28卷4期

• Link 綜論 Review Article
• 職業健康服務制度的發展與台灣制度現況Development of Occupational Health Services and the Current System in Taiwan
• 尤素芬、鄭雅文、鍾佩樺
  Su-Fen You, Ya-Wen Cheng, Pei-Hua Chung
• 職業健康服務 ； 職場健康檢查 ； 歷史沿革 ； 國際比較
  occupational health services ; workplace health examination ; historical development ; international comparison
• 職業健康服務制度乃是國家勞動保護制度中重要的一環；其中，健康檢查與偵測不僅可積極地預防職業疾病的發生，也是促進雇主改善工作環境的重要依據；勞工健康檢查的資料，也是流行病學探究因果關係以及政府發展職業傷病防治策略的基礎。我國職業健康服務制度自1974年「勞工安全衛生法」頒布以來已有30多年歷史，但此制度問題重重，未能充分發揮上述功能。我國制度沿襲自日本，而日本制度又深受西方工業國家影響，因此，考察先進國家制度發展過程與精神有其必要。本文回顧歐美與日本職業健康服務制度之歷史緣起與內容，並回顧國際勞動組織有關職業健康服務之相關報告書所彰顯的制度精神，接著我們回顧台灣職業健康服務制度的發展沿革，並分析檢討目前制度現況，最後對現行制度提出改善建議。從國際制度的發展歷程與制度內容可發現，雇主責任乃是職業健康服務制度的核心原則，而政府政策是否積極介入，以及勞工是否積極參與，乃是該制度能否發揮保護勞工功能之關鍵。
  A system of occupational health services is required by the nation's labor protection provisions. Use of data from routine health examinations and surveillance is meant to provide empirical evidence for proactively preventing work-related illness and improving working conditions. Occupational health data also serve as the basis for epidemiologic research that evaluates the link between work hazards and health outcomes, as well as for the development of adequate occupational health policies. The system, in Taiwan, which has been operational since the implementation of the Occupational Safety and Health Act in 1974, has been criticized as problematic and poorly functioning. In this paper, we first reviewed the historical development and principles of occupational health services in Western countries as well as in Japan (as the current system in Taiwan used the Japanese system as a model, which in turn was greatly influenced by Western experiences). We also reviewed related documents published by the International Labor Organization. Finally, we reviewed the development of Taiwan’s system, examined its current condition, and proposed some recommendations for its improvement. On the basis of this review, we conclude that the occupational health service system imposes on employers the responsibility to protect the health of their employees. Nevertheless, enforcement of this obligation is greatly determined by the extent of government’s involvement and workers' participation.
• 255 - 267
• 10.6288/TJPH2009-28-04-01

• Link 綜論 Review Article
• 以運動與身體活動預防失智症：文獻回顧Preventing Dementia through Exercise and Physical Activity: A Review
• 王駿濠、蔡佳良
  Chun-Hao Wang, Chia-Liang Tsai
• 老人 ； 身體活動 ； 運動 ； 失智症 ； 健康促進
  elderly ; physical activity ; exercise ; dementia ; health promotion
• 六十五歲以上的老年人即將是世界上人口比例成長最快速的年齡層，而此族群亦是罹患失智症的高風險群。截至目前為止，對於這種令人苦惱的失智疾病尚未開發出有效的治療及介入策略。由於身體活動不足會造成身體功能較差以及提高的心血管疾病的罹病率，而這些因子與失智症卻有間接的關係，因此，本文目的在於瞭解是否從事身體活動可以改善上述因子，進而達到預防失智症的效果。在回顧相關文獻後，會先從（一）身體功能好壞與失智症；（二）心血管危險因子與失智症等主題進行論述，再以身體活動介入對於失智症預防之健康行為促進做探討。根據文獻回顧發現：適當的身體活動應該能達到預防失智症的效益，而罹患該疾病的風險會受性別、基因型態、運動型態及社會因素而影響。綜合以上文獻，本研究提出以下幾點建議：1.目前國人對於藉由身體活動介入來預防疾病的觀念似乎不是很普及，因此，運動推廣人員應當將自身的專業知識大眾化，讓更多人瞭解運動對健康的益處及如何正當的運動。2.增加社區老人團康活動，以提高老年人的身體活動量及人際互動，從中獲得生理、心理及社會健康的益處，以降低罹患失智疾病的風險，進而達到健康老化社會之目的。
  The fastest growing age segment in the world will soon be adults (65 years and older), a high risk group for developing dementia. However, to date, no effective treatments or intervention strategies are available to fully ameliorate this condition. Dementia and the morbidity of cardiovascular diseases have been indirectly correlated with low physical activity. Thus, the aim of this article is to review studies on dementia prevention and its relationship to physical activity and health behavior promotion. We first discuss the risk of dementia and dementia-related diseases and the factors affecting the development of cardiovascular diseases and dementia; we then discuss the benefits of participation in physical activity for dementia prevention. The results suggest that adequate physical activity can prevent dementia. However, factors including gender, genetic type, exercise type, and social factors affect this relationship. On the basis of the studies in our review, we conclude that: (1) Disease prevention through physical activity is not a popular concept in our country, and so we need to inform average people about the benefits of exercise and encourage them to engage in exercise; (2) the level of exercise by senior citizens in the community should be increased to improve its physiological, psychological, and social health benefits. Taken together, we conclude that exercise can lower the risk of dementia and improve the health of an aging population.
• 268 - 277
• 10.6288/TJPH2009-28-04-02

• Link 原著 Original Article
• 餐飲實作課程暴露與齲齒、血鉛相關風險因子之追蹤研究Hazards of Dental Caries and Lead Absorption from Food Consumption during Culinary Training Programs: A three-year follow-up Study
• 林偉婷、劉淑惠、張偉翔、楊雅惠、吳聰能
  Wei-Ting Lin, Shu-Hui Liu, Wei-Hsiang Chang, Ya-Hui Yang, Trong-Neng Wu
• 齲齒值 ； 血鉛值 ； 餐飲 ； 調酒課程 ； 飲酒
  dental caries DMFT ; blood lead levels PbB ; culinary ; bartender curriculum ; alcohol
• 無
  Objectives: This study aimed to evaluate the effects of food consumption during culinary training programs on dental caries (decayed, missing, and filled teeth; DMFT) and on blood lead levels (PbB) in college students. Methods: In this longitudinal two-year follow-up study of 376 freshmen enrolled in the school year 2004 at one culinary college and at one medical university, both located in southern Taiwan, data were collected from September 2004 to September 2006. The final study population included the 247 students who completed the two-wave surveys. Results: After adjusting for the baseline number of dental caries (DMFT), DMFT was found to be reduced (0.302; p=.008) in students whose mothers graduated from college or university. Besides, compared to non-culinary students, culinary students had on average 0.509 more dental caries (p=0.008). After adjusting for baseline blood lead levels (PbB), blood lead levels were higher in men than women (ß=0.319; p=0.006). In addition, compared to non-bartender students, bartender students on average had 0.319µg/dL (p=0.006) more PbB. Conclusions: After adjusting for confounding factors, we found culinary training increases the risk for dental caries, and bartender training significantly increases PbB; therefore, occupational health education programs should alert people involved in the culinary field to the potential health hazards of their employment.
• 278 - 288
• 10.6288/TJPH2009-28-04-03

• Link 原著 Original Article
• 香菸課稅效果之研究－門檻迴歸模型之運用A study of the Effect of Taxes on Cigarettes-An Application of the Threshold Regression Model
• 葉春淵、邱城英、李家銘、黃玟儀、洪榮耀
  Chun-Yuan Yeh, Cherng-Ying Chiou, Jie-Min Lee, Wen-Yi Hwang, Lung-Yao Hung
• 門檻迴歸 ； 短視上癮模型 ； 價格彈性 ； 香菸消費
  threshold regression ; myopic addiction model ; price elasticity ; cigarette consumption
• 目標：在藉由香菸的價格彈性估計來評估提高香菸健康捐課徵對香菸消費的影響，研究結果有助於台灣未來調漲香菸健康捐之重要參考依據。方法：使用門檻迴歸(threshold regression)搭配短視上癮模型(myopic addiction model)，以1975-2006年的菸品價量時間數列資料，估計香菸的價格彈性。結果：高價區及低價區的香菸格彈性分別-0.7312及-0.1204。若依國民健康局菸害防制法修正案國內菸品健康捐由10元增加為20元，將使國人平均每人香菸消費減少14.36%，節省醫療支出約8.45%（約30.86億）。結論：門檻模型的估計結果與一般線性模式確實有差異；另一方面，從菸害防制及財政的觀點，課徵香菸捐將有助於抑制國人香菸的消費，又可以額外增加政府財政收益。
  Objectives: This study evaluated the effect of increasing the Health and Welfare Tax on cigarette consumption by estimating cigarette price elasticity. Methods: We utilized a threshold regression with myopic addiction model to estimate the price elasticity for cigarettes sold from 1975 through 2006. Results: The results indicated that the price elasticity for cigarettes is -0.7312. Raising the tobacco health welfare tax from NT$10 to NT$20 per pack in 2009 will result in a total reduction of an average of 14.36% per capita in cigarette consumption and generate medical saving of 8.45%, or NT$3.086 billion. Conclusions: The authors hope that the results of this study will provide a useful reference for policymakers when instituting taxes on cigarettes as part of health policy. From public health and financial perspectives, an increase in the excise tax on cigarettes will have a significant effect on reducing cigarette consumption, and it will also generate additional tax revenue.
• 289 - 299
• 10.6288/TJPH2009-28-04-04

• Link 原著 Original Article
• 社會經濟狀況、一般健康狀態、健康行為與社區成年民眾憂鬱情緒的關係The Association of Depressive Symptoms with Socioeconomic Status, General Health Conditions, and Health Behaviors in community-dwelling Adults
• 劉嘉年
  Chia-Nien Liu
• 憂鬱情緒 ； 台灣人憂鬱量表 ； 社會經濟狀況 ； 一般健康狀態 ； 健康行為
  depressive symptoms ; Taiwan depression questionnaire ; socioeconomic factors ; general health conditions ; health behaviors
• 目標：分析影響台灣成年民眾憂鬱情緒的社會經濟狀況、一般健康狀態、與健康行為因素。方法：採橫斷式研究，以2002年國民健康局「台灣地區國民健康促進知識、態度與行為調查」中20歲以上受訪者為研究對象，憂鬱測量以「台灣人憂鬱量表」之總分≧19分為「憂鬱情緒」者，並以邏輯式迴歸分析影響憂鬱情緒的因素。結果：有效樣本共23,466人，依據20~44歲、45~64歲、與65歲以上老人以及男、女分成六組，其憂鬱情緒比率分別為3.4%、5.4%、3.0%、5.5%、5.5%、10.2%。各組的憂鬱情緒主要受到一般健康狀況所影響，自覺健康狀況不好、有慢性疼痛、日常活動功能有困難、罹患慢性病種類越多者其憂鬱情緒比率較高。20~44歲與45~64歲男性的憂鬱情緒容易受到社會經濟因素所影響，特別是月所得因素，男性的月所得越高者其憂鬱情緒的比率越低；20~44歲組女性的憂鬱情緒僅受到婚姻狀態的影響。在健康行為方面，20~44歲組男、女性有規律運動者其憂鬱情緒比率較低；吸菸與飲酒行為對於女性較具影響力，特別是20~44歲與65歲以上女性的憂鬱情緒與吸菸行為顯著相關。結論：一般健康狀況因素與憂鬱情緒密切相關，而社會經濟與健康行為因素僅對於特定性別或年齡層具有影響力，因此，建議預防憂鬱的政策需要有多面向的策略。
  Objectives: Our aim was to investigate the relationships between depressive symptoms and socioeconomic status, general health conditions, and health behaviors in community-dwelling adults in Taiwan. Methods: This study selected a cross-sectional sample of adults aged 20 and over from the ”National Survey on the Health Promotion Knowledge, Attitudes, and Behavior of Taiwanese Adults” in 2002, conducted by the Bureau of Health Promotion (BHP). Depressive symptoms were measured using the Taiwanese Depression Questionnaire (TDQ), and the total score of =19 was used to identify depressive symptoms. Analysis was conducted using Chi-square and logistic regression. Results: Of the total sample of 23,466 adults, 3.4% of men aged 20~44, 5.4% of women aged 20~44, 3.0% of men aged 45~64, 5.5% of women aged 45~64, 5.5% of men aged =65, and 10.2% of women aged =65 had depressive symptoms. Poor general health conditions including poor self-rated health, chronic pain, difficulty in daily activities, and numbers of chronic diseases, were all strongly correlated with the presence of depressive symptoms in all six gender-age groups. Especially for men in the 20~44 and 45~64 age groups, depressive symptoms were associated with lower income level. For women aged 20~44, the only socioeconomic factor linked with depressive symptoms was marital status. Men and women aged 20~44 exercising regularly were less likely to have depressive symptoms. Depressive symptoms were associated with smoking and drinking behavior in women (especially in women aged 20~44 and aged =65). Conclusions: Depressive symptoms are strongly linked with general health conditions for all adults, and associated with socioeconomic factors and health behavior for specific gender and age groups. These findings suggest the need for a multidimensional approach to prevent depression.
• 300 - 311
• 10.6288/TJPH2009-28-04-05

• Link 原著 Original Article
• 探討警察參與清潔針具計畫的意願及影響因素Factors Associated with the Willingness of Policemen to Participate in a Needle Exchange Program
• 陳政惠、劉韋利、吳姿瑩、江欣怡、賴怡因、柯乃熒
  Cheng-Hui Chen, Wei-Li Liu, Tzu-Ying Wu, Hsin-I Chiang, Yi-Yin Lai, Nai-Ying Ko
• 清潔針具計畫 ； 知識 ； 態度 ； 靜脈毒癮者 ； 參與意願 
  needle exchange programs ; knowledge ; attitude ; injection drug users ; willingness of participating
• 無
  Objectives: The purpose of the study was to investigate the factors associated with the willingness of policemen to participate in needle exchange programs in Taiwan. Methods: A cross-sectional study was conducted among policemen who attended an introductory program about needle exchange programs in seven counties of southern Taiwan. Anonymous, voluntary questionnaires were distributed to the policemen. These included scales for assessing knowledge and attitude toward HIV and hepatitis, attitudes toward injection drug users (IDUs), and experiences during drug crackdowns. Results: A total of 745 policemen attended introductory programs. Of the 467 respondents (62.7% of the survey sample), fifty-six percent of the policmen (n=247) were willing to actively participate in the needle exchange programs. Compared to the unwilling participants, policemen willing to actively participate in the needle exchange programs: had higher scores on knowledge of HIV and hepatitis (OR, 1.27; 95%CI, 1.07-1.51; p<0.01), felt comfortable being with IDUs (OR, 1.24; 95%CI, 1.06-1.45; p<0.01), were older (OR, 1.12, 95%CI, 1.02-1.22; p<0.05), had a negative attitude toward IDUs (OR, 0.88 ; 95%CI, 0.78-0.99; p<0.05), and experienced fewer episodes of splattering by suspect’s blood (OR, 0.44; 95%CI, 0.21-0.90; p<0.05). Conclusions: It is important for policemen to improve their knowledge about HIV and hepatitis, and about ways to prevent occupational exposure to bloodborne transmitted viruses. A comprehensive and effective post-exposure protocol is essential in order to minimize the risk of occupational bloodborne viral infections for policemen and to enhance their willingness to actively participate in needle exchange programs.
• 312 - 321
• 10.6288/TJPH2009-28-04-06

• Link 原著 Original Article
• 青少年網路交友與約會、婚前性行為影響因素探討Influential Factors in Internet friend-making, Dating and Premarital Sexual Behaviors of Adolescents
• 晏涵文、劉潔心、馮嘉玉
  Han-Wen Yen, Chieh-Hsing Liu, Jia-Yuh Ferng
• 青少年 ； 約會 ； 婚前性行為 ； 網路交友
  adolescent ; dating ; premarital sexual behavior ; internet friend making
• 無
  Objectives: The study analyzed the dating and premarital sexual behaviors of adolescents with different backgrounds who had ever made friends on the Internet. The study also aimed to discern the differing influential factors on the dating and premarital sexual behavior of adolescents of the opposite sex who first met virtually or in-person. Methods: A stratified cluster sampling method was used to identify 1003 second-year public junior high school, high school, and vocational school students in Taipei with Internet friend-making experience. Participants completed a cross-sectional questionnaire. Results: Of the participants, 19.2% had dated a person of the opposite sex first met on the Internet, which was reflected in their lower score for the family relationship portion of the questionnaire (p<.001). The main factor influencing the pursuit of a virtual or reality-based romantic relationship varied with participants; those inclined to a virtual route were influenced by their friendship with opposite gender peers, while the degree of premarital sexual behavior acceptance influenced reality-based relationships (p<.001). The degree of willingness to date was the strongest predictive factor for sexual openness with Internet companions, while acceptance of premarital sexual behavior most strongly predicted pursuit of a reality-based relationship. Conclusions: Family relationship is an important protective factor to reduce high-risk sexual behavior of adolescents. The patterns of adolescent dating and premarital sexual behavior with opposite sex companions first met through the Internet and in person are different. Intervention strategies should take into account these different patterns. necessary to divide groups in designing the intervention courses to meet their different needs.
• 322 - 333
• 10.6288/TJPH2009-28-04-07

• Link 原著 Original Article
• 糖尿病共同照護網對偏遠地區中老年患者健康狀況之成效Effectiveness of the Diabetes Shared Care Network for middle-aged and Elderly Patients in a Rural Area of Taiwan
• 陳都文、王俊毅
  Tu-Wen Chen, Jiun-Yi Wang
• 偏遠地區 ； 糖尿病 ； 共同照護網 ； 醫療給付改善方案 ； 代謝指標
  rural area ; diabetes mellitus ; Diabetes Shared Care Network ; medical benefit improvement project ; metabolic indices
• 目標：許多研究評估「糖尿病醫療給付改善方案」之成效，然而這些評估多缺乏對照組，且較少著墨於偏遠鄉鎮的個案。本研究藉由比較共同照護網參與組和對照組重複測量資料，評估糖尿病共同照護網對偏遠地區中老年患者相關代謝指標的長期控制成效。方法：以回溯式研究法進行資料收集及分析。資料來源為中台灣某地區醫院2002年12月至2007年7月之門診個案。採共變量分析(ANCOVA)比較兩組在二時間點上的差異，並以混合模式(mixed models)比較兩組的變化趨勢。結果：參與組的空腹血糖控制在參與照護網約三個月後與對照組呈現顯著差異；糖化血色素、總膽固醇和三酸甘油酯則在參與照護網約九個月後與對照組有顯著差異。結論：糖尿病共同照護網對於改善個案之糖化血素、空腹血糖、總膽固醇和三酸甘油酯的成效佳，對高、低密度脂蛋白膽固醇的改善效果則不明顯。多數患者在多項代謝指標的控制上，仍未達美國糖尿病學會的建議目標。參與組的長期控制成效明顯較佳，建議患者應長期且持續接受適當的衛教和照護介入。
  Objectives: Many studies have been proposed to evaluate the effectiveness of the diabetes mellitus medical benefit improvement project in Taiwan. Most of these evaluations, however, lack a control group and pay little attention to rural areas. To evaluate the long-term effectiveness of the Diabetes Shared Care Network on related metabolic indices for diabetic patients in a rural area, we compared repeat measurements from the intervention group and a non-intervention group. Methods: Subjects were identified retrospectively from a database of outpatients with diabetes mellitus in a regional hospital in Mid-Taiwan between December 2002 and July 2007. Analysis of covariance (ANCOVA) and mixed models were used to demonstrate differences and trends in the related metabolic indices of the two groups. Results: The difference in fasting blood sugar levels between the two groups was significant after 3 months of network intervention. After 9 months, hemoglobulin A1C (HbA1C), total cholesterol, and triglycerides also showed significant differences. Changes in high density lipoprotein cholesterol and low density lipoprotein cholesterol did not. Conclusions: The effectiveness of the Diabetes Shared Care Network in improving HbA1C, fasting blood sugar, total cholesterol, and triglyceride levels was significant. For most patients; however, the related metabolic indices did not achieve the target suggested by the American Diabetes Association. In conclusion, the Diabetes Shared Care Network was somewhat effective in improving metabolic indices and can still serve as a model for the longterm education and care of diabetic patients.
• 334 - 343
• 10.6288/TJPH2009-28-04-08

• Link 評論 Commentary
• 評論：青少年網路交友與約會、婚前性行為影響因素探討 Commentary: Influential Factors in Internet friend-making, Dating and Premarital Sexual Behaviors of Adolescents
• 陳端容
  Duan-Rung Chen
• 無
  none
• 無
  none
• 333-333
• 無

• Link 評論 Commentary
• 作者回覆：青少年網路交友與約會、婚前性行為影響因素探討 Author's response: Influential Factors in Internet friend-making, Dating and Premarital Sexual Behaviors of Adolescents
• 晏涵文、劉潔心、馮嘉玉
  Han-Wen Yen, Chieh-Hsing Liu, Jia-Yuh Ferng
• 無
  none
• 無
  none
• 333-333
• 無