14卷3期

• Link 其他 Others
• 成癮藥物濫用防制宣言Declaration of Anti-Drug Abuse
• 姚克明 ； 李蘭 ； 李景美 ； 洪百薰 ； 楊銘欽 ； 鄭泰安
  ???, Lee-Lan Yen, Ching-Mei Lee, Bai-Syuan Hurng, Ming-Chin Yang, Andrew T.A. Cheng
• 無
  none
• 中華民國公共衛生學會有鑒於成癮藥物濫用在國內有快速蔓延的趨勢，對個人、家庭及社會均造成嚴重的危害，特呼籲教育、衛生、警政、司法等單位及民間團體，共同關切此一問題，期能透過協調與合作，以維護我全民健康及社會安寧。
  none
• 213 - 219
• 10.6288/CJPH1995-14-03-01

• Link 原著 Original Article
• 高尿酸血症在台北市雙園與北投地區之流行病學之調查Epidemiological Survey of Hyperuricemia in Urban Chinese
• 黃政典
  Chien-Tien Huang
• 中國人 ； 高尿酸血症 ； 流行病學
  Chinese ; epidemiology ; gout ; hyperuricemia
• 為了要瞭解台灣地區都市居民高尿酸血症的情形，吾人於台北市雙園區與北投區隨機調查其居民，抽血檢查其血清尿酸值之分佈情形。本研究發現：雙園區共1383名：其中男為592名、女為791名血清尿酸平均值：男為5.82±0.09mg/dl、女為4.22±0.05mg/dl。其中高尿酸血症，男佔16.2%、女佔11.2%。北投區共1540名，其中男為628名、女為912名。血清尿酸平均值：男為6.07±0.07mg/dl、女為4.70±0.05mg/dl。其中高尿酸血症，男佔19.3%、女佔17.8%。兩區之間，女性居民血清尿酸值有明顯差異、男性則無。男女兩性年齡超過70歲組，血清尿酸值都高於其它年齡組別。北投區居民中，男性教育程度在國中及大專以上的高尿酸血症罹患率較高。女性則以無教育者較高。依職業來分，男性並無高尿酸血症罹患率之差異，女性則有明顯差異，以無職業者最高。造成此男女間之差異，其原因尚不清楚，因此建議更進一步對特定族群血清尿酸檢測，以確立不同職業及教育程度與高尿酸血症之關係。
  In order to gain a better understanding of the prevalence of hyperuricemia in Urban Chinese people as well as to examine the association of hyperuricemia with sociodemographic fuctors, we compared the serum levels of uric acid in Shuangyuan and Peitou residents of Taipei City. A random sample of 1383 (592 male and 791 female) residents of the Shuangyuan precinct of southern Taipei City and 1540 (628 male and 912 female) residents of the Peitou precinct of northern Taipei City were included in the 1985 study. The level of serum uric acid was determined by autoanalyzer using an enzymatic method. The results of serum uric acid were 5.82±0.09 mg/dl for males and 4.22±9.05 for female from Shuangyuan, and 6.07±9.07 mg/dl for males and 4.07±9.05 mg/dl for females trom Peitou, and 5.95±0.06 for males and 4.48±0.04 for females together. The age-adjusted prevalence of hyperuricemia, defined as a serum uric acid>7.5 mg/dl for males and serum uric acid>6.0 mg/dl for females, was 17.8 percent for males and 12.4 for females together; 16.2 (raw 15.9 percent) for male and 11.2 percent (raw 9.5 percent) for female Shuangyuan residents; 19.3 percent (raw 19.6 percent) for male and 17.8 percent (raw 25.0 percent) for female Peitou residents, with a significantly in Peitou females and also the total prevalence, but not in the male subgroup. The mean level of serum uric acid was found to increase with age over 70 for males and over 50 for females in these two areas of Taipei city. Further studies aimed at certain specified groups are needed to further reveal the relationship of sociodemographic factors and hyperuricemia.
• 220 - 227
• 10.6288/CJPH1995-14-03-02

• Link 原著 Original Article
• 台灣登革熱流行區斑蚊密度及孳生場所調查Investigations on the Density and Breeding Habitats of Aedes Mosquitoes in Dengue Epidemic Areas in Taiwan
• 黃基森、徐爾烈、陳永仁
  Ji-Sen Hwang, Err-Lieh Hsu, Yeong-Ren Chen
• 登革熱 ； 埃及斑蚊 ； 白線斑紋
  dengue fever ; Aedes aegypti ; Aedes albopictus
• 1987年至1991年於登革熱開始發生之地區，立即在病患住家周圍展開斑蚊分布及密度調查，探討埃及斑蚊和白線斑蚊生態及其與登革熱流行之關係。結果顯示，九個登革熱流行地區埃及斑蚊密度皆高於白線斑蚊；其中在1989年12月高雄市三民區灣復里未發現有白線斑蚊；證明登革熱之發生埃及斑蚊為主要傳播媒介。在1991年10月調查三民區寶龍里埃及斑蚊密度住宅指數5%、容器指數3%，、布氏指數6（二級），此為台灣地區登革熱發生流行後，被擴散蔓延而成為地方性登革熱發生地區，埃及斑蚊最低臨界密度。依不同流行地區登革熱發生病例證實，埃及斑蚊傳播登革熱臨界密度也受人口密度影響。1987至1991年登革熱爆發地點主要發生在埃及斑蚊為優勢種之都市及沿海地區。截至目前止，仍無有力證據證明台灣地區之白線斑蚊與登革熱流行有直接關係。由台灣南部九個登革熱發生流行區斑蚊孳生場所調查顯示，埃及斑蚊和白線斑蚊孳生環境不同，埃及斑蚊孳生場所主要為花器、水桶，白線斑蚊以輪胎及甕為主。就兩種斑蚊孳生場所用途分類，裝飾容器最高32.3%、廢棄容器30.0%、儲水容器24.6%、冰箱之水盤10.4%、積水地下室2.7%。由此顯示，都市化及工商業化結果，導致登革熱病媒孳生容器種類、材質及其屋內外分布改變，而使埃及斑蚊和白線斑蚊分布及密度異於往昔，同時使埃及斑蚊與人類關係更密切，而導致登革熱之發生。在高雄市三民區三個流行地區住戶周圍皆發現有積水地下室孳生大量埃及斑蚊成、幼蟲，顯示積水地下室在高雄市是發生流行登革熱主要原因。
  Immediately following the discovery of dengue epidemics in southern Taiwan from December 1987 to October 1991, investigations on the vector mosquitoes and their ecology, especially related to the epidemiology of dengue, were undertaken in nine localities in Taiwan in which a number of indigenous dengue cases were found Results indicated that the density of Aedes aegypti was markedly higher than that of Ae. albopictus in the nine areas under investigation in southern Taiwan. During an epidemic which occurred in November 1989 in the Sanmin district of Kaohsiung city, no Ae. albopictus were found. The data obtained from the present study suggests that Ae. aegypti was involved in the transmission of dengue fever in Taiwan. Another finding in the same district in October 1991 revealed that Ac. aegypti with a low density figure of two (house index of 5%, container index of 3%, and Breteau index of 6) could still maintain the transmission of dengue in its endemic area. This is the threshold density of Ae. aegypti in relation to dengue transmission in Taiwan. However, transmission of the virus is enhanced by a dense human population. Surveys made in the nine localities with dengue epidemics reveal that Ac. aegypti breeds primarily in flower vases and buckets, while Ac. albopictus breeds mainly in discarded automobile tires and earthenware jars. The percentage of breeding sites used by both Aedes species was 32.3% in ornamental containers, 30.0% in discarded containers, 24.6% in water storage containers, 10.4% in refrigerator receptacles and 2.7% in flooded basements. More breeding sites of Ac. aegypti and Ac. albopictus occur in outdoor containers than in indoor ones.
• 228 - 236
• 10.6288/CJPH1995-14-03-03

• Link 原著 Original Article
• 新店市婦幼衛生服務使用與供給者選擇之研究：衛生所角色之重探Utilization and Provider Choice in Maternal and Child Health Care in Hsintien City: A Review of the Role of the Health Station
• 季瑋珠、符春花
  Wei-Chu Chie, Chun-Hua Fu
• 婦幼衛生 ； 衛生所
  Maternal and child health ; health station
• 本研究以按人口比例機率抽樣法，自台北縣新店市13至16個月大之嬰兒1102人中，抽得320人為研究對象，由8名經過訓練之訪員於1990年9月對其母親進行家庭訪視，以瞭解該市母親與嬰兒接受婦幼衛生服務情況及供給者的選擇。總共有222人完成訪視。結果發現：產前檢查，產後檢查，與目前避孕的比率分別為99.1%，78.8%與77.0%，但孕期中子宮頸抹片接受比率僅31.1%。新生兒先天代謝異常篩檢比率為81.5%，健兒門診檢查實施比率為77.9%。一歲內各類疫苗的預防接種率均在90%以上。幾乎所有的孕產婦照顧都由醫院或診所提供；嬰兒保健照顧方面，衛生所使用的比例隨嬰兒月齡而上升：無一新生兒代謝異常篩檢在衛生所進行，一個月內的預防接種只有30%由衛生所提供，一個月以上的頂防接種則高達70%以上由衛生所提供。逐步複迴歸分析顯示：完成接種嬰兒使用衛生所總次數與母親對衛生所的瞭解程度，衛生所地點的可近性，以及要求服務便宜或免費的程度呈正相關，與要求服務態度良好及同時提供接生服務的程度呈負相關，依變項的變異量有38.7%可被此模型解釋。根據本研究的結果，吾人建議類似研究社區之都會區衛星城市，應重新評估衛生所的角色，並重組各個可用資源，建立整合性的婦幼衛生照顧體系。
  A probability proportional to size (PPS) sample of 320 infants was drawn from 1102 infants between 13 and 16 months of age from the city of Hsintien, a satellite city of Taipei. Home visits and questionnaire interviews were conducted for all of the mothers by eight trained interviewers in September, 1990. Utilization and provider choice of maternal and child health care of these infants were investigated. Most of the mothers had had prenatal care and postnatal care and were currently using contraceptive methods, the rates were 99.1%, 78.8%, and 77.0% respectively. Only 31.1% had had Pap smears in the past year. In all, 81.5% of the infants had had neonatal screening, and 77.9% had had well baby examinations. The rate for completion of all immunizations before one year of age exceeded 90%. Almost all maternal care was provided in hospitals or clinics. Health stations were used more often for infant care, and usage increased as the baby grew older. None of the neonatal screening was provided in health stations. About 30% of the immunizations within one month and over 70% of the immunizations after one month were given in health stations. Stepwise multiple regression analysis shows that total use of health stations by completely immunized babies was positively related to the understanding of health stations, accessibility, and the need for cheap or free care, while being negatively related to requirements of good attitude and of attending delivery. The authors suggest a review the role of health stations and thedevelopement of an integrated health care system to organize all possible resources.
• 237 - 245
• 10.6288/CJPH1995-14-03-04

• Link 原著 Original Article
• 台灣地區長期照護的問題與對策Long-Term Care in Taiwan: Issues and Directions
• 吳淑瓊、江東亮
  Suwu-Chong Wu, Tung-Liang Chiang
• 長期照護 ； 衛生政策 ； 老人
  long-term care ; health policy ; aged
• 本文旨在評估目前台灣地區長期照護的問題並提出未來發展策略。我們依據長期照護系統中的五個構成要素：資源、經濟支持、組織管理、服務提供、與政策來進行評估，結果發現：(1)目前我國最迫切的問題是長期照護人力與設施的嚴重缺乏，以致不但失能老人的照護大都由其家人單獨承擔，且慢性病人長期佔用急性病床，與未立案安養中心快速成長；(2)長期照護費用幾乎全由老人或其家人負擔，而全民健保只列入慢性病床與有限的居家護理給付，並未將其它長期照護服務納入給付；(3)由於長期照護業務分屬衛生與社會福利體系，造成長期照護資源與服務提供無法有效組織與管理的困難。根據上述發現，我們建議應即設定明確政策目標，建立我國理想長期照護體系，包含：發展人力與設施，整合衛生與社會福利服務體系，籌措公共財源，鼓勵非正式服務，以提供合正可近的長期照護服務。最後，我們並建議進行深入的長期照護政策相關研究以促進政策的形成與推展，滿足老人的長期照護需要。
  Institute of Public Health and Center for Health Policy Research, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC. This paper aims to critically assess the issues and suggest directions for long-term care in Taiwan according to a conceptual framework that considers the long-term care system as being composed of five interconnected components: resources, organization, financing, management and delivery. Three major problems are identified. (1) The most urgent and severe problem is the lack of long-term care manpower and facilities. As a result, most dependent elderly persons are cared for by their families without any formal supporting program, and a substantial portion of acute hospital beds are occupied by long-stay patients. In addition, the number of uncertified nursing homes with poor quality care hasbegun to increase rapidly. (2) Almost all the expenses of long-term care come from out- of-pocket payment. National Health Insurance only covers the benefits of hospital services for long-stay patients, whereas, the benefits of long-term care services are excluded. (3) It is difficult to coordinate health and social services for the elderly because they are organized through different bureaucratic systems in Taiwan. Therefore, we recommend the establishment of clear policy objectives for the development of long-term a care system, including the production of manpower and facilities, the coordination of health and social systems, the financing of long-term care services, the encouragement of informal services, and the pursuit of equitable access to long-term care. Finally, intensive long-term care policy research is recommended to facilitate policy formulation and program implementation to meet the needs of the Taiwanese dependent elderly.
• 246 - 255
• 10.6288/CJPH1995-14-03-05

• Link 原著 Original Article
• 精神分裂病青年及母親對生活適應的態度研究The Attitude of Young Schizophrenic Adults and Their Mothers toward Life Adaptation
• 鍾寶珠、蕭淑貞
  Pao-Jue Jone, Shu-Jen Shiau
• 精神分裂病 ；適應
  schiophrenia ; adaptation
• 本研究係以訪談方式收集資料，瞭解社區生活的21位病患組精神分裂病青年患者及母親和21位對照組一般青年及母親對「家庭生活」、「交友」、「求學或工作」三方面之「生活適應」態度。訪談記錄經內容分析與類統計推論處理，主要研究發現： 一、由兩組青年提到使用的八種因應態度，可歸納出「因應策略」和「社會化趨勢」兩個雙極性向度，形成四類因應型態。 二、兩組比較下，病患組青年使用(a)因應型態偏向於「衝突性」的社會化趨努，(b)因應態度偏向於反抗家人，隨性而為。 三、由兩組母親提到使用的九種教養態度，歸納出「教養行為」和「教養重心」兩個雙極性向度，形成四類教養型態。 四、兩組比較下，病患組母親使用(a)教養型態偏向於「父母導向」，(b)教養態度偏向於服務代勞和指責要求。
  TThe purpose of this study was to assess the adaptative attitudes of young adults with schizophrenia on the issues of daily life, education or vocation, and social relations. This study was conducted through a series of semi structured interviews with 21 young adults with schizophrenia, 21 normal young adults. and their mothers, Analysis of the narrative materials indecates that (1) coping attitudes of the young adults with schizophrenia were reluctant to and more ignorant of their families than those of normal young adults: (2) coping pattcrns can developed from eight coping attitudes observed in young adults with schizophrenia, and can be interpreted in terms of two bipolar dimontions, namely, the coping methode and socialization: (3) parenting attitudes of the mothers of young adults with schizophrenia were more eritic and more dominant on their ehildren than those of the normal youths mothers (4) parenting patterns can be developed from nine paronting arttitudes of their mothers on those three issues, and can be interpreted in terms of two bipolar dimentions, namely, the parenting behaeior and parenting orientation.
• 256 - 267
• 10.6288/CJPH1995-14-03-06

• Link 原著 Original Article
• 影響護理應屆畢業生對精神科護理興趣及未來臨床就業意願之相關因素Factors Affecting Job Interests of Psychiatric Nurses among Nurses Graduates
• 蕭淑貞、呂雀芬、湯麗玉、黃怡菁、周照芳
  Shu-Jen Shiau, Chea-Fen Lui, Li-Yu Tang, Yi-Jing Hnang, Chaw-Fang Chou
• 護理應屆畢業生 ； 精神科護理興趣 ； 工作興趣 ； 未來臨床就業意願
  nursing graduates ; psychiatric nursing interests ; job interest ; job willingness
• 本研究主要目的是：為探討影響各級護理學校應屆畢業生對精神科的興趣及未來精神科臨床就業意願之相關因素，採用量性之相關性。研究設計，以結構式的問卷為主要收集的方法。研究對象為北部三所護理系，而五專、三專、二專隨機各選得一所，職校一所，共有451名護理應屆畢業生。結果得知：不同學制、實習經驗、實習指導老師、精神科課程、精神科作業、同學、醫院、個人滿意度，是影響護生對精神科興趣、工作興趣及臨床就業意願的重要因素。
  The major purpose of this study was to investigate the factors that influenc the job interests of psychiatric nurses among nursing graduates. Data was collected with questionnaires. Four hundred and fifty-one subjects were recruited from three nursing schools, one two-year college, one three-year college, one five-year college and one vocational nursing school. They were randomly selected from the northern part of Taiwan. Results indicate that ”school system,” ”practicum experience,” ”clinical relation,” and ”hosiptal and personal satisfaction” have significant impact on the job interests among nursing graduates.
• 268 - 275
• 10.6288/CJPH1995-14-03-07

• Link 原著 Original Article
• 台灣大型醫院手術室空間配置之調查研究A Study on the Surgical Suite Space Allocation of the Large Hospitals in Taiwan, ROC.
• 韓揆、田芳南
  Kuei Han, Fang-Nan Tien
• 醫院建築設計 ； 手術室 ； 醫院管理
  hospital architectural design ; surgical suite ; hospital management
• 醫院手術室之設置所費不貲，其開刀房間數及空間配置應剛好合於業務需要，過多過少或面積過大過小都將造成浪費或管理不經濟。本文蒐集了台灣25家大型醫院之建築藍圖（占全體200床以上醫院之63%），圖面丈量其手術室及各個開刀房間之面積，佐以其他資料，發現樣本醫院開刀房間數與一般病床數之比為一個房間比48.2張病床，開刀房平均面積為41.2平方公尺，延伸面積為174.8平方公尺。開刀房設置比率較美國略低，較日本高出很多。開刀房平均面積高於美、日醫院，延伸面積則較日本為低。經統計分析結果，除開刀房延伸面積一項稍微受醫院規模不同有所影響外，其他方面，即開刀房之間數與一般病床床數比，開刀房平均面積均不受醫院規模、評鑑等級及管轄歸屬影響，推論醫院開刀房／病床比，平均面積及其延伸面積均自成一格，不因醫院特質之不同而變異。
  Surgical suite comtruction is the most difficult and costly aspect of hospital construction. Excessive or inadeguate number of operating rooms and space causes waste and management difficulties. This study surveyed the blue prints of the surgical suites of 25 over-200-bed hospitals (63% of its kind in Taiwan, ROC), and found that the operating room/bed ratio of the sample hospitals is 1:48.2. The average size of the rooms is 41.2m^2, and the room to suite space ratio is 1:4.24. Statistically, the room to bed ratio and the average size of the rooms are not influenced by the hospital size, level of accreditation or ownership. The space of the surgical suite in relation to rooms, however, is influenced by the hospital size, not by the level of accreditation or ownership of the hospitals.
• 276 - 282
• 10.6288/CJPH1995-14-03-08

• Link 原著 Original Article
• 民國七十九年台灣地區國民健康調查遷移樣本之特性分析The Property of Migrated Sample for the 1990 National Health Survey in Taiwan
• 許博雄、洪永泰
  Po-Hsiung Hsu, Yung-Tai Hung
• 遷移樣本 ； 樣本代表性 ； 國民健康調查
  migrated sample ; sample representativeness ; national health survey
• 本研究以民國七十九年台灣地區國民健康調查中的1030份家戶及4196份個人標本為例，將樣本依照其原登錄地址是否與受訪當時有異，而區分成「原址樣本」與「遷移樣本」兩類，並分析「原址樣本」與「遷移樣木」在基本人口、社會特性，就醫行為、健康行為上是否顯著差異。 研究結果顯示，在家戶樣本部分：遷移樣本在「居住地區」、「家庭結構型態」、「現址居住時間」、「訪談使用語言」箏四項上，與原址樣本有顯著差異。在個人樣本部分：遷移樣本在「年齡」、「教育程度」、「有無職業」「從業身分」、「保險類別」、「訪談使用語言」、「就醫行為」箏五項人口社會特性上，與原址樣本有顯著差異。在就醫行為方面，遷移樣本的就醫方式，在「中藥房配藥」、「自行照顧」兩類上與原址樣本有顯著差異。因此，在台灣地區從事樣本調查工作，對於遷移樣本應儘量追蹤完訪，以避免忽略特殊樣本，提高樣代表性。
  The purpose of this study was to examine the differences between migrated and static populations with respect to demographic characteristics, social economic status, medical behavior, and health habit. The data for the analysis came from the 1990 National Health Survey in Taiwan. Samples, 1031 households and 4196 persons, were classified into migrated and static samples populations depend on whether the samples actually visited has the same address as those originally selected. There are two main findings of the study. First, household migrated samples are significantly different from static samples on five variables which include residential area, family structure, length of residency language usage. Second, the individual migrated samples are significantly different from static samples on the following variables: age, education level, occupation, insurance coverage, language, and medical behavior. Thus, the results of this study implicate the importance of following up migrated samples in the process of survey.
• 283 - 297
• 10.6288/CJPH1995-14-03-09