30卷2期

• Link 綜論 Review Article
• 以系統性文獻回顧檢視賦權介入在糖尿病個案的應用及成效The Application and Effectiveness of an Empowerment Intervention among Diabetes Patients: A Systematic Review
• 陳美芳、 王瑞霞、唐善美
  Mei-Fang Chen, Ruey-Hsia Wang, Shan-Mei Tang
• 系統性文獻回顧 ； 賦權 ； 糖尿病
  systematic review ; empowerment ; diabetes
• 世界衛生組織指出賦權對糖尿病個案是很重要的衛教策略。本文採系統性文獻回顧法，分析賦權介入措施於糖尿病個案之應用及其結果。方法為搜尋PubMed等6個中、英文資料庫，經收案與排除條件審核後，共19篇文章符合篩選標準。結果顯示，文章研究品質佔最多為A級的設計良好，具隨機化控制之研究與B級的控制好的回溯性研究或有良好的控制組研究，各佔8篇(42.1%)。
  The World Health Organization has postulated that education in empowerment strategies is essential for patients living with diabetes. This study reviewed the literature on empowerment interventions for these patients. The literature search included six medical databases in either Chinese or English, including PubMed. Nineteen studies that met the inclusion criteria for this study were reviewed. The authors evaluated all studies in terms of quality of the research. Of the nineteen articles rated, eight (42%) received an A rating (a well-conducted and adequately randomized and controlled study), and eight (42%) received a B rating (a well-conducted cohort study or a well-conducted case-control study). Eighteen studies delivered the empowerment programs to groups. Whether the content of the programs focused mainly on specific problems which patients had, or on pre-planned diabetes related issues, the strategies included raising awareness, open communication, mutual participation and the provision of necessary information. With regard to outcome analysis, only two studies used qualitative methods whereas the others used quantitative methods. The results of all reviewed studies were consistent with the theory regarding change in self, change in behavior and change in relationships. Of the fifteen studies indicating that the HbA1C level was an important indicator of empowerment in this patient group, thirteen reported that empowerment interventions significantly improved HbA1C levels in their participants. The content and outcome of empowerment interventions were consistent with the theory about patient empowerment. The findings of this study may provide a reference for clinical practice and empowerment research.
• 93 - 109
• 10.6288/TJPH2011-30-02-01

• Link 原著 Original Article
• 營養訊息及價格介入對大學校園商店低熱量食品銷售之影響效果The Effects of Nutritional Information and Pricing on Sales of low-calorie Foods in College Campus Stores
• 魏米秀、 陳建宏
  Mi-Hsiu Wei, Chien-Hung Chen
• 環境介入 ； 低熱量 ； 價格 ； 營養訊息
  environmental intervention ; low-calorie ; price ; nutrition information
• 目標：探討在大學校園便利商店中，進行營養訊息與價格環境介入對於低熱量食品的銷售影響。方法：以兩間大學校園的便利商店為對象，一間為實驗商店，一間為對照商店。實驗目標商品為低脂鮮乳、無糖優酪乳、低糖豆漿、無糖綠茶及無糖可樂，對照商品是與實驗商品同品牌但熱量較高的常規商品。實驗階段分為基準期、訊息介入期（提供熱量訊息）、價格介入期（價格降低約25%）、訊息價格介入期。依收銀系統記錄商品的每日銷售量。結果：整體上實驗介入對於低熱量目標商品的銷售反應有提升效果。實驗商店與對照商店於各實驗階段的目標商品銷售率反應不同，在實驗商店，目標商品於訊息價格介入期的銷售率顯著高於基準期。結論：在公共衛生實務上，未來可透過價格與購買點營養訊息的策略，促進消費者對健康目標食品的選購。
  Objectives: The purpose of this study was to examine the effects of environmental interventions designed to increase nutritional information and price incentives on the sale of low-calorie foods in convenience stores on college campuses. Methods: Two college convenience stores participated in the study: one was the experimental store, and the other served as a control. The target foods consisted of low-fat milk, no-sugar yogurt, no-sugar tea, low-sugar soybean milk, and no-sugar cola. The control foods were regular products containing more calories. The experimental periods consisted of baseline, nutritional information intervention, price decrease intervention (the price of the target foods decreased by approximately 25%), and a combination of information and price intervention. The sales of food items were monitored. Results: The percentages of low-calorie foods sold differed by store and intervention period. In the experimental store, the percentages of low-calorie foods sold during the combination information and price intervention period were significantly higher than those during baseline. Conclusions: Public health policies can influence the dietary environment through pricing and nutritional information displayed at the point-of-purchase to encourage customers to select healthier foods.
• 110 - 120
• 10.6288/TJPH2011-30-02-02

• 評論 Commentary
• 評論：營養訊息及價格介入對大學校園商店低熱量食品銷售之影響效果Commentary: The Effects of Nutritional Information and Pricing on Sales of low-calorie Foods in College Campus Stores
• 葉志嶸
  Chih-Jung Yeh
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• 評論 Commentary
• 作者回覆：營養訊息及價格介入對大學校園商店低熱量食品銷售之影響效果Author's response to Commentary: The Effects of Nutritional Information and Pricing on Sales of low-calorie Foods in College Campus Stores
• 魏米秀、 陳建宏
  Mi-Hsiu Wei, Chien-Hung Chen
• 無
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• Link 原著 Original Article
• 台灣老人食物攝取頻率與憂鬱風險關聯性之探討Association between the Frequency of Food Consumption and the Risk of Depression in Elderly Taiwanese
• 游瑞鳳、蔡仲弘
  Rei-Fong Yu, Alan C. Tsai
• 食物攝取 ； 憂鬱風險 ； 蔬菜 ； 水果 ； 茶
  food consumption frequency ; depression ; vegetables ; fruits ; camellia tea
• 目標：探討台灣老年人食物攝取頻率與憂鬱之關聯。方法：本研究資料來源為「台灣中老年身心社會生活狀況長期追蹤調查」第一世代樣本於1999年（2074名，≥67歲）及2003年的資料庫。以邏吉斯迴歸分析各類食物攝取頻率與憂鬱傾向（1999年）的關聯性，及預測四年後(2003)憂鬱風險的能力。結果：在控制性別、年齡、教育年數、獨居與否、吸菸、飲酒、運動、慢性疾病數、自覺健康狀況、經濟、活動功能、身體質量指數、及食慾等變項下，橫斷分析顯示每週攝取蔬果≥3次者比以下者之憂鬱風險少38%(OR=0.62, 95 CI=0.44-0.87, p=0.005)；茶每週飲用≥3次比以下者少38%(0.62, 0.45-0.86, p=0.004)；縱貫分析顯示，蔬果每週攝取≥3次者比以下者，其四年後的憂鬱傾向少38%(0.62, 0.42-0.93, p=0.022)，而茶每週飲用≥3次者比以下者少44%(0.56, 0.38-0.82, p=0.003)；其他食物如肉禽、乳品、蛋、豆類、魚類、穀類及營養補充品，則不顯著。結論：蔬果及茶的攝取與老年人的憂鬱風險呈負關聯，也是憂鬱風險的預測因子。此結果顯示食物攝取可能影響憂鬱風險，也凸顯健康飲食的重要性。
  Objectives: To investigate the association between the frequency of intake of the major food categories and the risk of depression in older Taiwanese. Methods: The study analyzed the 1999 and 2003 data sets (2074=67 year-old individuals) of the ”Survey of Health and Living Status of the Elderly in Taiwan”. Multivariate logistic regression analysis was used to determine the significance of the association between frequency of food intake and the risk of depression (cross-sectional analysis) and the ability of frequency of intake to predict the risk for future depression (longitudinal analysis) in older Taiwanese after controlling for gender, age, education, living status, smoking, drinking, physical exercise, number of chronic diseases, self-rated health status, satisfaction with economic condition, functional status, Body Mass Index and appetite. Results: Results showed that more frequent consumption (=3 times/wk vs. =2 times/wk) of fruits & vegetables and more frequent consumption of tea (camellia sinensis) were significantly associated with reduced risk of depression (OR=0.62, 95% CI=0.44-0.87, p=0.005 and 0.62, 0.45-0.86, p=0.004, respectively) and more frequent fruit & vegetable consumption and tea-drinking also significantly predicted a lower risk of depression (0.62, 0.42-0.93, p=0.022 and 0.56, 0.38-0.82, p=0.003, respectively) four years later. Other food groups including meat-poultry, dairy, legumes, fish, grain and nutritional supplements were of no significant benefit. Conclusions: Results suggest that more frequent consumption of fruits and vegetables is associated with reduced current and future risk of depression in older Taiwanese. These results suggest that diet may play a role in depression, and a healthy diet is the key to a healthy life.
• 123 - 134
• 10.6288/TJPH2011-30-02-03

• Link 原著 Original Article
• 台灣地區1991~2007年男女性之健康差距：以平均餘命、死亡率及潛在生命年數損失為指標Gender Differences in Health in Taiwan, 1991~2007: Life Expectancy, Mortality and Years of Potential Life Lost as Indicators
• 潘怜燕、邱淑媞
  Ling-Yen Pan, Shu-Ti Chiou
• 性別差距 ； 零歲平均餘命 ； 死亡率 ； 潛在生命年數損失YPLL
  Gender Differences ; Life Expectancy ; Mortality ; Years of Potential Life Lost YPLL
• 目標：國人健康狀況逐年改善，然性別健康差距卻日漸擴大。本研究就平均餘命、死亡率及潛在生命年數損失三項指標探討性別的健康差距狀況，並討論可能的解釋原因。方法：研究資料下載自行政院內政部及衛生署所發布之官方統計數字，並以台灣地區2000年年中人口做為標準人口，計算1991~2007年間的男女性主要死因別標準化死亡率和標準化每千人口潛在生命年數損失(SYPLL)。結果：台灣地區零歲平均餘命之性別差距由5.31歲擴大為6.26歲。惡性腫瘤與自殺之標準化死亡率不論男女均逐年上升，且性別差距擴大；心臟疾病及腦血管疾病的標準化死亡率都逐年下降，但性別差距卻略增。男性事故傷害標準化死亡率之下降幅度大於女性且性別差距逐年縮小。兩性全死因之SYPLL逐年下降且性別差距由38.60年縮小為33.32年，然若將因事故傷害所造成之SYPLL扣除，則兩性之性別差距是擴大的，由19.48%增為25.79%。但惡性腫瘤之SYPLL的性別差距則上升，且佔全死因性別差距之比例也由9.82%升為19.47%。結論：台灣地區之性別健康差距逐年擴大，推論係因男性高吸菸率之故。是否會因男性吸菸率下降而縮小，尚需密切觀察。
  Objectives: The health status of the Taiwanese people has improved; however, the gender difference in life expenctancy is widening. Three indicators, life expectancy at birth, standardized mortality rate and standardized years of potential life lost, were applied to understand the potential causes of gender gap. Methods: Data were obtained from the statistics published by the Department of Interior and the Department of Health, Executive Yuan, Taiwan. The standardized mortality rate (SMR) and standardized years of potential life lost (SYPLL) between 1991 and 2007 were calculated by the applied direct standardization method and adjusted to the 2000 Taiwan mid-year population. Results: The gender difference in life expectancy at birth widened from 5.31 years to 6.26 years. The SMR for malignant neoplasms and suicide in both genders increased year by year and the gender differences widened. The gender differences in SMR for cardiovascular diseases and cerebrovascular diseases also widened slightly although the SMRs themselves decreased each year. The SMR for accidents in both males and females decreased dramatically and the gender difference also narrowed. The SYPLL from all causes decreased yearly and the gender difference narrowed from 38.60 to 33.32; however, the gender gap for SYPLL widened if the SYPLL caused by accidents were deducted from the SYPLL from all causes. The gender difference in malignant neoplasm-specific SYPLL increased and its proportion to SYPLL from all causes increased from 9.82% in 1991 to 19.47% in 2007. Conclusions: In Taiwan, the gender differences in health were widening. It was inferred that this was related to the high smoking rate among male adults. Whether the gender difference will be narrowed by lowering the male smoking rate remains to be determined.
• 135 - 149
• 10.6288/TJPH2011-30-02-04

• Link 原著 Original Article
• 基層醫師對實施基層分科總額預算之意願及影響因素Factors Associated with the Willingness of Primary Care Physicians to Implement the Department Global Budget
• 陳文侯、龔佩珍、蔡文正、李亞欣、曾盈甄
  Wen-Hou Chen, Pei-Tseng Kung, Wen-Chen Tsai, Ya-Hsin Li, Ying-Chen Tseng
• 總額預算 ； 基層醫師 ； 分科總額預算
  global budget ; primary care physician ; department global budget
• 目標：探討實施基層分科總額管理試辦計畫對醫師執業之影響及滿意度，並了解基層醫師對實施分科總額預算之意願及其影響因素。方法：針對中部四縣市所有健保特約西醫基層醫師，利用結構式問卷以郵寄方式進行普查，回收579份問卷。除描述性與雙變項統計分析外，以羅吉斯迴歸分析探討影響基層醫師是否贊成實施分科總額預算之相關因素。結果：55%的基層醫師認為分科方式不合理，54.63%認為分科管理對未來發展為負面影響，整體滿意度認為滿意者20.67%，但是有38.52%表示不滿意。在較都市化區執業競爭較激烈而整體滿意度較低。不贊成實施分科總額預算者佔57.99%。對於實施繼續分科總額之意願，泌尿科、外科、骨科、耳鼻喉科及婦產科明顯較贊成，而精神科、皮膚科及家醫科傾向不贊成。由羅吉斯迴歸分析結果發現「實施後基層醫師間之競爭度」、「實施後平均每週看診次數之變化」、「執業年資」、「分科方式合理性」、「對該科未來之影響」及「科別」會影響醫師是否贊成實施分科總額預算。結論：基層醫師對於分科管理的滿意度偏低，對於在都會區中執業之醫師較不利，多數基層醫師不贊成進一步實施分科總額預算。
  Objectives: This study investigated the influences on implementation of the department global budget (DGB) demonstration project in primary care physicians' practices and their satisfaction with DGB. In addition, this study explored the factors associated with the willingness of primary care physicians (PCPs) to implement DGB. Methods: This study adopted the survey method with a structured questionnaire. All national health insurance-contracted PCPs practicing Western medicine s in four cities/counties in central Taiwan were surveyed, and 579 valid responses were received. In addition to descriptive statistics and bivariate analysis, this study utilized a logistic regression analysis to explore the factors associated with the PCPs' willingness to accept DGB implementation. Results: Fifty-five percent of PCPs thought that the methodology of DGB was unreasonable; 54.63% thought the DGB had a negative effect on departmental development; 20.67% were satisfied with DGB while 38.52% were dissatisfied. The level of satisfaction was lower in more urbanized areas, probably due to a higher rate of competition. A total of 57.99% of PCPs disagreed with the implementation of DGB. The PCPs in urology, surgery, orthopedics, ENT, obstetrics and gynecology agreed more with continuing the implementation of DGB, but PCPs in psychiatry, dermatology and family medicine were inclined to disagree. According to logistic regression analysis, the factors that affected agreement with DGB included the level of competition after DGB, alteration in work time after DGB, years of practice, perception of the rationality of DGB, the anticipated effect on departmental development and the field of the department. Conclusions: Satisfaction with the DGB demonstration project was relatively low. The DGB is disadvantageous to PCPs in more urbanized areas and the majority of PCPs disagreed with implementation of the DGB.
• 150 - 164
• 10.6288/TJPH2011-30-02-05

• Link 原著 Original Article
• 台灣不同族群老人長期照護需要差異之趨勢分析Trend Analysis of the long-term Care Needs of Elderly Different Ethnic Groups in Taiwan
• 陳正芬、呂寶靜、王彥雯
  Chen-Fen Chen, Pau-Ching Lu, Charlotte Wang
• 長期照護 ； 老人 ； 族群 ； 健康差距 ； 貫時研究
  Long-term care ; Elderly ; Ethnicity ; Health Disparities ; Longitudinal Study
• 目標：本研究運用雙重困境觀點、老年均質化及持續不平等論點，檢視台灣不同省籍老人的長期照護需要之差異及省籍隨歷史時間推移之變化趨勢。方法：本研究利用「台灣地區中老年身心社會生活狀況長期追蹤調查」，歷時十四年的資料，以線性混合模式進行分析，將隨機效果納入模式之中。結果：研究發現，未控制社經變項時，本省籍老人的長期照護需要項目較多；在控制社經地位的差異後，發現省籍之間的長期照護需要差異不僅持續存在，即是將歷史時間及健保實施因素納入考量，而且隨著歷次調查時間的推移，本省籍老人的長期照護需要項目每年較外省籍老人多0.019項，表示省籍的差異出現擴大的趨勢，進入老老人階段後更加明顯，也就是長期照護需要差距在生命歷程最後階段更加擴大。結論：我國不同省籍老人的長期照護需要差距符合雙重剝奪觀點的論述，未來在規劃與執行老人健康與社會政策時，需考量族群與時間因素對老人長期照護需要造成的影響，且應特別關注本省籍老人在使用健康及長期照護資源的可能阻礙，進而排除服務使用的阻礙因素。
  Objectives: From the perspectives of double jeopardy, aging as leveler, and persistent health inequality, this study examined the trends in long-term care needs of native Taiwanese and Mainlanders in Taiwan. Methods: Data used in this study were collected by the Bureau of Health Promotion, Department of Health in 1989, 1993, 1996, 1999 and 2003. A linear mixed model was applied for trend analysis. Results: Without controlling for independent variables, the long-term care needs of the native Taiwanese elderly were greater than those of elderly Mainlanders. After controlling for the socioeconomic and health status of the respondents, and considering the implementation of health insurance over the period of 1984 to 2003, the disparity became greater over time. The native Taiwanese elderly seemed to be more vulnerable to disability than their counterparts, the Mainlanders. Furthermore, the disparity in long-term care needs between the elderly Taiwanese and the elderly Mainlanders will continue to grow as the lifespan of the elderly steadily increases. Conclusions: This study supports the ”double jeopardy” hypothesis. The results also suggest that public policymakers must understand that the elderly in different ethnic groups face various barriers to receiving health care and long-term care in our society.
• 165 - 179
• 10.6288/TJPH2011-30-02-06

• Link 原著 Original Article
• 慢性病老年人潛在不適當用藥影響因素之研究The Risk Factors of Potentially Inappropriate Prescribing for the Elderly with Chronic Diseases in Taiwan
• 黃光華、葉玲玲、洪錦墩、謝儀靜、蔡東翰
  Kuang-Hua Huang, Ling-Ling Yeh, Chin-Tun Hung, Yi-Ching Hsieh, Tung-Han Tsai
• 老年人 ； 慢性病 ； 潛在不適當用藥 ； 比爾斯標準
  the elderly ; chronic disease ; potentially inappropriate prescribing in the elderly PIPE ; Beers criteria
• 目標：老年人屬多重藥物使用族群，且為藥物不良反應高危險群；雖然老年人潛在不適當用藥之問題，已受到全球醫療實務界之重視，但在台灣卻鮮少有相關研究。本研究目的為探討老年人潛在不適當用藥之影響因素，希望據此作為改善老年人處方用藥安全之參考。方法：本研究資料來源為國家衛生研究院「全民健康保險學術研究資料庫」之「承保抽樣歸人檔」(LHID2005)。並以「Beers老年人潛在不適當用藥準則－2002版」作為潛在不適當用藥之判斷標準，分析2005-2007年65歲以上老年慢性病患西醫門診處方潛在不適當用藥之影響因素，包括病患特性、醫療機構特性及醫師特性三大構面。結果：納入100,578位慢性病老人及其7,521,186張處方，其中91,772位慢性病老人(91.24%)至少接受過一次潛在不適當用藥，而其有1,839,654張處方(24.46%)為潛在不適當用藥；而病患性別、病患年齡、用藥品項數、醫療院所評鑑層級、就醫科別、權屬別、都市化程度、醫師性別、醫師年齡及醫師年資等，皆為處方潛在不適當用藥之影響因素。結論：國內老年人潛在不適當用藥之盛行率遠高於國外，衛生相關單位及醫師可參考本研究潛在不適當用藥影響因素之結果，謹慎處方以確保加強需要長期服藥的慢性病老年病患之健康及用藥安全。
  Objectives: The elderly often receive poly-pharmacy and may be at a higher risk for adverse drug reactions. Potentially inappropriate prescribing in the elderly (PIPE) is one of the major patient safety concerns worldwide; however, few studies have been conducted on PIPE in Taiwan. The aim of this research was to investigate the risk factors associated with PIPE. Methods: The data source was the 2005-2007 Longitudinal Health Insurance Database (LHID2005), a nationally representative database established by the National Health Research Institutes. We analyzed the patients, facilities and physicians as risk factors for PIPE among patients over age 65 with chronic diseases. PIPE was identified by the 2002 Beers criteria. Results: A total of 91,772 patients (91.24%) out of 100,578 had received at least one PIPE between 2005 and 2007. Among a total of 7,521,186 outpatient prescriptions, 1,839,654 (24.46%) were PIPE. Patients' gender, age, number of drug items, level of hospital, department visited, ownership, urbanization, and physician’s gender, age and seniority were the risk factors associated with PIPE. Conclusions: The prevalence of PIPE in Taiwan was higher than that in other countries. We suggest that health authorities and physicians consider the risk factors for PIPE in order to ensure drug safety for the elderly with chronic diseases.
• 180 - 190
• 10.6288/TJPH2011-30-02-07

• Link 原著 Original Article
• 出國旅客登革熱之防護知識及態度與其行為之相關因素探討Knowledge, Attitudes and Practices with Regard to Dengue Fever among Travelers in Taiwan
• 王穎筠、蔡慈儀
  Ying-Yun Wang, Tzu-I Tsai
• 登革熱 ； 知識態度行為 ； 旅客
  Dengue fever ; Knowledge ; Attitudes and Practices KAP ; traveler
• 目標：東南亞國家是登革熱疫情盛行，也是國人出國旅遊、探親商務往返最頻繁的地區，本研究調查台灣出國旅客其登革熱知識及態度與其防護行為之相關。方法：採橫斷式調查研究設計，自填式結構問卷設計以KAP(knowledge, attitudes and practices)模式為基礎，研究對象為18歲以上準備由桃園機場前往東南亞國家的出境旅客。結果：共完成有效問卷386份（回收率90.6%）。研究顯示出國旅客對登革熱的防護認知答對率為68.5%，防護態度偏積極正向（平均值為3.87分），有74.9%旅客至少攜帶一種防蚊用物。女性、教育程度愈高及出國前曾利用旅遊健康門診獲得登革熱防護訊息的旅客，與登革熱之知識及防治態度方面有正相關，且自我防護行為表現較佳。結論：對於前往東南亞國家之旅客，透過多種形式的宣導管道，包括旅遊門診、大眾傳播媒體，提供給不同出國旅客健康資訊，增強其對登革熱防護知識及態度，進而強化其自我防護行為。
  Objectives: Dengue fever is endemic in Southeast Asia-the most popular business and travel destination for people from Taiwan. The purpose of this study was to investigate the association between knowledge and attitude about Dengue fever and preventive behaviors of travelers. Method: This was a cross-sectional study. A questionnaire was developed based on the KAP (knowledge, attitudes and practices) model. Participants who were over 18 years of age and headed to a Southeast Asian country completed a self-administrated survey at the departure gates at the Taiwan Taoyuan International Airport. Results: In total, 386 travelers completed the questionnaires, for a response rate of 90.6%. The percentage of individuals with correct knowledge about the prevention of Dengue fever was 68.5%, the attitude towards Dengue fever prevention was positive (average 3.87 points), and 74.9% of the passengers had prepared at least one method to protect themselves from mosquito bites. Women, those with higher education, and those passengers who had received health information from travel clinics had better knowledge about and attitudes toward Dengue fever, and also practiced better personal preventive behaviors. Conclusions: Information about Dengue fever needs to be distributed through diverse methods, i.e. travel clinics, mass media, and print material, in order to encourage travelers heading to Southeast Asian countries to practice preventive behaviors.
• 191 - 200
• 10.6288/TJPH2011-30-02-08