30卷3期

• Link 原著 Original Article
• 健全公衛安全網，我們需要公共衛生師～為【公共衛生師法】催生健全公衛安全網，我們需要公共衛生師～為【公共衛生師法】催生
• 李玉春
  Yue-Chune Lee
• 無
  none
• 無
  none
• 201 - 206
• 10.6288/TJPH2011-30-03-01

• Link 原著 Original Article
• 三歲幼兒居家安全與事故傷害相關性研究A Study of the Association between Household Safety and Injury among three-year-old Children in Taiwan
• 蔡益堅、吳秀英、林宇旋、陳瑞菊、吳淑惠
  Yih-Jian Tsai, Show-Ing Wu, Yu-Hsuan Lin, Rachel Chen, Shu-Hui Wu
• 幼兒 ； 居家安全 ； 事故傷害 ； 跌傷 ； 台灣出生世代研究
  children ; household safety ; injury ; fall injury ; TBCS Taiwan Birth Cohort Study
• 目標：本研究旨在探討三歲幼兒居家環境安全與事故傷害的相關性。方法：分析2008年嬰幼兒健康照護需求調查（台灣出生世代研究第三波調查）資料檔，先檢視幼兒過去一年各種事故傷害之盛行率，及事故傷害與幼兒及其照顧者特性、幼兒居家安全簡要檢核表各個項目及居家安全檢核分數（分為低、中、高風險組）的相關性。再使用多變項邏輯迴歸模式，控制幼兒及其照顧者特性，以檢視居家安全檢核分數與事故傷害之相關性。結果：在完訪的19,910位三歲幼兒家長當中，約13.08%（2,653人）自述在過去一年其幼兒曾因事故傷害而就醫；前五項事故傷害盛行率高低排序為：跌傷(8.03%)、物體或人撞擊(1.33%)、尖利物刺割傷(1.06%)、燒燙傷(1.00%)及器物夾壓(0.77%)。19,251人進入後續分析，雙變項分析發現：事故傷害盛行率男童顯著高於女童；白天為幼托園或保母且晚上為父母親照顧者，高於全天皆由父母親照顧者，以及白天為（外）祖父母，晚上為父母親照顧者。事故傷害盛行率隨居家安全檢核分數之增加而升高。以多變項邏輯迴歸控制幼兒性別及現住地；母親年齡、教育程度、過去一年工作情形及競爭照護需求；幼兒主要照顧者，發現：幼兒居家安全檢核分數高風險組之幼兒事故傷害及跌傷風險均為低風險組之1.5倍。結論：三歲幼兒過去一年事故傷害盛行率為13.08%，幼兒居家安全檢核分數與事故傷害風險均顯著相關，其因果關係值得後續研究。
  Objectives: This study examined the association between household safety and unintentional injury among three-year-old children in Taiwan. Methods: Data from the third wave TBCS (Taiwan Birth Cohort Study) were analyzed to examine the prevalence of unintentional injuries (e.g. falls, being hit by objects or persons, being stabbed or cut by sharp instruments), and the association between injury and each item on a household safety checklist and its summary household safety score (categorized as low, moderate, and high risk groups). The association was further investigated with multiple logistic regression after controlling for the characteristics of children and their caregivers. Results: Of the 19,910 three-year-old children studied, 13.08% received medical care due to an unintentional injury. The top five categories of injuries were falls (8.03%), being hit by objects or persons (1.33%), being stabbed or cut by sharp instruments (1.06%), burns (1.00%) and being clamped by an instrument (0.77%). Data about 19,251 of these children were analyzed further. On bivariate analysis, the prevalence of unintentional injury was higher for boys than for girls, and higher for those at kindergarten in the daytime and cared for by a parent at night than for those cared for by a parent for the whole day and those cared for by a grandparent in the daytime and by a parent at night. The prevalence of unintentional injury increased as the household safety score did. The high risk group had 1.5 times the risk of unintentional injury as did the low risk group in the multiple logistic regression model when controlled for children's gender, current address, mothers' age, education, and job in the previous year, competitive demand of caring, and type of principal caregiver. Conclusions: Over thirteen percent of three-year-old children received medical care due to unintentional injury in the past year. The household safety score was significantly associated with the risk of unintentional injury. A causal relationship is worth further study.
• 207 - 216
• 10.6288/TJPH2011-30-03-02

• Link 原著 Original Article
• 不安定僱用模式與受僱者健康之相關Precarious 
• 王佳雯、鄭雅文、徐儆暉
  Chia-Wen Wang, Ya-Wen Cheng, Jin-Huei Hsu
• 不安定僱用 ； 受僱者 ； 健康狀況
  precarious employment ; employees ; health status
• 目標：此研究旨在檢視台灣受僱者不安定僱用的盛行狀況，並探討不安定僱用與工作者健康狀況之相關。方法：我們分析2007年全國性25~65歲受僱者問卷調查之資料，包括男性9,303人，女性7,165人。以問卷詢問受測者之僱用契約狀態，並將其分為「安定僱用」與「不安定僱用模式」兩類，後者包括約聘僱、臨時性、短期性、季節性契約、派遣或人力仲介公司等類別。此調查並詢問受測者自評健康狀況、工作滿意度、生病缺勤、身體各部位痠痛、疲勞等面向。結果：分析結果顯示，台灣受僱者中有21%屬不安定僱用模式；不論男、女性，不安定僱用盛行於較高年齡層、低教育程度、低職等、小公司、工時短之受僱者族群。相較於長期受僱者，不安定僱用模式之受僱者有較差的自評健康、較高的工作不滿意度、較高的生病缺勤及身體痠痛不適等問題，此外，亦有較高的疲勞指數。結論：研究結果顯示，屬不安定僱用模式之受僱者，不僅職場工作條件較差，健康狀況亦較差，乃是職場健康促進工作需要關注的族群。
  Objectives: This study investigated the prevalence of precarious employment and its association with health status among employees in Taiwan. Methods: We analyzed data from a national survey of 9303 male and 7165 female employees aged 25~65 years in 2007. Information with regard to the types of employment was obtained by questionnaire and dichotomized into permanent employment vs. precarious employment; the latter included contract-based, temporary, short-term, seasonal, or outsourced employment. Health status was also assessed by the questionnaire. This included self-rated health, job dissatisfaction, days of absenteeism due to sickness, bodily pain, and burnout status. Results: The results showed that 21% of employees were on precarious employment. For both genders, precarious employment was more prevalent among employees who were older, had a lower level of education, were in lower grades of employment, were employed in smaller enterprises, and had shorter working hours. When compared to workers with permanent employment, precarious employees had poorer self-rated health, higher levels of job dissatisfaction, higher risk of absenteeism due to sickness, more bodily pain, and higher scores for burnout status. Conclusions: These results suggested that workers with precarious employment were more likely to be exposed to adverse work conditions and had poorer health. These issues should be targets for health promotion at the worksite.
• 217 - 227
• 10.6288/TJPH2011-30-03-03

• Link 原著 Original Article
• 台灣公私部門受僱者僱用方式和職場疲勞狀況的相關性Association of Employees' Types of Employment and Their Burnout Status in the Public and Private Sectors in Taiwan
• 湯家碩、葉婉榆、劉梅君、蔡宗宏、 徐儆暉
  Chia-Shuo Tang, Wan-Yu Yeh, Mei-Chun Liu, Chung-Hung Tsai, Jin-Huei Hsu
• 僱用方式 ； 非典型僱用 ； 工作壓力 ； 疲勞 ； 台灣
  employment type ; atypical employment non-standard employment ; work stress ; burnout ; Taiwan
• 目標：了解國內不同僱用方式（長期、非長期受僱）工作者的人口社會背景和工作特性差異，並探討在公、私部門中，受僱者僱用方式和疲勞程度的相關性。方法：運用勞委會2007年全國受僱者調查進行分析，樣本共17,016人，疲勞以「職場疲勞量表」中的「個人疲勞」與「工作疲勞」兩個分量表來測量。問卷也詢問人口學與工作背景、家庭照顧負荷等。結果：台灣受僱者有23.6%處於約聘、外包、人力派遣等的非長期僱用模式；在私部門中非長期受僱者比長期受僱者年齡較長，教育程度和職等較低，個人疲勞和工作疲勞指數均高於長期受僱者；在公部門中的長期、非長期受僱者年齡分佈和私部門不同，且兩者疲勞程度差異較不明顯；運用複迴歸模式將個人、工作變項納入控制後，結果仍然類似。結論：台灣私部門中非長期受僱者其工作條件比長期受僱者較為不利，並面臨較高心理壓力與職場疲勞的風險；然而公部門對彈性勞動的人力運用和私部門有相當不同的考量，僱用方式和疲勞狀況的相關性不若私部門明顯。
  Objectives: This study was designed to investigate differences in social distribution and job characteristics between non-permanent and permanent workers and the association of type of employment and burnout in the public and private sectors in Taiwan. Methods: A national survey of 17016 employees was conducted by the Council of Labor Affairs in 2007. The status of personal burnout and work-related burnout was measured by an occupational burnout inventory. Also assessed were demographic backgrounds, job characteristics and family care workloads. Results: In 2007 Taiwan, 23.6% of employees were in non-permanent employment such as contract-based, outsourced or agency workers. In the private sector, non-permanent employees were found to be older, less educated and in lower employment grades than permanent employees. Compared with permanent workers, higher personal and work burnout scores were also found among non-permanent employees in the private sector. In the public sector, the distributions of ages and employment grades of permanent and non-permanent workers were different, but there was no significant difference in burnout scores between them. Our results remained the same in multivariate regression models even after adjusting for demographics, family, and work-related variables. Conclusions: Our results showed that non-permanent employees in the private sector had worse work conditions and faced greater psychosocial stress and risks for burnout. The use of flexible labor resources might be different between the public and private sectors, so that the association between type of employment and burnout in the public sector was not as significant as it was in private sector enterprises.
• 230 - 244
• 10.6288/TJPH2011-30-03-04

• Link 原著 Original Article
• 從醫療職場工作特質探討醫院護理長與臨床護理人員之工作壓力源Exploring Job Stressors for Head Nurses and Clinical Nurses from the Perspective of Their Job Characteristics
• 林瑜雯、莊子萱、 劉曦宸、陳韻柔、陳富莉
  Yu-Wen Lin, Tzu-Hsuen Chuang, His-Chen Liu, Yun-Jou Chen, Fu-Li Chen
• 工作負荷 ； 危害暴露 ； 工作壓力源 ； 質性研究 ； 護理人員
  Job demand ; Hazard exposure ; Job stressor ; Qualitative research ; Nurse
• 目標：本研究以醫療職場的工作特質，分析不同職位護理人員之工作壓力源。方法：採質性訪談方式，共訪問九位護理長及十七位臨床護理人員，訪談資料經轉譯、編碼形成類組，發展概念。結果：研究發現護理長的工作壓力源來自於處理許多單位內及醫院所交付的行政工作，但欠缺管理上自主權又難獲得同事間的社會支持；而臨床護理人員來自於短時間內劇增病人量或輪班交班延長工作時數的負荷，且缺乏病人照護的技能及決定自主權，並面對無法控制的危害暴露及病人或同事間溝通不良的問題。結論：醫院護理長及護理人員之工作壓力源雖不盡相同，但均來自於工作環境因素及個人因應能力。故建議護理長可參與醫院政策制定過程，以降低主管與基層單位的想法差異；並調整臨床護理人員排班制度及改善行政作業流程。另外，為提升護理長領導技能及新進護理人員醫療照護技能提供相關訓練。醫院亦可以提供一些健康促進活動，增進醫療人員互動，強化社會支持。
  Objectives: The aim of this study was to explore the job stressors for head nurses and clinical nurses from the perspective of their job characteristics. Methods: Nine head nurses and 17 clinical nurses participated in this study. All interview contents were transcribed and coded. Matrices were constructed to identify themes and evolving concepts. Results: Execution of administrative tasks without sufficient decision-making authority and lack of colleagues' social support were the major stressors for head nurses. The clinical nurses' stress levels were raised by an overwhelming workload such as a large number of patients checking in within a short time period or work-hour extension due to task transfer between shifts, inadequate professional skills in patient care and a lack of decision-making authority. Involuntary exposure to hazardous materials and poor communication with patients or coworkers were also job stressors. Conclusions: Head nurses and clinical nurses experienced different job stressors. Most came from the work environment and poor personal coping strategies. We suggest that head nurses be involved in hospital policy making processes and that the work-shift arrangements for clinical nurses be adjusted. Optimizing administrative procedure is also recommended. Skill-based training courses that promote leadership skills for head nurses and patient care skills for newly hired nurses are needed. Hospitals might also offer health promotion activities to improve employee interaction and encourage social support.
• 245 - 256
• 10.6288/TJPH2011-30-03-05

• Link 原著 Original Article
• 台灣兒童疫苗接種的社會差異：以三合一疫苗及流感疫苗為例Social Disparity of Childhood Immunization in Taiwan: The Cases of diphtheria-tetanus-pertussis (DTP) and Influenza Vaccines
• 黎伊帆、江東亮
  Yi-Fan Li, Tung-Liang Chiang
• 兒童 ； 疫苗接種 ； 社經差異
  children ; vaccine immunization ; socioeconomic disparity
• 無
  Objectives: This study aims to examine the social disparity of child vaccination in Taiwan using both of diphtheria-tetanus-pertussis (DTP) vaccine and influenza vaccine as examples. Methods: Data for the analysis came from the Taiwan Birth Cohort Study. We included 20,099 children who completed interview surveys at both 6 months and 18 months old, with a response rate of 83.4%. The dependent variables were whether vaccinated with DTP (any DTP or DTaP) and influenza vaccine; the independent variables used were parents' educational attainment, monthly family income, and urbanization of residential areas. Results: The vaccination rate of any DTP vaccine and influenza vaccine reached 97.1% and 59.9%, respectively. The multiple logistic regression analysis showed that: after controlling children’s sex, maternal nationality and age at birth, the odds ratio of taking DTaP vaccine was two times higher for the highest socioeconomic groups than that of their lowest counterparts (p<0.001), while the influenza vaccination rates were higher only in the groups of the highest family income group and higher urbanization. Conclusions: Our study reconfirmed that socioeconomic status affects childhood vaccination. The efficacy of vaccine and compulsory vaccination policy play an essential role in increasing coverage rate of childhood immunization, and free of charge could be an important strategy to tackle disparities of childhood immunization across different socioeconomic groups.
• 257 - 264
• 10.6288/TJPH2011-30-03-06

• Link 原著 Original Article
• 中小學校雨水及中水貯留再利用系統水質分析之研究Research on the Quality of Rain Water and Grey Water Reused on Campuses
• 王仁俊、張麗蓉、余光昌
  Jen-Chun Wang, Li-Zone Chang, Kuang-Chung Yu
• 永續校園 ； 水資源再利用 ； 雨水 ； 中水 ； 水質
  Sustainable Campus ; Harvested Water ; Rain Water ; Grey Water ; Water Quality
• 目標：回收水之水質為重要議題。本文為國內首次大規模針對中小學校雨水及中水回收水體之水質調查。方法：以教育部補助設置雨水及中水回收90校永續校園為例，遴選有效樣本34例，包含純收雨水23例、併收雨中水9例、純收中水2例，分別進行大腸桿菌群、化學項目及物理項目等水質檢測。結果：純回收雨水樣本，水質明顯優於併收雨中水的樣本，整體有65%符合飲用水水源取用標準，僅9%能符合沖廁用水基準。在化學項目及物理項目檢測上，分別有26%及12%之水質未能符合環保署訂定之標準。而大腸桿菌群和總有機碳的相關呈顯著。結論：多數學校以屋頂面且不設置任何過濾之方式收集雨水，以應噴灌或飲用水水源取用，然多數水質均未能符合沖廁用途基準。
  Objectives: The quality of harvested water is a public health concern. This study is the first large-scale investigation of the harvested rain water and grey water collected on campuses. Methods: The Ministry of Education has subsidized 90 sustainable campuses. We selected 34 eligible sites for this field investigation. Among them, 23 harvested only rainwater; 9 harvested both rainwater and grey water; and 2 harvested only grey water. Samples were collected for water quality analyses including tests for Escherichia coli, chemicals and physical characteristics. Results: The quality of rain water was obviously better than that of grey water. Approximately 65% of the samples met the standards for drinking water. Only 9% of samples were adequate for flushing a toilet. On chemical and physical analyses, 26% and 12% of the samples, respectively, did not conform to the standards of the Environmental Protection Administration. There was a significant association between the measurements of Escherichia coli and total organic carbon. Conclusions: Most of the schools collected rainwater on the roof without filtration. This was adequate for use as sprinkling water or as drinking water. Most of collected water samples did not qualify for use in flushing toilets.
• 265 - 276
• 10.6288/TJPH2011-30-03-07

• Link 原著 Original Article
• 極端氣溫對台灣都會區65歲以上族群心肺疾病死亡之風險趨勢分析A Chronological Study of Mortality Risks Associated with Extreme Temperature for Elderly Populations in Metropolitan Areas of Taiwan
• 林于凱、吳祐誠、黃鈴雅、林嘉明、吳聰能、周昌弘、宋鴻樟、王玉純
  Yu-Kai Lin, Yu-Chung Wu, Ling-Ya Huang, Chia-Ming Lin, Trong-Neng Wu, Chang-Hung Chou, Fung-Chang Sung, Yu-Chun Wang
• 心血管 ； 呼吸道 ； 死亡 ； 溫度
  cardiovascular ; respiratory ; mortality ; temperature
• 無
  Objectives: To evaluate the mortality risks from all causes as well as cardiorespiratory diseases associated with extreme temperatures among the elderly in the Taipei, Taichung and Kaohsiung areas of Taiwan from 1994-2008. Methods: We used the distributed lag model to analyze the 7-day cumulative mortality risks associated with 1? daily average temperature increases above 30? and the 21-day cumulative mortality risks associated with 1? daily average temperature decreases below 18? in the study areas. Relative risks associated with extreme temperature (>95% and <5%) for more than 3 consecutive days were also evaluated. Results: Taipei had a significant 5% excess mortality from all causes as well as cardiovascular diseases as daily average temperature above 30? with each 1? rise. Low temperature resulted in higher risks in Kaohsiung where the relative risk was 1.07 (95% CI: 1.05-1.10) for mortality from all causes and 1.09 (95% CI: 1.03-1.04) for mortality from cardiovascular diseases as the daily average temperature below 18? decreased by each 1?. We observed adaption for high temperature but not cold temperature. No significant associations were observed between temperature changes of 1? and mortality from respiratory diseases. Conclusions: Cumulative mortality risks from all causes and cardiovascular diseases were significantly associated with high and low temperatures in metropolitan areas of Taiwan. The impact of each 1? temperature change appeared to be greater for people in the Taipei area than for those in other areas.
• 277 - 289
• 10.6288/TJPH2011-30-03-08

• Link 原著 Original Article
• 提高社區面訪調查回應率之可行策略與成效分析Practical Strategies to Improve the Response Rate for a Household Interview Survey
• 林宇旋、楊景閔、洪百薰、劉怡妏、吳秀英、邱淑媞
  Yu-Hsuan Lin, Chin-Min Yang, Baai-Shyun Hurng, I-Wen Liu, Shiow-Ing Wu, Shu-Ti Chiou
• 面訪調查 ； 回應率 ； 選擇性偏誤
  Household interview survey ; response rate ; selection bias
• 目標：探討依據戶籍抽樣之社區面訪調查，若針對未居住於原抽戶籍地址樣本加以追蹤，能否提昇調查回應率及改善完訪樣本代表性，並估算所需投入行政成本。方法：資料來源為2008年「台灣第十次家庭與生育力調查」，該調查以設籍台灣20至49歲婦女為訪查對象，以內政部戶籍資料為抽樣母體清冊。運用描述性統計方法，計算不同追蹤程度回應率，再以類別變項比例檢定，比較原抽戶籍地址完訪與追蹤完訪樣本之背景特性差異。結果：若僅就居住在原抽戶籍地址樣本進行訪查，整體回應率僅4成5左右，就未居住於原抽戶籍地址樣本追蹤訪查，整體回應率可提高至7成以上，投入之行政成本只相對增加6.3%。原址完訪與追蹤完訪樣本在年齡、居住地區以及經濟狀況等，均具統計顯著差異，驗證樣本居住於原抽戶籍地址與否具選擇性。結論：針對未居住在原抽戶籍地址樣本追蹤訪查，為提高社區面訪調查回應率與改善完訪資料代表性之可行且具成效策略。
  Objectives: This study had two specific aims. The first was to determine if the tracing of household interview survey samples could improve response rates and data representativeness. The second was to estimate the proportion of increased administrative cost arising from sample tracing as compared with the proportion of increased response rate. Methods: The data used for analysis were from the ”Women's Health and Fertility Survey” conducted in 2008 by the Bureau of Health Promotion. Household registration data managed by the Ministry of the Interior were used as the sampling frame and all females aged 20 to 49 were eligible. We used a descriptive statistical method to calculate response rates by level of administrative input and used the Chi- Square test to detect significant differences in background characteristics between those who were residing at the registered address and those who were not. Results: Results showed that only a 45% response rate could be achieved without tracing those who did not reside at the registered address. By tracing those who were not residing at the registered address, the response rate increased, remarkably, to greater than 70%, whereas only a 6.3% increase in administrative cost was required. There were significant differences between those who were residing at the registered address and those who were not in terms of age distribution, urbanization of residence, and income. Conclusions: We concluded that survey results were biased if those who did not reside at the registered address were not traced. To improve the response rate and data representativeness, household interview surveys that use household registration data as their sampling frame need to trace samples of those who do not reside at the registered address.
• 290 - 299
• 10.6288/TJPH2011-30-03-09