH1996-15-03-05

• Link 原著 Original Article
• 醫院評鑑評量表指標及配分之適切性研究On the Measurement Scale and Weighting of Distinguishable Items of the National Hospital Accreditation Program (NHAP)
• 蘇喜
  Syi Su
• 評鑑指標 ； 配分適切性 ； 具區別能力指標 ； 不具區別能力指標
  Hospital Accreditation Indicator ; Appopriate Weight ; Distinguishable indicator ; Non-Distinguishable Indicator
• 近來國民對醫療需求不僅是「量」的需求，亦要求「醫療照護品質」的提昇，政府乃實施醫院評鑑制度來控制醫療品質及指定教學醫院，而現行評鑑評量表之指標及配分適切性就攸關醫院評鑑的結果，故本研究同的在於探討現行醫院評鑑暨教學醫院評鑑指標是否具區分力及配分是否適當。本研究以八十年度醫院評鑑暨教學醫院評鑑評量表為資料來源，作Pearson correlation分析各項目得分與總分之相關性，將相關值未達顯著意義之單項列入不具區分能力項目，其餗項目則到為指標項目，再以因素分析方法測定各指標項目之因素負荷量及建議配分。研究結果根據醫院評鑑評量表之分類分為十大部門，每個部門再就區域醫院以上、地區醫院分別分析及合併分析。依研究結果本研究有兩個建議，其一為建議重新考量無區別能力(Non-distinguishable)項目，另為就簡化後具區別能力的項目給予新的建議配分，提供決策時參考。
  The National Hospital Accreditation Program (NHAP) is aimed to assure health care quality and to determine the eligibility of teaching hospitals. In this paper, using 1991 NHAP results, the appropriateness of the measurement scale and the weight of each item designed in the current accreditation program is investigated. Correlation analysis is first used to detect the relevance of measurement indicators preliminary. Then, factor analysis is applied to final determination of distinguishability. The analysis is proceeded with respect to ten major accreditation categories, and within each category both the pooled data of four-level hospitals and the data of combination of medical centers and regional hospitals and combination of district teaching and district non-teaching hospitals are investigated. Those non-distinguishable items are suggested to be reevaluated based on practical needs.
• 228 - 248
• 10.6288/CJPH1996-15-03-06

• Link 原著 Original Article
• 南部某家醫院病人對醫院服務滿意度的調查Patients' Satisfaction with Hospital Service in a Southern Taiwan Hospital
• 潘靜雲、柯純卿、陳季員、劉雅瑛、曾英芬、金繼春
  J-Y Pan, C-C Ko, J-Y Chen, Y-Y Lieu, Y-F Tseng, C-C Chin
• 病人滿意度 ； 醫院服務
  Patient Satisfaction ; Hospital Service
• 為了明瞭住院病人對醫院服務的滿意狀況，藉由結構性問卷，收集506名南部某教學醫院欲出院病人或家屬的意見，答卷者平約年齡43.4歲，女性佔52.6%，已婚者佔86.2%，有過住院經驗者佔62.3%。由多變項變異數分析：病室的空調、病室噪音的防治、清楚的路標指示之滿意度與受訪者個人特質因素（年齡、性別、教育程度、職業、婚姻、住院經驗、病室人數、住院日數、住院科別、保險）有關，而受訪者個人特質因素對本次病人住院滿意度沒有關連，但發現：1．病室的空調、2．公用電話的設置、及3．清潔工友的工作效率之滿意，對本次住院的滿意具有預測力。從病人或家屬對護理人員在執行護理活動時的行為反應分析，發現應加強護理人員對病人隱私性、舒適感的注意，同時護理人員應維持交談用語的適當性、親切態度、穩重，且與病人或家屬建立好人際關係。而護理人員的行為、態度及專業能力方面：應加強觀察、應對、應變及教導的能力：並得保持儀表端莊且重現病況問題的處理效率。在醫院物理環境及設備方面，則應再加強清楚的路標指示、病室噪音的防治、公用電話的設置及配膳室的設置，另得注意病室的光線、清潔衛生及床邊設備的功能。在醫療團隊人員之互動關係則須加強業務人員對住院手續、收費問題的解釋；而醫師得對病人的檢查治療作清楚解釋且對病人不適之因予以回答。對醫療團隊人員的態度、行為和專業技能方面；則須加強業務人員的工作效率和服務態度、X-光電腦斷層掃描及社會服務部門人員的工作效率、出院手續的方便性。另醫師、辦事員及輸送人員、清潔工友的工作效率得續予良好的維持。
  In order to assess patient satisfaction with hospital service in a southern teaching hospital, 506 soon to be discharged patients, from the ages of 14 to 86 years, were questioned in this study. The data were collected by a structured and limited 42 item questionnaire. Data was analyzed by multivariate variance. The variables included satisfaction with ward air-conditioning, noise-prevention, and clarify of direction signs were related with the subjects' characteristics. Our results showed satisfaction was not related to patients' characteristics. However, it was predicted from air-conditioning, public telephone service, and the efficiency of cleaning workers. Nursing factors, including nurses' behavioral reactions, were studied. The nurses' performance in terms of attention to the patient's privacy and comfort should be enhanced. Meanwhile, nurses should communicate with appropriate words and with a better attitude. Moreover, nurses' should focus on building a good relationship with patients and their families. Regarding the nurses' behavior, attitude, and professional abilities, nurse training in observing, communicating, reacting, and teaching should be enhanced. Nurses should appear polite when bringing orders to patients and be on time. Some environmental factors also should be enhanced. These areas include clarify of direction signs, ward noise-prevention, public telephone service, hospital food service, business staff efficiency and attitude, technician (X-ray, CT scanning) efficiency, social service staff efficiency, and discharging procedures. Moreover, physicians should pay more attention to reasons for explaining examinaation and treatment, and should take more time discussing the reasons for the patient's discomfort.
• 249 - 258
• 10.6288/CJPH1996-15-03-07

• Link 原著 Original Article
• 中小學校廁所清潔維護現況評估與促進Evaluation and Promotion on the Cleaning Maintenance of Toilets in Mid-High/Elementary Schools in Taiwan
• 林佳谷、翁瑞宏、李卓翰、邱弘毅、 陳叡瑜
  Chia-Ku Lin, Ruey-Hong Wong, Chou-Han Lee, Hung-Yi Chiou, Ruey-Yu Chen
• 廁所 ； 清潔維護 ； 評估 ； 促進
  toilet ; toilet cleaning maintenance ; toilet usage evaluation ; toilet software promotion
• 無
  To upgrade the house-keeping, correct usage, and cleaning maintenance of toilets in the mid-high/elementary schools in Shin-Tsu and Miao-Lee counties, an evaluation and promotion program involving 255 schools were conducted by the joint efforts of a volunteer organization and an academic institute. This program was approached in two stages: (1) Evaluation. From questionnaires and field inspection, data were collected and analyzed. (2) Promotion. Through a series of conferences, correspondence, work-shop demonstration, local government enforcement, etc., message of toilets management in school was propagated. The current status of the school toilets in these two counties are generally satisfactory. Schools have received specific funds from Taiwan Government for hardware construction or remodeling during past 4 years. But, minor drawbacks and defects are still existed, such as: safety, male/female separation, privacy, water flushing, toilet paper, handicapped facilities, etc. From the sanitary inspection, before and after, the imprevement is statistical significant (Paired-t test, P<0.05). From the positive approval of K.A.P. inquiry over major issues in upgrading the toilets maintenance and the enthusiastic participation of all sectors (students, schools, government, and community), we are envisioning a better school toilets management in the near future.
• 259 - 267
• 10.6288/CJPH1996-15-03-08

• Link 原著 Original Article
• 台灣23個鄉鎮高血壓的認知率、治療率與控制情形－1988-1993年陽明十字軍社區預防醫學成果Tue Awareness, Treatment and Control of Hypertension in 23 Towns, Taiwan-Community-Based Preventive Medicine by Yang-Ming Crusade in 1988-1993
• 趙耿裕、周碧瑟
  Keng-Yu Chao, Pesus Chou
• 社區性研究 ； 流行病學 ； 高血壓 ； 認知率 ； 治療率 ； 陽明十字軍
  community-based ; hypertension ; control ; treatment ; awareness ; the Yang-Ming Crusade
• 本研究由國立陽明大學學生組成的陽明十字軍，於1988年至1993年暑假期間，經過訓練和檢定後，在全省23個鄉鎮推廣社區預防醫學工作，並從事高血壓流行病學研究。陽明十字軍隊員根據戶籍資料為40歲以上民眾，以挨戶家訪方式，從事衛教並作身高、體重、血壓、尿糖等基本檢查。凡疑似陽性個案，則轉介到當地的群體醫療執業中心，進行確認診斷與治療。高血壓定義採世界衛生組織定義為標準，凡血壓三次測量平均值，收縮壓超過160 mmHg以上或舒張壓超過95mmHg以上者，以及曾經被診斷為高血壓且正服用抗高血壓藥物者，皆定義為高血壓。累計共完成31432份問卷，在測量當時為高血壓的患者有5274位，當中有2288位(43.4%)已自知有高血壓，有1829位(34.7%)接受治療，而在自知有高血壓的患者中，有79.9%接受治療。在所有接受治療的病患，只有21.7%能有效地控制血壓在正常範圍(?140/90mmHg)。分析其治療方法，以西醫為主佔83.7%，有4.6%接受中醫治療，有48%自行買西藥治療，有2.5%則服中藥。各種治療方法對血壓的控制未具統計上的顯著差異。
  A community-based preventive medicine project was carried out by the Yang-Ming Crusade in 1988-1993 in 23 towns, Taiwan. We interviewed 31432 registered residents over 40 years old. Their blood pressure, the status of awareness, and treatment were taken by the crusaders through door by door interviews. The screening postive cases were referred to the local Group Practice Center for confirmatory diagnosis and follow-up treatment. Subjects who had systolic blood pressure >=160 mmHg and/or diastolic pressure >=95 mmHg or received treatment with antihypertensive agents were considered hypertensives. Among 5274 current hypertensive cases, 2288(43.4%) were self- recognized and 1829 (34.7%) had received medication. In all hypertensive cases receiving treatment, only 21.7% had effectively controlled their blood pressure (?140/90 mmHg). Their treatments included modern medicine 83.7%, traditional medicine 4.6%, drug store 4.8%, and herbs 2.5%. No significant difference existed among different kinds of regimen to control blood pressure.
• 268 - 273
• 10.6288/CJPH1996-15-03-09