27卷3期

• Link 綜論 Review Article
• 提早因應高齡化社會的特殊醫療保健需求：以骨質疏鬆症為例Actions in Advance to the Special Medical Care Need in an Aging Society: Osteoporosis as an Example
• 楊南屏、楊榮森、周碧瑟
  Nan-Ping Yang, Rong-Sen Yang, Pesus Chou
• 高齡化社會 ； 骨質疏鬆症 ； 防治政策
  Elderly Society ; Osteoporosis ; Policy of Prevention and Intervention
• 由於經濟的繁榮及預防醫學的進步，國人預期壽命大幅延長，伴隨總生育率空前的降低，使台灣人口快速老化，台灣已進入高齡化社會，慢性病已成為國人最主要的健康保健照護問題，老人保健乃成為一重要課題。2008年衛生署制定中的「2020健康國民白皮書」中，亦將老人族群列為未來需要健康關注的焦點族群。公務部門在制定有關老人健康及特殊醫療保健需求的衛生政策之前，相關決策者必須對於此一議題有一深入且正確的了解。本文嘗試以骨質疏鬆症為例，針對骨質疏鬆症之最新診療標準、分類和照護方式、各國骨質疏鬆症之盛行率或相關現況加以探討，並且比較各國政府對骨質疏鬆（以下簡稱骨鬆）之防治政策與推動落實方式、非政府組織或婦女團體對於骨鬆防治貢獻與建議，進而提出我國對於骨鬆防治政策的短、中、長期策略建議。
  Because of progress in the economy as well as in preventive medicine, the life span of Taiwanese people has increased markedly in recent years. This phenomenon has combined with an unprecedented decline in the overall fertility rate to create a rapidly aging society. As a result, some chronic medical conditions have become major public health problems. Promoting health among the elderly is an important medical issue; in fact, the elderly population has been identified as one of the target populations in the ”Healthy People 2020 in Taiwan” program. Policymakers should thoroughly consider all related medical issues before making any important decisions on health policy, especially regarding the health-care needs of the elderly. In this article, the example of osteoporosis is presented, including current diagnostic and classification criteria and management, nationwide epidemiological data and related issues, comparison of various national policies, and the contributions and suggestions of selected nongovernmental organizations and women's health-promotion groups. Finally, appropriate short-, medium-, and long-term strategies for osteoporosis prevention and intervention in Taiwan are recommended.
• 181 - 197
• 10.6288/TJPH2008-27-03-01

• Link 原著 Original Article
• 監所收容人納入全民健康保險可行性之探討Feasibility of Prisoners Enrolling in National Health Insurance
• 蔡文正、龔佩珍、廖家慧、張伍隆、林正介、許南榮、李奇學
  Wen-Chen Tsai, Pei-Tseng Kung, Chia-Hui Liao, Wu-Long Chang, Cheng-Chieh Lin, Nan-Yung Hsu, Chy-Hsuei Lee
• 收容人 ； 全民健保 ； 健康保險 ； 受刑人
  Inmates ; National Health Insurance ; Health Insurance ; Prisoners
• 目標：本研究調查收容人對於本身納入全民健保之意見，及醫院對收容人提供醫療服務之意願。方法：以全國48家矯正機關收容人及全國515家醫院為對象進行問卷調查，回收有效問卷為收容人2,849份、醫院194份，同時以羅吉斯回歸分析影響收容人納保意願之因素。結果：有80.87%收容人贊同其納入全民健保，贊成之主因為可減輕醫療費用，反對之主因為必需繳交保費。若以全面納入全民健保方式，有51.10%收容人贊成加入，有40%自認有能力負擔。若只保住院險，有66.75%收容人表示贊成加入。影響收容人納保意願之相關因素包含：性別、已入監執行刑期、需定期看醫師、每月自費看病金額、健保費用合理性認知、對收容人需退保合理性認知、由保管金中扣除保費認知。醫院有76.29%願意提供門診服務，59.07%願意提供住院服務。結論：顯示收容人較希望入獄時也能加入健保，但繳保費之能力為最需解決的問題。
  Objectives: This study explored inmates' attitudes toward enrolling in National Health Insurance (NHI), as well as the willingness of hospitals to provide medical care to inmates. Methods: Inmates from 48 correctional facilities and all 515 hospitals were surveyed. The effective sample sizes for inmates and hospitals were 2,849 and 194, respectively. Logistic regression analysis was performed to examine factors associated with the willingness of inmates to enroll in NHI. Results: Of the inmates surveyed, 80.87% expressed willingness to enroll in NHI during the term of imprisonment. The main reason for willingness to enroll was a desire to reduce the inmate's medical cost burden. The requirement to pay insurance premiums was the main reason for unwillingness to enroll. If enrolling in NHI, 51.10% of inmates agreed to join. Forty percent of inmates believed that they could afford the insurance premium. If inmates were insured only for inpatient care, 66.75% of inmates were willing to enroll. Factors associated with willingness to enroll in NHI included the inmate's sex, length of stay in prison, need for regular physician visits, out-of-pocket payment for physician visits, perception of reasonableness of NHI premiums, whether the inmate was qualified for NHI, and whether payments were deducted from inmates' money under custody. Of the hospitals surveyed, 76.29% were willing to provide outpatient services to inmates, whereas only 59.07% were willing to provide inpatient services. Conclusions: A high percentage of inmates expressed willingness to enroll in NHI. The ability to pay the insurance premiums was the major obstacle needing to be overcome.
• 198 - 213
• 10.6288/TJPH2008-27-03-02

• Link 原著 Original Article
• 中文版病人安全態度問卷信效度分析Validation Study of the Chinese Safety Attitude Questionnaire in Taiwan
• 李偉強、簡淑芬、陳玉枝、黃東波、李建賢、李壽東
  Wui-Chiang Lee, Shu-Feng Chien, Yu-Chih Chen, Tong-Po Huang, Chen-Hsen Lee, Shou-Dong Lee
• 安全態度問卷 ； 病人安全 ； 安全文化 ； 問卷調查
  safety attitude questionnaire ; Patient safety ; safety culture ; questionnaire survey
• 無
  Objectives: The Safety Attitude Questionnaire (SAQ) has been used in several countries to measure healthcare workers' attitudes toward patient safety. It has not been validated in Taiwan, however. The objective of this study was to develop and validate a Chinese version of the SAQ. Methods: The original SAQ was translated into Chinese in October 2006. There were 30 core items, measuring six domains of an organization's safety culture: Teamwork Climate, Safety Climate, Job Satisfaction, Stress Recognition, Perception of Management, and Working Conditions. A hospital-wide safety attitude survey was conducted in one medical center in Taipei in April 2007. The reliability and validity of the SAQ were examined by multilevel confirmatory factor analysis. Results: The overall response rate was 71.1%. The internal consistency of each domain was high (composite reliability: 0.77-0.93). The explanatory abilities of two-thirds (21/30) of the core items are considered important for the corresponding domains (squared multiple correlation [SMC]=0.5). The standardized factor loadings (?) for most core items were statistically meaningful (?=0.75-0.85), but the two reverse items were not (?<0.5). The model fit was satisfactory for the six domains and for the safety culture via structural equation models. Except for Stress Recognition (?=-0.09, SMC=0.01), all domains were highly correlated to one another (correlation coefficients: 0.67-0.93) and had good factoral loadings (?=0.69-0.88) and SMC (0.48-0.78) to the hospital safety culture. Conclusions: The Chinese version of the SAQ is reliable and valid in measuring frontline workers' safety attitudes in this healthcare organization in Taiwan.
• 214 - 222
• 10.6288/TJPH2008-27-03-03

• Link 原著 Original Article
• 全民健保下不同所得群體醫療利用不均因素分析Decomposition of income-related Inequality in Health Care Utilization under National Health Insurance in Taiwan
• 李妙純、沈茂庭
  Miaw-Chwen Lee, Mao-Ting Sheen
• 醫療服務利用 ； 集中係數 ； 水平不公平 ； 台灣全民健康保險
  Health care utilization ; Concentration index CI ; Horizontal inequity HI ; National Health Insurance
• 目標：台灣在1995年建立全民健康保險(NHI)將全體國民納入為保險對象，重要的政策意涵是希望不論經濟狀況、社會狀態或地理位置，有相同醫療需要的人皆能公平的就醫。本研究目的以集中係數(CI)測量台灣醫療利用在不同收入群體之分布，並分析影響不均的因素。方法：以2001年國民健康訪問調查(NHIS)為研究對象，並串連其2001年全民健康保險門診及住院之就診資料，得到受訪者之實際醫療服務利用資料。結果：西醫門診次數呈現有「扶貧(propoor)」的水平不公平，費用及住院使用呈現不同收入間的使用是能依照其不同的需要而分佈。需要及地區因素是使用次數不均的主要兩大貢獻因素，而需要及收入是費用不均的兩大主要貢獻因素，收入不均會促使醫療服務利用往富人集中。結論：與歐洲國家比較，台灣西醫門診次數處於中度「扶貧」的水平不公平，與實施全民健保制度及對弱勢群體或偏遠地區居民的醫療協助方案習習相關。結果有助於規劃醫療資源分布的政策、建置良好的健康照護體系的參考。
  Objectives: Since the inauguration of National Health Insurance (NHI) in Taiwan in 1995, the government has attempted to provide health services equitably for all of the population according to their needs, regardless of their economic resources, social standing, or geographical location. The objective of this paper is to measure and to decompose income-related inequality and horizontal inequity (HI) in health care utilization using concentration indices (CI). Methods: Samples were taken from the 2001 National Health Interview Survey (NHIS) in Taiwan and from records kept by the National Health Insurance (NHI) for health care utilization. Results: Significant pro-poor horizontal inequities in the number of visits for Western medicine emerged, while insignificant horizontal inequity indices for the expenditure of outpatient Western medicine and inpatient admission utilization appeared, indicating an equal utilization according to empirical needs. The two largest contributions for the number of visits of outpatient Western medicine and inpatient admission came from the inequality of need and geographic factors, while need and income were the two most important contributors for the inequality of expenditure. This analysis showed that pro-rich income inequality leads to pro-rich income-related inequality in health care utilization. Conclusions: When compared to OECD countries, Taiwan experiences moderate propoor horizontal inequity in the category of Western medicine. This finding supports the necessity of universal coverage of NHI and integrated health care strategies for the disadvantaged, such as exemptions from co-payments and an integrated delivery service plan. The implications of the results are important for how policy makers allocate resources and will assist with devising an equitable and functional health care system.
• 223 - 231
• 10.6288/TJPH2008-27-03-04

• Link 原著 Original Article
• 子宮頸抹片篩檢“認知”與“利用”的影響因素分析－雙元普羅比模型之實證研究Determinants of Awareness and Use of Pap-smear Screening: The Bivariate Probit Model Study
• 徐瑋宏、郭平欣
  Wei-Hong Shu, Ping-Sing Kuo
• 子宮頸抹片檢查 ； 雙元普羅比模型 ； 認知
  cervical screening ; bivariate probit model ; awareness
• 目標：本研究旨在探討影響台灣婦女對子宮頸抹片檢查認知(Awareness)與行為之社經因素。方法：研究資料為行政院衛生署國民健康局「民國91年台灣地區國民健康促進知識、態度與行為調查問卷」，使用雙元普羅比模型(bivariate Probit model)考量「認知」因素後，探討社經特性及其他因素對婦女抹片認知與檢查行為的影響。結果：模型估計結果顯示，抹片檢查的認知和行為兩條迴歸式之間有顯著的高度正相關，因此研究影響檢查行為的社經因素，必須同時考慮影響認知的社經因素。在認知迴歸式中，影響婦女對抹片檢查認知的顯著因素有：年齡、大學以上教育程度、已婚、良好自我健康狀況評估與預防保健服務利用。在檢查行為迴歸式中，影響婦女作抹片檢查的顯著因素有：年齡、高中(職)教育程度、都市化程度低、南部地區、已婚、宗教信仰與預防保健服務利用。結論：本文以雙元普羅比模型顯示，「認知」是婦女作子宮頸抹片檢查的重要影響因素，並推估出影響婦女認知與從事檢查的重要社經因素，可以提供相關單位作為擬定更有效率的抹片檢查推廣政策之參考。
  Objectives: The purpose of this study was to investigate the impact of cervical-screening awareness on the cervical-screening behavior of women in Taiwan. Methods: The bivariate probit model and data from the ”Survey of the Health Promotion Knowledge, Attitudes, and Behavior of Taiwan Citizens” conducted by the Bureau of Health Promotion in 2002 were used to investigate the socioeconomic factors in cervical-screening awareness and compliance of women in Taiwan. Results: The estimation results of the bivariate probit model indicated a significant and strong positive correlation between awareness and screening, supporting the role of ”awareness” in cervical-screening behavior of women in Taiwan. Age, education level (college or above), married status, better self-assessment of health condition, and regular use of preventive health-care services were significant factors in women’s awareness of Pap-smear screening. Age, education level (senior high school or above), lower degree of urbanization, residence in the southern areas of Taiwan, married status, religious beliefs, and regular use of preventive health-care services were significant factors in use of Pap-smear screening. Conclusions: The role of awareness in cervical-screening behavior, as well as socioeconomic factors in both awareness and compliance, must be taken into account in the design of cost-effective cervical cancer prevention policies and programs in Taiwan.
• 232 - 242
• 10.6288/TJPH2008-27-03-05

• Link 原著 Original Article
• 不同來源之豬隻沙氏桿菌流行病學調查：探討台灣居民感染人畜共通沙氏桿菌症風險Sero-groups and Antimicrobial Resistance in Salmonella Isolates from Pig Herds, Abattoirs and Clinical Cases: Risk of Salmonella Zoonotic Transmission
• 林正忠、劉哲宏、張照勤、李維誠、劉正義、陳德勲
  Cheng-Chung Lin, Che-Hung Liu, Chao-Chin Chang, Wei-Chen Lee, Cheng-I Liu, Ter-Hsin Chen
• 沙氏桿菌 ； 豬場 ； 屠宰場 ； 分離 ； 抗生素抗藥性
  Salmonella ; pig herd ; slaughter house ; isolation ; antimicrobial resistance
• 無
  Objectives: The aim of the study was to determine the grouping and microbial resistance in Salmonella isolates from pig herds, abattoirs and clinical cases. Methods: Direct culture of lesions was collected from clinical cases. Feces was collected from pig herds and abattoirs. Preenrichment (BPW) and selective enrichment (TT, RV) were processed then plated on selective agars. Isolates were grouped by sero-agglutination and 16 antimicrobial discs were selected for agar disc diffusion tests. Results: S. Cholerasuis was the dominant strain isolated from clinical salmonellosis cases. Grouping of the isolates found in pig herds and abattoirs included group B and others, but group C1 was only found in abattoirs. Microbial resistance of the clinical cases was 78.5%, and of the healthy pigs from abattoirs and pig herds, 39.4% and 39.2%, respectively. Conclusions: The isolated Salmonella from ill pigs has substantially different serotypes and drug resistance than from farmed and slaughtered healthy pigs. Therefore, healthy pigs slaughtered in well-processed slaughterhouses can reduce the risk of human Salmonella infection.
• 243 - 249
• 10.6288/TJPH2008-27-03-06

• Link 原著 Original Article
• 不同族群間代謝症候群相關指標之探討－以屏東地區整合性篩檢民眾為例An Investigation of Metabolic Syndrome Indicators among Different Ethnic groups-a Case Study from a Health Screening in Pingtung Area
• 黃惠屏、許秀月、鍾蝶起、 孫建安、朱基銘、楊燦
  Hui-Ping Huang, Hsiu-Yueh Hsu, Tieh-Chi Chung, Chien-An Sun, Chi-Ming Chu, Tsan Yang
• 族群 ； 代謝症候群 ； 中老年人
  ethnic ; metabolic syndrome ; middle-aged and elderly population
• 無
  Objectives: The objective of this study was to assess and compare the incidence and specific indicators of metabolic syndrome among Taiwanese, Hakka and aboriginals. Methods: This study employed a cross-sectional design with non-random purposive sampling. A total of 493 effective samples were collected from Taiwanese, Hakka, and aboriginal group between April 18(superscript th), 2006, and July 15(superscript th), 2006. Metabolic syndrome was defined according to the guidelines of the Department of Health (2006). Statistical analyses were conducted using SPSS 13.0. Results: Metabolic syndrome was identified in significantly more individuals in the aboriginal group (83.3%) than in the Taiwanese (46.4%) or Hakka (40.6%) groups (p<.001). Both men and women showed significant differences in hyperglycemia, elevated low-density lipoprotein cholesterol, and incidence of metabolic syndrome between different ethnic groups. After adjusting for gender, age, and body mass index, the aboriginal group had the highest risk for metabolic syndrome. This aboriginal risk was 2.08 times (95% CI=0.65~6.63) and 10.45 times (95% CI=3.79~28.79) greater than the Hakka descendents in males and females, respectively. Conclusions: This study revealed that the aboriginal group had a considerably higher prevalence of metabolic syndrome than the Taiwanese and Hakka groups. The aboriginals included in this study resided in Wu-tai Township and Mudan Township in mountainous areas of Pingtung County, where medical services were relatively scarce. Lifestyle differences and a relative lack of medical services may contribute to the increased incidence of metabolic syndrome in aboriginals.
• 250 - 258
• 10.6288/TJPH2008-27-03-07

• Link 實務 Public Health Practice
• 醫院對顧客知識吸收能力與自費醫療開發績效的相關性研究Relationship between Customer Knowledge Absorption Capacity and Performance of Self-pay Service Development in Taiwanese Hospitals
• 翁瑞宏、黃靖媛、黃金安、蔡文正
  Rhay-hung Weng, Ching-yuan Huang, Jin-an Huang, Wen-chen Tsai
• 自費醫療 ； 吸收能力 ； 顧客知識 ； 醫務管理
  Self-Pay Service ; Absorptive Capacity ; Customer Knowledge ; Healthcare Management
• 目標：探討現今台灣醫院自費醫療開發績效現況，並分析顧客知識吸收能力對醫院自費醫療開發績效的影響。方法：以郵寄問卷方式，針對全國460家地區醫院級以上醫院之高階主管或自費醫療管理者進行問卷調查，有效問卷回收率為41.11%，在檢驗樣本代表性、無反應偏差、共同方法變異與問卷信效度後，以階層迴歸進行驗證。結果：國內醫院自費醫療開發之自評績效平均值為2.63分(最高5分)，顧客知識潛在性吸收能力與實現吸收能力之平均值分別為3.02、3.12。顧客知識吸收能力會對醫院自費醫療開發績效產生正向影響，且顧客知識實現性吸收能力會對於顧客知識潛在性吸收能力與自費醫療開發績效之間產生顯著的完全中介效果。結論：醫院的自費醫療開發績效的影響確實不甚理想，醫院若欲提昇自費醫療開發績效，則不可忽略顧客知識，並應致力於強化對於外部顧客知識的吸收能力。
  Objectives: This study was conducted to examine the current performance of self-pay service development (SPSD)and the impact on SPSD performance of customer knowledge absorption capacity (CKAC) in Taiwanese hospitals. Methods: A self-administered mail-based survey was used for data collection. Questionnaires were sent to the senior managers or self-pay service managers of 460 hospitals accredited at the district level and above. The valid return rate was 41.11%. After testing sample representativeness, nonresponse error, common method variance, questionnaire reliability, and questionnaire validity, the data were analyzed using hierarchical multiple regression. Results: On a 5-point scale with 5 representing the maximum, the mean self-evaluated SPSD performance was 2.63. The mean potential and realized CKACs were 3.02 and 3.12, respectively. Customer knowledge absorption capacity had a significant impact on SPSD performance, and realized CKAC fully mediated the relationship between potential CKAC and SPSD performance. Conclusions: The SPSD performance of Taiwanese hospitals is currently less than ideal. Because external customer knowledge is an important factor in SPSD performance, hospitals must strengthen CKAC.
• 259 - 269
• 10.6288/TJPH2008-27-03-08