14卷4期

• Link 原著 Original Article
• 生育先天性缺陷兒對家庭的影響The Impact of Newborns with Congenital Defects on Family
• 黃璉華
  Lian-Hua Huang
• 先天性缺陷 ； 衝擊 ； 家庭
  congenital defects ; impact ; family
• 本研究探討生育先天性缺陷兒對家庭的影響。研究對象為衛生署登記的八十年度生育光天性缺陷兒家庭，以郵寄問卷及電話訪問的方式收集資料，以SPSS電腦軟體和內容分析法分析資料，共有51個家庭參與本研究。 研究結果發現先天性缺陷兒對母親的影響是多方面的，缺陷特性的嚴重度、配偶及其他有意義家人的態度、醫護人員的態度會影響母親對缺陷兒的感受及態度。所以護理人員在照護生育先天性缺陷兒母親時，應慎加注意本身的官行態度，同時須瞭解其他有意義家人的態度與需要，才能幫助母親調適因生育先天性缺陷兒帶來的壓力與影響，進而協助整個家庭的適應過程。研究結果顯示生育先天性缺陷兒對父親亦同樣造成影響，但對母親的影響大於對父親的影響。 其它家人，包括手足及（外）祖父母，也不可避免的有哀傷及情緒反應。因生育光天性缺陷兒會對整個家庭帶來影響，建議衛生機構、社會福利及教育當局提供適切的服務。
  The purpose of this study was to investigate the impact of the birth of a child with a congenital defect on the family. The target population were mothers who gave birth to a child with a congenital defect in 1991. Data were collected by mailed questionnaires and telephone interviews and were analyzed by using Author Write out full name computer software and content analysis. A total of 51 families participated in this study. The study results revealed that the impact of having an imperfect child on a mother was multidimensional: the characteristics of the congenital defect, the attitudes of the spouse and other family members, health profcssionals' attitudes, and the mother's attitudes and feelings were found to be correlated. Clinical implications are that health professionals are obligated to help the child's mother and family cope with the periodic adjustment stress. Gender differences were found between mothers' and fathers' responses to having a child with a cougenital defect. As for other family members, such as siblings and grand parents, unavoidable grief and emotional reaction were noted. The impact of a child with birth defects on the whole family is obvious. It is recommended that comprehensive health, welfare and educational serrices be provided.
• 299 - 313
• 10.6288/CJPH1995-14-04-01

• Link 原著 Original Article
• 以因素分析探討凝血因子、血清生化值、血壓、血脂前蛋白及肥胖指標因素與心肌缺氧指標（心電圖ST段改變）年齡趨勢之關係To Describe the Age Trends between Coagulation Factors, Biochemistry Indices, Blood Pressure, Apolipoproteins, Obesity Indices and ST Segment Depression by Factor Analysis
• 白其卉、 潘文涵、陳建仁
  Chyi-Huey Bai, Wen-Ham Pan, Chen-Jen Chen
• 因素分析 ； ST段 ； 年齡效應 ； 心臟血管疾病危險因子 ； 方法學
  factor analysis ; ST segment ; age effect ; cardiovascular risk factor ; methodology
• 分析人體生理變項和疾病之關係，常有下列的困擾：在統計上，這些生理變項彼此問的相關極強，即共線性相當嚴重，同時這些變項彼此問實際生理意義重疊性極高。本研究嘗試使用因素分析的方法，儘可能不損失各個生理變項之解釋力的情況下，解決分析時變項之間相關太強及意義重複的困難，來觀察某些心血管疾病危險因子特性與心肌缺氧指標（ST段改變）之年齡趨勢的關係。本研究使用在竹東朴子進行之「臺灣地區重要體液傳染病及心臟血管疾病危險因子長期追蹤研究」第二循環之資料，進行各因素與ST段改變幅度年齡趨勢之關係。依變項為心電圖之ST段(ST Segment)幅度改變，自變項為年齡、七項凝血因子、四項血清生化項目、血壓、肥胖指標及血脂前蛋白等22個變項，以「主成份分析法」執行因素分析，男性得到8個因子，分別為肥胖因子、凝血因子、膽固醇因子、血壓因子、凝血時間因子、insulin相關因子、血脂蛋白－A因子及中段軀體肥胖因子。女性得到7個因子，分別為肥胖因子、凝血因子、膽固醇因子、血壓因子、凝血時間因子、insulin相關及中段軀體肥胖因子與血脂蛋白－A因子。經過因素分析援，各因素之問的相關遠比單獨各生理變項的相關要低，且解釋力仍達顯著，顯示因素分析解決了變項之間相關太強及意義重複的困難。ST段隨著年齡的增加而下降，男性在肥胖、高的三酸甘油酯、血糖、尿酸及低的血脂前蛋白－A濃度的特性下，ST段下降的傾向會增加；女性則在肥胖、高的三酸甘油酯、血糖、尿酸、血壓、及低的血脂前蛋白－A濃度的特性下，ST段下降的危險會上升。另肥胖及血脂前蛋白兩特性之高、中、低三組在方向性上有很好的解釋力。 本研究發現心肌缺氧的老化現象（ST段改變量）之年齡趨勢，在不同心臟血管危險因子有類似的情形，也就是已知的心血管疾病危險因子冉法完全解釋ST段改變量隨年齡下降之情形。
  Problems exist in simultaneously relating physiological variables such as obesity indices, blood pressure and biochemistry indices to disease. Correlation of these variables is very strong. Collinearity is difficult to handle. Physiological meanings of these variables largely overlap. We discuss these difficulties in this paper. The purpose of this study is to describe the age trend of ST segment depression and to examine whether such trends differ in subjects with variables cardiovasculav disease (CVD) risk profiles. Using data from CVD facts, we used factor analysis to organize the correlated CVD risk factors. There were 22 CVD risk factors selected for this study including body mass index (BMI), skinfold measure, diastolic and systolic blood pressure, seven hemostatic parameters, and apolipoproteins A-I and B-100. Eight factors were studied in men. These were obesity factor, coagulation factor, cholesterol factor, blood pressure factor, coagulation time factor, apolipoprotein-A1 factor, central-obesity factor, and insulin-related factor. In females seven factors were studied including the obesity factor, coagulation factor, cholesterol factor, blood pressure factor, coagulation time factor, apolipoprotein-A1 factor, and central- obesity-and-insulin-related factor. The correlation coefficients among these factors were lower than those among original CVD risk variables. Regression analysis revealed that age, sex, obesity, blood pressure, and apolipoprotein-A1 were predictors of ST segment change. The magnitude of ST segment depression decreased with age. These decreasing trends showed the same shape between the obese group and the lean group. But there was not no difference beteen the group with high levels of apo-A and the group with low levels. These results indicate that the aging effect can not be completely explained by CVD risk factor studies.
• 314 - 324
• 10.6288/CJPH1995-14-04-02

• Link 原著 Original Article
• 台北都會區不同高度懸浮微粒濃度之變異Aerosols at Street Level and Rooftop in Taipei
• 王秀娟、王秋森
  Shiou-Jiuan Wang, Chiu-Sen Wang
• 懸浮微粒 ； 鉛濃度 ； 機動車輛
  aerosol ; lead ; automobile
• 懸浮微粒在台北都會區的濃度極高，尤其在交通頻繁的街道更是嚴重，故本研究主要在評估機動車輛對台北都會區不同高度、不同時段空氣中懸浮微粒的貢獻情形。使用微孔均勻沈積衝擊器於地下道、屋頂及建築物旁之不同高度採集懸浮微粒，並以微量天平及石墨爐原子吸收光譜儀分析懸浮微粒質量濃度及含鉛量。在人行道及不同高度之懸浮微粒及鉛濃度，白天和晚上兩採樣時段沒有顯著差異。對不同高度而言，環境中之懸浮微粒及鉛濃度隨高度升高而遞減，並且在愈高處遞減速率愈慢，在16至70公尺之間幾乎維持平穩。機動車輛對氣動直徑小於10μm之懸浮微粒的貢獻分率介於0.18-0.35之間，因採樣地點、高度、時間不同而異。細微粒（氣動直徑小於2.5μm）及粗微粒（氣動直徑在2.5-10μm之間）之機動車輛貢獻分率不同，人行道細微粒之交通貢獻分率介淤0.19-0.56之間，平均為036，租微粒之交通貢獻分率介於0.20-0.36之間，平均為0.26。
  This study's primary objective was to assess the contributions of automobile exhaust to the particulate air pollutants in the city of Taipei. Samples of airborne particles were taken with Micro-Orifice Uniform Deposit Impactors at an underpass and two nearby buildings of diffenent heights. The particle samples were weighed and analyzed for lead content by an atomic absorption spectrometer. The results for samples taken from 7 A.M.-7 P.M. did not differ significantly from those taken form 7 P.M.-7 A.M. of the same day. Rising from 1 to 16 meters in elevation, both the mass concentration and the lead content of airborne particles decrease rapidly. However, the rate of decrease dropped markedly at about 16 meters above ground. Particles sampled at the underpass during rainy days originated mainly from automobile exhaust, and therefore their lead content was used as the basis for estimating the contribution of automobile exhaust to airborne particles at street level and higher elevations. The contribution of automobile exhaust to airborne particles ranged from 18 to 35%, depending on location, elevation, and time of the day when the samples were taken. The fractions of contribution of automobile exhaust differed between fine particles (smaller than 2.5 µm in aerodynamic diameter) and coarse particles (2.5-10 µm). At 1 meter above the sidewalk, the contribution of automobile exhaust to fine particles ranged from 0.19 to 0.56, with an average of 0.36, and to coarse particles ranged from 0.20 to 0.36, with an average of 0.26.
• 325 - 333
• 10.6288/CJPH1995-14-04-03

• Link 原著 Original Article
• 1993年臺閩地區恙蟲病流行病學調查報告Tsutsugamushi Disease in Taiwan, 1993
• 李淑芳、蔡淑芬、施清河、趙秀琳、吳聰能
  Shu-Fang Lee, Su-Fen Tsai, Cheng-Ho Shih, Show-Lin Chao, Trong-Neng Wu
• 恙蟲病 ； 焦痂
  Scrub typhus ; Tsutsugamushi disease ; Eschar
• 本調查報告的目的在了解臺閩地區恙蟲病要生情形、感染地區、季節分佈，並探討恙蟲病確定病例臨床症候等之流行病學特質。結果顯示近十幾年來，臺灣地區恙蟲病報告與確定病例數有逐年增加的趨勢，至1993年達到最高峰，共有231例報告病例。確定病例自1989年始有區分，亦自該年的10例增至1993年的58例。以感染地來看，主要分佈在臺東縣、澎湖縣、花蓮縣與金門縣、連江縣等偏遠山區；以發病月份來看，五至九月為尖峰季節。另調查58例確定病例中，出現皮膚焦痂者佔70.69%，有林巴病變者佔89.66%，發生高燒者佔89.66%。如選擇具有此三項中之二項臨床症狀為判別標準，則可達98.28%的陽性預測值。另對未完成血清判讀的60名病例，進行個案調查，在完成調查的34例個案中，今現有23例具有上迷之臨床症狀，如這些病例確屬確定病例，則1993年的恙蟲病十萬人口罹病率將從每十萬人口的0.28人增為0.40人。
  Tsutsugamushi disease is one of the endemic rickettsial infections in the Taiwan area. The number of reported has shown an increasing trend since 1989, and case numbers reached a climax in 1993 (231 reported cases and 58 confirmed cases). The main purpose of this investigation was to illustrate the epidem-iological characteristics of Tsutsugamushi Disease in Taiwan. The endemic areas are mainly mountainous areas and isolated islands, such as Taitung County. Hualien County, Penghu County, Kinmen County and Lienkiang County, The seasonal trend showed the disease pre-dominated in the summer and early autumn. Of the 58 confirmed cases, 70.69% showed skin eschar, 89.66% had lymphadenopathy, and 89.66% presented with fever. After applying two of above three symptoms, 98% of the 58 seroconfirmed cases, presented clinical sypmtoms consistent with Tsutsugamushi disease, and the positive prediction value was estimated as 98.28%. In contrast, only 23 of 60 serological indeterminant cases (39%) met the clinical symptoms.
• 334 - 341
• 10.6288/CJPH1995-14-04-04

• Link 原著 Original Article
• 參加某教學醫院住院健康檢查者之攝鈉行為探討The Sodium Intake of Participators Undergo a Physical Examination in a Teaching Hospital
• 吳宏蘭、李蘭
  Hung-Lan Wu, Lee-Lan Yen
• 攝鈉 ； 健康信念
  sodium intake ; health belief
• 本研究主要目的在瞭解參加健康檢查者的攝鈉行為，並探討與該行為有關之背景因素及健康信念。在民國八十一年十一月九日至八十二年一月十七日期問，以參加某教學醫院住院式全身健康檢查者為對象，利用問卷取得有效樣本220人之資料。結果發現；（1）攝取高鈉食物的頻率平均每週為4.6次；（2）男性、40歲及以下、國中及以上程度、有職業、與慢性病、及有心血管疾病家族史者，其攝取高鈉食物的頻率較高；（3）與攝取高鈉食物頻率有關之因素主要包括心血管疾病家族史及自覺採取低鈉飲食的障礙因素。欲鼓勵民眾採取低鈉飲食，介入計畫應從障礙因素之減少著手。
  The purpose of this study was to understand sodium intake and related factors among participants undergoing a physical examination. Questionaires were employed for data collection. Two hundred twenty adults who entered a teaching hospital for physical examination from Nov. 9, 1992 to Jan. 17,1993 were interviewed. The results indicated that (1) the average frequency of sodium intake was 4.6 times per week; (2) the subjects mone likely to have a high sodium intake were male, aged 40 years and unkey words: sodium intake, health belief der, had a middle school or higher educationwereemployed, and had no chronic disease, or CVD family history. (3) CVD family history and perceived barrier to low sodium intake were significantly associated with the frequency of sodium intake. In order to encourage people to have a low sodium diet,an interventional program should be focused on managing or decreasing the barriers to having a low sodium diet.
• 342 - 349
• 10.6288/CJPH1995-14-04-05

• Link 原著 Original Article
• 全民健保開辦時(1995)牙醫醫療需求之推估Prediction of Dental Service Demand for the First Year of Commencing National Health Insurance
• 邱清華、邱丕霞、洪錦墩
  Ching-Hwa Chiu, Pi-Shia Chiou, Ching-Tuan Hung
• 牙醫醫療 ； 需求 ； 全民健保
  dental service ; demand ; national health insurance
• 無
  A total of 1305 subjects were interviewed with a structured questionnaire to study the demand for dental services from July to December, 1991. The results showed that people in Taiwan experienced an average of 0.81±2.83 dental visits within a half year. Sex and age factors are not significant determinants in dental care utilization (male 0.69 visits, female 0.95 visits). The under-10 age group used dental services the least (0.55 visits) and the 30-to-39 age group used the services most frequently (1.07 visits). There was no significantly different demand among different health insurance systems. Significant differences did exist between insurees and non-insurees (1.03 visits vs. 0.60 visits). In order to predict the demand in 1995, the first year of commencing National Health Insurance, utilization of insurees of different sex and age groups was tentatively applied to the estimation. A 26% increase in total demand could be expected compared to that in 1991.
• 350 - 357
• 10.6288/CJPH1995-14-04-06

• Link 原著 Original Article
• 台灣地區成人的健康行為探討：分佈情形、因素結構和相關因素An Investigation of Health Behaviors in Taiwanese Adults: Distribution, Factor Structure, and Related Factors
• 李蘭、黃美維、陸玓玲、潘怜燕、李隆安、鄧肖琳
  Lee-Lan Yen, Dih-Ling Lu, Lung-An Lee, Mei-Wei Huang, Ling-Yen Pan, Hsiao-Ling Teng
• 健康行為 ； 健康促進 ； 成年人 ； 行為流行學
  health behavior ; health promotion ; adult ; behavioral epidemiology
• 本研究目的為瞭解台灣地區成年人在與健康相關行為上的分佈情形、因素結構、並探討與不利健康行為相關的背景因素。以台灣地區年滿十八歲及以上之現住人口為母群体，利用多步驟抽樣過程，先取得二十五個地區（鄉、鎮、市、區）；再自各地區隨機選出三個各有相連十五戶住家的集區；最後以各戶中的成人為訪視對象。研究工具為自行發展之「台灣地區成人有關慢性病的認知與保健行為調查」問卷，調查期間為民國八十三年三月至五月，共取得2565份有效資料。整體說來，與健康相關之行為在研究樣本中較普遍存在的項目是：少吃非精製穀類食物(70.0%)、從不運動(41.1%)、常喝甜飲料(31.6%)等。與健康相關的行為項目經歸納並以主成份分析處理後發現，這些行為聚集成四個因素，分別命名為：菸酒檳鄉習慣、不良飲食習慣、茶與咖啡習慣、和不當生活習慣。因素解釋率分別為34.3%, 22.1%, 22.0%，和21.6%。控制相關的行為變項後，背景因素包括性別、年齡、教育、婚姻、籍貫、保險、信仰、自覺健康、自己罹病、和親友罹病等變項，分別與各個「不利健康之行為」有不同程度的關係。根據本研究結果，除建議加強調查研究和篩檢服務外，並針對介入計畫主題及介入計畫對象之選擇，提出具体的參考方向。
  The purposes of this study were to: (1) understand the distribution of health behaviors among Taiwanese adults; (2) analyze the factor structure of these behaviors; and (3) find out the factors related to behaviors adverse to health. We studied Taiwan residents aged 18 years and over. Using a multi-stage sampling procedure, 25 regions (village, city, township, and district) were first selected. Three clusters having 15 linked households in each cluster were randomly chosen from each region. The subsects were all the about of each of these house holds. A total of 2565 adults completed a version of ”Taiwanese Adults' Cognitions and Behaviors Related to Chronic Diseases Survey Questionnaire”. Overall, more prevalent behaviors among the subjects were: less intake of unrefined cereal (70.0%), never exercising (41.1%), frequent intake of sweet beverages (31.6%), etc. Using principle component analysis, the health behaviors were categorized into four factors with the names of ”smoking, drinking, and betel-nut chewing”, ”undesired food intake”, ”drinking tea and coffee”, and ”inappropriate lifestyle”. The proportion of the total variances that can be explained by these four factors are 34.3%, 22.1%, 20.0%, and 21.6% respectively. When other behavioral variables were controlled, background factors including gender, age, education, marriage, Place of binth, religion, insurance, perceived health, having chronic disease, and having ralatives with chronic disease all have a different relation to each item of behavior adverse to health. Results of this study suggest that health surveys and health screening should be strengthened. Priorities for selecting behavioral problems and farget groups were also suggested.
• 358 - 368
• 10.6288/CJPH1995-14-04-07

• Link 原著 Original Article
• 民眾對老人長期照護安排之態度：1994台灣地區社會意向調查之發現Public Attitudes toward Long-Term Care Arrangements for the Elderly: Findings from 1994 Social Image Survey
• 吳淑瓊、朱昭美
  Shwu-Chong Wu, Chao-Mei Chu
• 長期照護 ； 安排 ； 態度 ； 一般民眾 ； 台灣
  long-term care ; arrangements ; attitudes ; general population ; Taiwan
• 本研究旨在探討台灣一般民眾對三類老人長期照護安排的態度及其影響因子。根據1556位20-64歲台灣地區代表性樣本的調查發現，民眾認為一般家庭在有照護老人的需求時，58.1%會選擇居家式的照護，而選擇社區與機構等照護方式的比率分別為31.8%、與10.1%，可見傳統居家式的照護最受歡迎，但已有略多於四成的民眾贊同社區與機構等正式照護方式。多變項對數複迴歸分析發現，在控制其他重要變項下，年齡50-64歲、收入較高、居住城區、家中女性照護人力較少、認為政府有照護責任者較贊同送老人進機構療養；而社區式的照護較受閩南人、外省人、大專以上教育程度、認為政府有照護責任者的贊同。
  This study examines the distribution of public attitudes toward three long-term care arrangements as well as the factors associated with those attitudes. Data came from a survey of a representative nation-wide sample of 1556 respondents aged 20-64. The results revealed that 58.1% of the respondents stated that they would choose home-based care to assist families with dependent elderly. Community-based care and institutional care were selected by 31.8% and 10.1% of the respondents respectively. Apparently, home-based care was most frequently preferred by people in Taiwan. However, slightly over 40% were in favor of community-based and institutional care. The results of polytomous logistic regression indicated that institutional care was more likely to be preferred by those aged 50-64, who had a higher income, lived in a city, had fewer family caregivers, and had higher expectations of government involvement in the care of the dependent population. Community-based care, on the other hand, was more likely to be preferred by Fukien-Taiwanese, mainlanders, and those with higher education or higher expectations of government involvement in the care of the dependent population.
• 369 - 382
• 10.6288/CJPH1995-14-04-08