27卷2期

• Link 綜論 Review Article
• 兒童與青少年身心障礙者運動健康行為促進之回顧與探討A Review of Health Promotion in Children and Youth with Disabilities: Exercise and Physical Activity
• 許雅雯、林麗娟、蔡佳良
  Ya-Wen Hsu, Linda-L Lin, Chia-Liang Tsai
• 兒童及青少年身心障礙者 ； 健康促進 ； 運動 ； 身體活動
  children and youth with disabilities ; health promotion ; exercise ; physical activity
• 身心障礙的兒童及青少年是最缺乏身體活動的族群之一，且其身體活動不足及坐式生活形態，是造成許多身體疾病的主要因素，目前對於身心障礙的兒童及青少年相關的運動健康促進策略及研究仍較為不足，因此本文的目的即在瞭解與身體活動或運動相關的兒童及青少年身心障礙者健康行為促進。搜尋回顧國內、國外相關的文獻之後，可分為與運動有關的：1．健康行為促進模式；2．健康促進影響因子與需求；3．實證研究等三大主題進行論述。而綜合以上之文獻回顧，本研究有以下幾點建議：1．發展以家庭、日常生活環境及社區為基礎之運動健康介入計劃，較能有效地延續服務傳遞；2．提升身體活動是健康促進計畫設計者應該優先考慮的健康促進需求，設計適合長期進行的家庭及日常生活環境身體活動處方，並輔以場所性的健康促進課程，能達到較佳的執行成效；3．目前國內對於兒童及青少年身心障礙者運動健康促進之研究仍然缺乏，未來需要更大量更廣泛的國內實證研究作為推動國內兒童及青少年身心障礙者運動健康促進計劃的基礎。
  Children and youth with disabilities are among the least active groups of individuals and therefore are at high risk for secondary disorders associated with a physically inactive, sedentary lifestyle. Because of the low abundance of research examining exercise in children and youth with disabilities, the purpose of this article was to review the effects of exercise (or physical activity) and the promotion of health behaviors in children and youth with disabilities. Selected articles were categorized into 3 areas: 1) health promotion such as exercise in children and youth with disabilities; 2) factors that contribute to health promotion and exercise; and 3) health promotion interventions using exercise strategies. Overall, a family-centered, community-based health promotion model plays an important role in not only health promotion and exercise, but also health care delivery. Furthermore, the most critical requirement for an exercise intervention project is to enhance the physical activity participation. In addition, long-term exercise prescriptions performed under daily-life conditions, along with complementary programs held in institutions, are more effective in maintaining and improving the health status of children and youth with disabilities. Finally, after all environmental factors are considered, the design and implementation of research-based exercise intervention programs is required in order to widely promote exercise in children and youth with disabilities in Taiwan.
• 91 - 100
• 10.6288/TJPH2008-27-02-01

• Link 原著 Original Article
• 台灣地區糖尿病病患及其視網膜病變的醫療資源耗用Healthcare Utilization by Patients with Diabetes and Diabetic Retinopathy among National Health Insurance Enrollees in Taiwan
• 蔡明足、翁林仲、蔡維河、蔡景耀、周歆凱、林敬恆、周碧瑟
  Ming-Tsu Tsa, Lin-Chung Woung, Wei-Her Tsai, Ching-Yao Tsai, Hsin-Kai Chou, Cheng-Heng Lin, Pesus Chou
• 糖尿病 ； 視網膜病變 ； 醫療耗用
  Diabetes ; Diabetic Retinopathy ; Health Expenditure
• 目標：過去，有關糖尿病視網膜病變的研究多屬於以醫院為基礎，或是針對特定地區為主的區域型研究，缺乏全面性之探討；因此，本研究欲利用全民健保資料庫來觀察與分析台灣地區糖尿病視網膜病變患者之疾病及醫療費用關係。方法：採橫斷性研究，從2004年國家衛生研究院全民健康保險學術資料庫中根據ICD-9-CM診斷碼及降血糖藥品碼精確篩選出糖尿病患者4,988人、視網膜病變患者1,216人進行統計分析。結果：台灣地區2004年糖尿病視網膜病變病患平均總醫療費用為128,661元，為無合併視網膜病變患者的2.02倍；其中，門診次數每年平均36.9次高於無視網膜病變患者9.6次，住院天數平均6.9天亦高於無視網膜病變患者2.3天。結論：有視網膜病變併發症的糖尿病患，在總醫療費用、門診次數、住院天數均高於沒有視網膜病變的糖尿病患，並且隨著視網膜病變的嚴重度增加而提升醫療資源耗用。因此，由本研究可得知及早預防視網膜病變的發生與治療現網膜病變的併發症，對台灣地區糖尿病患者醫療費用的減少，有相當的助益與實證。
  Objectives: In the past decades, most diabetic retinopathy research included either hospital-based or regional studies with few population-based and comprehensive studies. Therefore, a cross-sectional study in Taiwan was conducted to investigate the health expenditure and associated factors amongst adult diabetics in 2004, including those with diabetic retinopathy. Methods: Data from the National Health Insurance Academic Database in 2004 identified 4,988 diabetics along with 1,216 patients with diabetic retinopathy based upon ICD-9-CM and drug codes. Results: The average total medical expenditure of diabetic patients with diabetic retinopathy was 128,661 NT dollars in 2004, which was 2.02-fold higher than that of diabetic patients without diabetic retinopathy. In addition, the average number of outpatient department (OPD) visits by diabetic patients with diabetic retinopathy was 36.9, which is again higher than those without diabetic retinopathy. Finally, the average length of hospital stay for patients with diabetic retinopathy was longer than those without diabetic retinopathy (6.9 days versus, respectively). Conclusions: In this study, adults with diabetic retinopathy, who were NHI enrollees, were consistently more expensive than diabetic adults without diabetic retinopathy. This nationwide, population-based study provides strong evidence that controlling the severity and comorbidity of diabetes along with its associated complications such as diabetic retinopathy is worthy in terms of medical expenditure, OPD visits, and length of hospital stay.
• 101 - 109
• 10.6288/TJPH2008-27-02-02

• Link 原著 Original Article
• 台灣自殺死亡率趨勢：1959-2006Trends in Suicide Mortality in Taiwan, 1959-2006
• 吳若寧、鄭雅文
  Ruo-Ning Wu, Ya-Wen Cheng
• 自殺 ； 死亡率 ； 趨勢 ； 台灣
  suicide ; mortality ; trend ; Taiwan
• 目標：本研究旨在描述台灣自1959至2006年間自殺死亡率的長期趨勢，並分析其年代、年齡及也代效應。方法：我們以衛生署出版的生命統計資料，計算年齡、性別分層，以及年齡標準化死亡率，並以圖表與Poisson回歸模型分析年代、年齡及也代對自殺死亡率之影響。結果：台灣的自殺死亡率在1960年代早期以及1980年代早期分別出現高峰，並在1990年代中期之後逐年攀升；在所有男女年齡層族群皆呈現一致的年代效應。在年齡效應方面，台灣自殺死亡率隨著年齡上升而增加，進一步分析則發現有年齡與年代之交互作用，特別是在最近十年來中壯年男性自殺死亡率的上升趨勢高於其他年齡層與女性族群。不同也代在自殺風險的差異則與年代、年齡相關的社會環境因素較有關，亦即也代效應並不明顯。結論：自殺死亡率長期趨勢之變動，顯然受到年代效應影響最為顯著，凸顯社會情境對於群體的自殺風險之重要性。後續研究應進一步探究影響台灣自殺風險之因素。
  Objectives: This study was conducted to examine long-term trends in suicide mortality in Taiwan from 1959 to 2006 and to analyze the effects of age, time period, and cohort. Methods: Suicide mortality was calculated using official vital statistics data. The effects of age, time period, and cohort on suicide mortality were examined graphically and with Poisson regression models. Results: An ubiquitous period effect on suicide mortality in both genders across all age groups was observed, with peak rates in the early 1960s and early 1980s and an upward trend since the mid-1990s. Suicide mortality increased with age, and evidence for an age-by-period interaction was found. Over the past decade, the sharpest increase in suicide mortality was found in middle-aged men. Evidence of cohort effects was less clear, and suicide risk of different cohorts appeared to be associated with period-and age-specific social environmental conditions. Conclusions: The changing patterns of suicide mortality highlight the importance of period-and age-specific social conditions in determining a population's risk of suicide. Further research is needed to explore the factors involved in such changes.
• 110 - 120
• 10.6288/TJPH2008-27-02-03

• Link 原著 Original Article
• 居家失能老人在照顧服務使用的自我選擇權之相關因素研究Self-determination of the Home Care Service Use among Disabled home-dwelling Elders of Taiwan
• 紀玫如、吳淑瓊
  Mei-Ju Chi, Shwu-Chong Wu
• 自我選擇 ； 照顧服務 ； 居家失能老人
  self-determination ; home care services ; home-dwelling disabled elderly
• 目標：瞭解影響居家失能老人是否能夠自己選擇照顧服務的相關因素。方法：本研究對象選自嘉義市及台北縣三峽鎮。鶯歌鎮兩個實驗社區中，能夠自答問卷之65歲以上居家失能老人947名，再以SPMSQ量表經教育程度校正後取得有效樣本942人，並以多分變項邏輯斯迴歸進行相關因素之檢驗分析。結果：分析樣本中有45.9%的個案表示能夠自己選擇服務，16.8%的個案則完全不能由自己選擇服務，其餘36.3%的個案則表示自己可以選擇部分服務。多分變項邏輯斯迴歸分析結果顯示，比較完全可以自己選擇服務和完全不可以自己選擇服務兩組個案發現，具社會福利身份(OR=0.45, 95%CI=0.25-0.79)、重度身體功能障礙(OR=0.29, 95%CI=0.15-0.56)、認知功能有障礙(OR=0.40, 95%CI=0.24-0.68)、沒有個人收入(OR=0.43, 95%CI=0.24-078)、照顧者為媳婦(OR=0.36, 95%CI=0.15-0.88)，比較不是由自己選擇照顧服務；對長期照護服務認知較高(OR=1.13, 95%CI=1.01-1.27)者，則能夠由自己選擇服務的機會較高。結論：個人經齊狀況、對服務的認知、教育程度、與照顧者之照顧關係以及身體和認知功能，都是會影響失能老人能否自己選擇服務的重要因素。未來在長期照護相關政策的規劃，應加以考量上述因素的影響。
  Objectives: To examine the prevalence and correlates of self-determination of homecare service among disabled Taiwanese elders. Methods: Nine hundred forty two (942) subjects among the 2079 disabled elders from the ”Pilot Program for the Development of Long Term Care System Study” implemented in Taipei and Chiayi City were recruited. Elders with severe cognitive impairments and those with surrogate responses were excluded. Multinomial logistic regressions were applied for statistical analysis. Results: Forty-six percent of the respondents indicated that they could choose the care services by themselves, 36.3% could choose some services, and 16.8% were unable to choose services. Compared with those who could not make their own decisions, those who could not choose their services totally are more likely to have social welfare status (OR=0.45, 95%CI=0.25-0.79), severe ADL disability (OR=0.29, 95%CI=0.15-0.56), cognitive disability (OR=0.40, 95%CI=0.24-0.68), without personal income (OR=0.43, 95%CI=0.24-0.78), daughter-in-law caregivers (OR=0.36, 95%CI=0.15-0.88). Elderly with greater awareness of long-term care services exhibited higher probability of choosing their services (OR=1.13, 95%CI=1.01-1.27). Conclusions: Economic status, physical and mental functioning, the relationship with caregiver, education and the awareness of services were the important factors associated with self-determination of disabled Taiwanese elders. Our government should consider these factors when promoting relative long-term care policy for disabled elders.
• 121 - 132
• 10.6288/TJPH2008-27-02-04

• Link 原著 Original Article
• 青少女自費接種子宮頸癌疫苗意向之相關因素探討Factors Associated with Adolescent Girls' Intention to self-paid Human Papillomavirus Vaccination
• 溫麗芬、洪麗珍、張彩秀
  Li-Fen Wen, Li-Chen Hung, Tsai-Hsiu Chang
• 子宮頸癌 ； 子宮頸癌疫苗 ； 健康信念模式
  cervical cancer ; human papilloma virus HPV vaccine ; health belief model
• 目標：旨在探討中部地區青少女對自費接種子宮頸癌疫苗之意向及其相關影響因素。方法：採橫斷面設計，以有效問卷便利取樣809名高中、職女學生，進行人口學特質、罹患子宮頸癌易感性與嚴重性認知、行動利益及障礙與自費接種意向之資料收集。結果：1.青少女在疫苗接種意向上，67.4%的人願意（含非常願意）自費接種，可負擔之平均費用為793元。2.以逐步迴歸分析後發現，影響整體自費接種意向之重要預測因子為「障礙」與「家中經齊」(R^2=14.6%)；就高中生而言，重要預測因子為「障礙」、「家中經齊」、「吸菸」與「家人罹患子宮頸癌情形」(R^2=18.4%)；就高職生而言，重要預測因子為「障礙」與「性伴侶人數」(R^2=24.1%)；在不同的對象中「障礙」皆是最重要的預測因子。結論：透過瞭解影響青少女子宮頸癌疫苗接種之相關因素探討，於實務方面：建議社區醫療網絡日後能針對可能之障礙因素加以排除，以提高青少女接種意向。於教育方面：高中（職）相關課程中（如：軍護課或健康與護理）可再加以宣導，增加同學對子宮頸癌疫苗的瞭解，以提升接種率。
  Objectives: The aim of this research is to assess the intention of, and the factors related to, adolescent girls to pay for human papillomavirus vaccination. Methods: This cross-sectional study included 809 girls chosen by convenience sampling in Central Taiwan. A valid structured questionnaire was designed and by self write to collect data on demographic characteristics, perceived risk and severity of cervical cancer, benefits of and barriers to human papillomavirus vaccine, and the intention about pay for human papillomavirus vaccination. Results: Two-thirds (67.4%) of the girls were willing to pay for human papillomavirus vaccination up to a maximum of 793 NT dollars (about 26 US dollars). Using stepwise regression, we found barriers to vaccine (i.e. too busy, no money, too far and family don't agree to vaccine) were negative associated with intention and family economic status was positive associated with intention in the full study sample to pay for vaccination (R^2=14.6%). Among the sample subset who are senior high school students (n=416), the barriers to vaccine and smoking status were negative associated with intention, but family economic status, and family history of cervical cancer were positive associated with intention to pay for vaccination (R^2=18.%). Among vocational high school students (n=393), the barriers to vaccine were negative associated with intention and sexual partner were positive associated with intention to pay for vaccination (R^2=24.1%). Conclusions: We suggest eliminating the possible barriers to primary health care in the community. In the educational system, the curricula of military and nursing training programs should provide knowledge that will enable high school girls to increase their awareness of human papillomavirus and their willingness to pay for human papillomavirus vaccination.
• 133 - 142
• 10.6288/TJPH2008-27-02-05

• Link 原著 Original Article
• 大學生線上遊戲成癮對身心健康與學習態度之影響－以台灣北區六所大學為例Influence of online-game Addiction on physical-mental Health and Learning Attitude among University Students in Northern Taiwan
• 蔡明春、鄭青展、林淑萍
  Ming-Chun Tsai, Ching-Chan Cheng, Shu-Ping Lin
• 線上遊戲成癮 ； 身心健康 ； 學習態度
  Online-game addiction ; Physical-mental health ; Learning attitude
• 目標：本研究旨在探討線上遊戲成癮現象對大學生身心健康與學習態度的影響。方法：研究主要以線上遊戲成癮為基礎，採立意抽樣法成功調查台灣北部地區六所大學485位具線上遊戲經驗之大學生，瞭解其線上遊戲成癮、身心健康與學習態度之實際狀況，並利用結構方程模式及多變量變異數分析進行資料分析。結果：大學生線上遊戲成癮對其身心健康(γ1=-0.39)及學習態度(γ2=-0.28)具有負向影響，線上遊戲成癮對大學生身心健康的影響大於學習態度；而在各構面之影響程度，以心理健康與求知慾望的影響最為明顯，且線上遊戲成癮之亢奮性是影響身心健康與學習態度最明顯的因素，此結果與國中生電玩成癮具有明顯的差異。結論：線上遊戲成癮對大學生具顯著的負向影響，家長及教育單位應高度重現與適當輔導，方可確保大學生之身心健康與良好的學習態度。
  Objectives: This study explores the influence of online-game addiction on the physical-mental health and learning attitude of university students. Methods: We used purposive sampling to survey 485 students of six universities in northern Taiwan who have played online-games. The survey data were analyzed using structural equation modeling and multivariate analysis of variance. Results: Among the students surveyed, the addiction to online-games had a statistically significant, negative influence on physical-mental health (?1=-0.39) and learning attitude (?2=-0.28). The influence was greater on the students' physical-mental health than it was on their learning attitude. Specific aspects influenced by addiction included mental health and the thirst for knowledge, and the ”excitement” of the addiction was the most obvious component of the influence on physical-mental health and learning attitude. Conclusions: online-game addiction has a substantial negative influence on university students-larger than this behavior's influence on junior high school students. Parents and educational institutions should provide appropriate guidance for university students to maintain their physical-mental health and learning attitude.
• 143 - 157
• 10.6288/TJPH2008-27-02-06

• Link 原著 Original Article
• 女性海洛因使用者共用注射針具和稀釋液行為與愛滋感染之初探An Exploratory Study of Sharing Injecting Equipment and HIV Infection among Female Heroin Users
• 盧幸馡、李思賢
  Hsing-Fei Lu, Tony Szu-Hsien Lee
• 女性 ； 海洛因使用者 ； 共用針具 ； 共用稀釋液 ； 愛滋感染
  female ; heroin user ; needle sharing ; sharing of rinse water ; HIV infection
• 目標：探討女性海洛因使用者在注射海洛因過程中，共用注射針具與稀釋液的行為與愛滋感染之關係。方法：以個別深度訪談訪問女性海洛因使用者共15名，將訪談內容轉謄為逐字稿，依據逐字稿進行主題內容分析。結果：受訪者過去缺乏對稀釋液共用之危險認知，全部都曾共用過稀釋液。在針具方面，受訪者共用針具的主因是對藥渴求時缺乏清潔針具可使用；共用針具的對象則多半為熟識。與之具緊密社會關係者；對共用針具之認知有完全缺乏危險認知與行為者(13.3%)、對共用針具有危險認知，但無正確安全行為者(66.7%)、以及拒絕與他人共用針具者(20%)。受訪者中有8位(53.3%)愛滋病毒帶原者，其中有五位自陳由共用針具感染，三位認為是共用稀釋液感染。結論：本研究發現受訪者對稀釋液之傳染性、共用對象之安全性、性伴侶之危險評估與其自身是否感染愛滋有認知落差，因而暴露於感染愛滋的危險中。
  Objectives: The purpose of this study was to describe the association of sharing injecting equipment and HIV transmission among female heroin users. Method: A total of 15 female heroin users were interviewed face-to-face with their consent. Audio transcripts were translated verbatim and content analysis was used to retrieve themes. Results: Participants indicated that they had no idea that sharing rinse water may cause HIV transmission, and hence they had all previously shared water. Most participants shared needles with sexual partners, friends, and other drug users. They usually shared needles because of their craving for drugs and because no clean needle was available. Participants were categorized based on their cognition of sharing needles: no risk awareness (13.3%), awareness of risk but no preventive behavior (66.7%), and awareness with preventive behavior (20%). Eight participants (53.3%) tested HIV positive, five self-reported that they were infected through needle sharing and three through sharing rinse water. Conclusions: There exists a gap among study participants between their knowledge regarding sharing rinse water, needles, and sexual partners and actual risk of their behaviors. This gap puts female heroin users in our study at elevated risk of contracting HIV.
• 158 - 169
• 10.6288/TJPH2008-27-02-07

• Link 實務 Public Health Practice
• 從國際比較探討台灣醫院病床數Hospital Beds in Taiwan: An International Comparison
• 姚素俐、朱育增、吳君誠、朱慧凡、吳肖琪
  Su-Li Yao, Yu-Tseng Chu, Chun-Chen Wu, Hui-Fan Chu, Shiao-Chi Wu
• 醫院病床 ； 病床 ； 人口老化 ； 國際比較
  hospital beds ; beds ; aging ; international comparison
• 目標：為瞭解我國醫院病床數在國際之水準，乃探討世界各國病床人口比之相關因素，以提供台灣政策制定參考。方法：採衛生署統計室、內政部統計處、世界衛生組織、世界銀行、經齊合作暨發展組織、世界各國紀實年鑑及聯合國教育、科學與文化組織等網站之統計資料，進行分析。結果：依世界衛生組織醫院病床定義，我國2004年底每萬人口病床數48.38床，國際排名第48名。以逐步迴歸分析世界各國資料，顯示60歲以上人口百分比、15歲以上男性識字率、嬰兒死亡率與各國每萬人口病床數呈顯著正相關，「國民醫療保健支出(NHE)佔國內生產毛額(GDP)比例」呈顯著負相關，校正後解釋力(Adj R^2)為76.9%，均方誤差(MSE)為0.037，依此估計台灣所需病床數為每萬人口43.54床(95%CI: 37.26~50.89)。結論：我國病床數已達國際水準。未來病床資源的規劃，應考量人口、教育、健康、經齊、現有病床使用效率、醫療科技發展、以及社區資源開發程度等因素。
  Objectives: To compare the number of hospital beds in Taiwan on an international basis and use the results as a reference point for government policy making. Methods: We investigated factors related to the number of hospital beds per 10,000 population through international comparison. The data for analysis was collected from statistical reports of the Department of Health, Ministry of the Interior, the World Health Organization, the World Bank, the Organization for Economic Cooperation and Development, the World Factbook, and the United Nations Organization for Education, Science and Culture. Results: According to the World Health Organization's hospital bed definition, the number of hospital beds per 10,000 population in Taiwan in 2004 was 48.38. The ranking was 48 among 141 countries. Stepwise regression analysis showed that the number of hospital beds per 10,000 population was positively associated with the percentage of population aged over 60 years, the male literacy rate for those above 15 years old, infant mortality rate, and was negatively associated with National Health Expenditure (NHE) as a percentage of Gross Domestic Product (GDP, adjusted R^2: 76.9%; MSE: 0.037). The predicted value of hospital beds per 10,000 population in Taiwan was 43.54 (95%CI: 37.26~50.89). Conclusions: From the perspective of international comparison, hospital beds per 10,000 population is sufficient in Taiwan. For planning hospital beds as a resource, a variety of factors should be considered simultaneously. These include population, education, health and economic indicators as well as utilization patterns, the development of medical techniques, and the development of community care.
• 170 - 179
• 10.6288/TJPH2008-27-02-08