31卷2期

• Link 公衛論壇 Public Health Forum
• 傳染病與國家競爭力Infectious disease and national competitiveness
• 羅秀雲、李政益、楊祥麟、莊人祥、張峰義
  羅秀雲、李政益、楊祥麟、莊人祥、張峰義
• 無
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• 97 - 104
• 10.6288/TJPH2012-31-02-01

• Link 綜論 Review Article
• 國際間學齡前兒童生長體位標準之現況分析A Current Review of the International Growth Standards for Preschool Children
• 陳姿媛、盧立卿
  Tzu-Yuan Chen, Li-Ching Lyu
• 兒童 ； 營養評估 ； 生長曲線 ； 身體質量指數 ； z分數
  children ; nutrition assessment ; growth chart ; BMI ; z-score
• 兒童期的生長發育，為奠基未來生長與健康發展的重要時機，因此此時期用以評估生長發展及營養狀況的體位標準，包括生長曲線百分位、身體質量指數及z分數等方式，更是一不可忽視的課題所在。本文整理國際組織及各國公共衛生單位針對學齡前兒童生長體位標準之現況進行探討撰述，主要議題為生長曲線（growth chart）之比較分析，此部分資料來源為台灣、美國、英國、日本、中國及世界衛生組織等相關文獻；續而則針對身體質量指數（body mass index, BMI）及z分數（z score）使用進行相關陳述。在臨床及公共衛生領域中，評估兒童生長狀況的方法不可勝數，因此於繁多的評估指標中選用正確的估量工具，將是個複雜且益顯重要的議題。國內公共衛生、小兒科及營養學界對於兒童生長體位標準之評估文獻尚屬缺乏，期盼未來有更多相關研究投入於評估指標的信效度精進與推廣，藉此以使兒童的生長歷程整體評估更斟全面完善。
  Growth and development in childhood are pivotal for future health and well-being. Therefore, anthropometric assessments using growth standards including growth charts by percentiles, BMI and z-scores are important for the evaluation of nutritional status. This article reviewed the current international growth standards for preschool children as published by public health agencies in Taiwan, the Unitd States, the United Kingdom, Japan, China and the World Health Organization. We then compared and discussed the applications of the growth chart, the BMI and the z-score for assessing growth and nutritional status during childhood. Since there are various methods for assessing children's growth status, the choice of assessment tools is a complex issue. In the fields of public health, pediatrics, and nutrition in Taiwan, there has been very limited study of growth standards. We hope that this research will increase awareness about the issue and make nutritional assessments of children much more comprehensive.
• 105 - 118
• 10.6288/TJPH2012-31-02-02

• Link 原著 Original Article
• 影響護理之家評鑑結果之因素研究：以2009年台灣首次全國護理之家評鑑為例Factors Associated with the Outcome of Accreditation of Nursing Homes: Results from the 2009 Taiwan Nursing Home Accreditation Survey
• 蔡淑鳳、林育秀、梁亞文
  Shwu-Feng Tsay, Yu-Hsiu Lin, Yia-Wun Liang
• 長期照護 ； 護理之家 ； 評鑑
  Long-term care ; nursing home ; appraisal
• 目標：本研究旨在瞭解台灣一般護理之家評鑑結果，並探討通過評鑑之影響因素，作為護理之家經營者及評鑑制度未來修正參考。方法：本研究為一橫斷性研究，以2009年「台灣護理之家評鑑資訊網資料庫」之351家一般護理之家為研究對象，進行次級資料分析；本研究將評鑑結果「特優」、「優」及「甲」者定義為「評鑑通過」，再以邏輯斯迴歸探討影響評鑑通過之因素。結果：受評鑑的護理之家中有169家（48.15%）通過評鑑，182家（51.85%）未通過評鑑；邏輯斯迴歸分析發現，設立區域、經營所有權、規模、負責人教育程度、負責人角色、競爭程度及占床率顯著影響護理之家是否通過評鑑。結論：主管機關應加強輔導護理之家，提升健康照護、人員管理、經營管理及安全環境四面向；提供機構管理者完整務實的繼續教育，提升機構經營成效。護理之家負責人除積極提昇本身經營管理知能外，也應重新思考護理之家本身的市場定位及發展方向，審慎評估護理之家組織特質之適當性。
  Objectives: This study examined the results of the Taiwan Nursing Home Accreditation Survey and analyzed the factors related to qualifications for accreditation. Methods: This was a cross-sectional study using data from the 2009 Taiwan Nursing Home Accreditation Survey Dataset. A total of 351 nursing homes were analyzed. Passing accreditation was defined as obtaining a rating of ”especially excellent”, ”first-rate”, or ”A-grade”. Multivariate logistic regression analysis was performed to identify factors associated with passing accreditation. Results: Among the 351 nursing homes appraised, 169 (48.15%) passed and 182 (51.85%) did not. Significant factors associated with passing were: region, ownership, scale, owner's educational background, owner's role, competition, and occupancy rate. Conclusions: Policymakers should help nursing homeadministrators improve their performance in the provision of care, treatment services, human resources, management, and environment of care, and provide comprehensive continuing education to assist administrators in improving operational efficiency. Nursing home administrators should develop their management skills and reconsider their market position, development, and structural appropriateness.
• 119 - 132
• 10.6288/TJPH2012-31-02-03

• Link 評論 Commentary
• 評論：影響護理之家評鑑結果之因素研究：以2009年台灣首次全國護理之家評鑑為例Commentary: Factors Associated with the Outcome of Accreditation of Nursing Homes: Results from the 2009 Taiwan Nursing Home Accreditation Survey
• 劉慧俐
  Hui-Li Liu
• 無
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• 無
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• 133 - 134
• 10.6288/TJPH2012-31-02-04

• Link 評論 Commentary
• 作者回覆：影響護理之家評鑑結果之因素研究：以2009年台灣首次全國護理之家評鑑為例Response: Factors Associated with the Outcome of Accreditation of Nursing Homes: Results from the 2009 Taiwan Nursing Home Accreditation Survey
• 蔡淑鳳、林育秀、梁亞文
  Shwu-Feng Tsay, Yu-Hsiu Lin, Yia-Wun Liang
• 無
  none
• 無
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• 135 - 135
• 10.6288/TJPH2012-31-02-05

• Link 原著 Original Article
• 台灣醫院網頁公開揭露財務資訊決定因素Determinants of Financial Disclosure at the Websites of Hospitals in Taiwan
• 何怡澄
  Yi-Cheng Ho
• 自願性公開揭露 ； 網際網路 ； 財務資訊
  voluntary disclosure ; web information ; financial information
• 目標：近年各界呼籲醫療機構提高財務透明度，而網際網路提供一個有效且低成本的資訊傳播工具。本研究探討影響醫療機構在網路公開揭露財務資訊程度，及影響揭露行為的因素。方法：建立醫院在網頁公開揭露財務資訊的量表，並調查230家醫院在網頁公開揭露財務資訊情況。財務資訊揭露指標分為財務資訊類型、財務資訊品質、財務資訊易取得性及網頁揭露總指標。然後分別以4項資訊揭露指標為應變數進行迴歸分析，探討影響醫院在網頁公開揭露財務資訊的因素。結果：公立醫院在網頁公開揭露財務資訊的程度最高，其次為非營利醫院，營利醫院公開揭露程度最低；區域醫院公開揭露財務資訊程度高於地區醫院。醫學中心的財務資訊易取得性與揭露總指標顯著高於地區醫院；市場集中度愈高，網頁公開揭露財務資訊種類與資訊品質也愈高；醫院新聞能見度愈高，其網頁資訊易取得性較高。結論：實證顯示醫院自願性公開揭露財務資訊的誘因甚低，若要達成醫療機構全面公開揭露財務資訊，需要透過強制性規範。
  Objectives: Internet reporting has gained in popularity in recent years because of its low cost and wide reach. This study investigated the differences in online disclosure of financial information by hospitals under different ownership and the quantity, quality and accessibility of financial information on the websites of hospitals in Taiwan. Methods: The financial information disclosure index was constructed based on the data from the web-sites of 230 hospitals in Taiwan. The index included three parts: the categories of financial disclosure, the quality of the disclosed financial information, and the convenience of the internet search. Results: This study demonstrated significant differences in the online disclosure of financial information by hospitals under different types of ownership. Public hospitals had the highest degree of disclosure followed by not-for-profit hospitals and for-profit hospitals. The general information index was higher for metropolitan hospitals than for local community hospitals. General information and information accessibility for academic medical centers were both higher than those for local community hospitals. The index of financial categories and quality increased as the medical market concentration increased. Information accessibility from the websites of hospitals was positively correlated with visibility by the press. Conclusions: The incentives for voluntary online financial information disclosure are inadequate. Therefore, mandatory disclosure is a more effective way to increase the availability of financial information about hospitals.
• 136 - 151
• 10.6288/TJPH2012-31-02-06

• Link 原著 Original Article
• 氫離子幫浦抑制劑輔以衛生教育介入對胃食道逆流性疾病及其症狀影響尺度改善之探討The Effect of Proton Pump Inhibitors (PPIs) along with Health Education Intervention on Gastroesophageal Reflux Disease (GERD) and the Disease Impact Scale
• 黃勇傑、朱恆成、高森永
  Yung-Chieh Huang, Heng-Cheng Chu, Sen-Yeong Kao
• 胃食道逆流性疾病 ； 氫離子幫浦抑制劑 ； 衛生教育介入 ； 改良型胃食道逆流性疾病影響尺度（mGIS） ；
  Gastroesophageal Reflux Disease ; Proton Pump Inhibitors (PPIs) ; health education intervention ; modified Gastroesophageal Impact Scale (mGIS)
• 目標：現行臨床針對胃食道逆流疾病（Gastroesophageal Reflux Disease, GERD）病人之治療僅著重內科藥物之投予或採外科手術治療，鮮少提供衛教介入之輔助性治療或評估衛教介入之成效。因此，本研究旨在探討臨床上投予氫離子幫浦抑制劑（Proton Pump Inhibitor, PPIs）輔以衛生教育介入，以6－8週之追蹤期間了解其對GERD病人之危險因子、疾病認知、態度與行為、改良型GERD症狀影響尺度（mGIS）及內視鏡嚴重度改善之成效，進而探討mGIS改變量（ΔmGIS）之預測因子。方法：本研究為隨機控制試驗（Randomized Controlled Trial, RCT）並追蹤6－8週，將181位GERD病人隨機分派至實驗組（N＝92）或控制組（N＝89）。實驗組接受PPIs治療及衛生教育介入措施；控制組則接受PPIs治療及門診常規照護。結果：實驗組與控制組於飲食、生活習慣或行為、GERD認知、態度與行為及mGIS之改善情形達顯著差異。經多元逐步迴歸分析後顯示：實驗組提升GERD認知（β＝1.221，t＝2.716）、避免吃甜食（β＝0.101，t＝3.644）及睡覺枕頭刻意墊高（β＝0.539，t＝=12.344）為ΔmGIS之預測因子。結論：本研究證實PPIs輔以衛教介入可有效改善GERD病人部分不良飲食習慣及生活習慣或行為，並增進對疾病相關認知、態度與行為及減少受疾病影響之程度。其中實驗組於衛教介入後改善不良危險因子者，其受疾病影響程度呈顯著減少。
  Objectives: Gastroesophageal Reflux Disease (GERD) has become a public health issue in Taiwan; however, current clinical treatment focuses only on surgery or drugs to inhibit gastric acid secretion, and seldom takes into consideration the effect of concurrent health education which includes diet, lifestyle modification, and disease knowledge, attitude and practice (KAP). The aims of this study were to evaluate the concurrent effects of health education and Proton Pump Inhibitors (PPIs) on diet, lifestyle changes, KAP, the modified GERD impact scale (mGIS), and severity of the condition as determined by endoscopy, and to further explore the predictors of difference on the modified GERD impact scale (?mGIS). Methods: A 6-8 week randomized controlled trial was conducted at a medical center between 2010 and 2011. This involved 181 gastroenterology outpatients with GERD. Participants were randomly assigned to one of two treatment strategies: 89 in the medication management (PPIs) only group and 92 in the medication management (PPIs) plus concurrent health education group. Results: The experimental group was significantly better than the control group in avoiding or decreasing related risk factors, increasing disease KAP, and decreasing mGIS. Multiple linear regression (stepwise) analysis showed that improved knowledge (ß=1.221, t=2.716), sleeping with the head of the bed raised (ß=0.539, t=12.344) and avoiding or decreasing eating sweets (ß=0.101, t=3.644) were ?mGIS predictors. Conclusions: PPIs and concurrent health education may be the best way to improve patients' diet, lifestyle, and disease related KAP, and reduce the severity of clinical symptoms.
• 152 - 163
• 10.6288/TJPH2012-31-02-07

• Link 原著 Original Article
• 非正式社會支持網絡在全民健康保險實施前後對健康檢查服務利用之影響The Effect of Informal Social Support Networks on the Use of Health Examination Services Before and after the Implementation of National Health Insurance
• 朱僑麗、陳肇男
  Chiao-Lee Chu, Chao-Nan Chen
• 社會支持 ； 戶基護航網絡 ； 健康檢查服務利用
  Social Support ; household-based convoy ; Health physical examination services utilization
• 目標：檢視非正式社會支持網絡對健康檢查服務利用的影響。方法：非正式社會支持以戶基護航網絡概念為基礎，檢視不同網絡型態對健康檢查服務利用的影響。戶基護航網絡由家戶型態、常連絡不同住家人、常連絡親屬及常連絡朋友等四圈所構成。分析資料來源，為1993年、1996年與1999年國民健康局的台灣中老年人身心狀況調查資料。結果：控制了其它相關影響變項，全民健保實施後，1999年資料分析結果顯示具有常連絡朋友網絡者，會顯著的增加其健康檢查服務利用，但是兩代或以上家戶、不同住家人、與親屬之網絡則無顯著影響；而1996年與1999年資料分析結果則顯示戶基護航網絡圈數越多者，亦會傾向利用健康檢查服務。結論：朋友的社會支持可以促進老年人健康檢查服務的利用。
  Objectives: To examine the effect of informal social support structures on the use of physical health examination services. Methods: A household-based convoy was used to reflect an individual's informal social structure. This variable included four circles: type of household, and frequent-contact non-co-residing family members, relatives, and friends. Data were obtained from ”The Health and Living Conditions of the Middle Aged and the Elderly” complied by the Health Promotion Bureau of the National Health Administration in 1993, 1996, and 1999. Results: In 1999, after the implementation of National Health Insurance, frequent-contact friends had a significant positive effect on the use of physical health examinations when other relevant factors were controlled; however, two generations or more households, and non-co-residing family members or relatives did not have a significant effect. In addition, the analytical results of 1996 and 1999 data indicated that respondents with more circles were more inclined to have physical health examinations. Conclusions: Social support received from relatives and friends were able to promote the use of physical health examination services.
• 164 - 175
• 10.6288/TJPH2012-31-02-08

• Link 原著 Original Article
• 修正簡易營養評估量表（MNA）以改善其評估血液透析患者營養風險之效能Modifying the Short-form Mini-Nutritional Assessment to Improve the Prediction of Nutritional Risk in Patients on Hemodialysis
• 許智怡、蔡仲弘
  Chih-Yi Hsu, Alan C. Tsai
• 血液透析病患 ； 營養評估 ； 簡易營養評估量表
  Hemodialysis patients ; Nutritional assessment ; Mini Nutritional Assessment
• 目標：改良MNA（Mini-Nutritional Assessment）使其更適用於血液透析（hemodialysis, HD）患者的營養評估。方法：本研究徵求中部某地區醫院門診洗腎中心血液透析患者100名（18－97歲，男43女57名）。經同意後，以短式及長式MNA－台灣二版評估營養狀況並與生化指標比較。MNA台灣二版為採用台灣老人體位指標的改良版。版本之修正以選擇較能反應HD病情的非短式題項（如O題）與較不反應HD病情的短式題項（如E題）互換題位，並檢定其改良成效。以Wilcoxon Signed-Rank Test進行事後檢定，比較短式MNA台灣二版各改良版本與長式MNA台灣二版的評估結果。以Pearson's相關分析長式及各短式MNA台灣二版的總分與血清白蛋白、血清肌酸酐、住院天數、及急診次數的相關性。結果：本研究發現短式MNA台灣二版用於評估血液透析病患時，以量表O題（自評營養狀況）取代（對換）E題（失智），最能改進評估功能，且其評估成果與長式MNA台灣二版相當一致。結論：本研究的結果顯示MNA量表以O題（自評營養狀況）取代（對換）E題（失智）或D題（精神壓力）最能改進其血液透析患者的評估功能。此簡單的改良，使短式MNA量表可適用於台灣的血液透析患者。
  Objectives: To modify the Mini-Nutritional Assessment (MNA) so that it would be suitable for use in hemodialysis (HD) patients. Methods: Subjects were 100 HD outpatients (18-97 years of age, 43 men and 57 women) recruited from a district hospital in Central Taiwan. With their consent, we rated the nutritional status of each subject with the long-, short-, and modified short-form versions of the MNA and measured their biochemical values. We examined various alternative short-form versions of the MNA based on the dietary characteristics of HD patients. The study used the Wilcoxon Signed-Rank Test, Pearson's correlation analysis and the crosstabulation test to evaluate the ability of the short-form versions to predict the long-form MNA (T2). Results: Results showed that a modified short-form version that exchanged item O (selfrated nutritional status) for item E (dementia) improved the predictive ability of the MNA in HD patients. The modified short-form performed well compared to the long-form. Conclusions: The study demonstrated that replacing item O for E or D in the MNA can best improve the functionality of the MNA. This simple revision makes the short-form suitable for assessing the risk of malnutrition in patients on hemodialysis.
• 176 - 183
• 10.6288/TJPH2012-31-02-09

• Link 原著 Original Article
• 「中文健康識能評估量表」簡式量表的發展與效度檢測Development and Validation of the Short-form Mandarin Health Literacy Scale
• 李守義、蔡慈儀、蔡憶文、郭耿南
  Shoou-Yih D. Lee, Tzu-I Tsai, Yi-Wen Tsai, Ken N. Kuo
• 功能性健康識能 ； 中文健康識能評估量表 ； 簡式量表發展
  functional health literacy ; Mandarin Health Literacy Scale ; short-form scale development
• 目標：目前國內已發展出一套中文健康識能評估表，用以評估成年民眾的功能性健康識能，瞭解民眾閱讀、理解及應用健康資訊之能力。本研究的目的是根據「中文健康識能評估表」來發展出簡式量表，檢驗原始量表和簡式量表測量模式的適配性，並進行簡式量表的信度及效度檢核。方法：本研究為橫斷性研究設計，以面訪方式進行資料收集。樣本對象為全國成年民眾，採三階段分層、抽取率與單位大小成比例之等機率抽樣設計，有效樣本共計3,491。測量模式的檢驗是以AMOS 19.0統計軟體進行驗證性因素分析。結果：簡式量表的題目是選擇與原始總量表之間的皮爾森相關係數最高的兩題組，題目由原始量表的33題文字性題目減少成8題，17題數字性題目減少到3題。驗證性因素分析結果支持簡式量表為單一構面的模式。適配度測量結果顯示，簡式量表的增值適配度及精簡適配度指標均比原始量表有更好的配適性表現，有達到模式的簡約原則。簡式量表與原始量表間的相關達0.97，簡式量表的內在一致信度係數為0.94。以「教育程度」、「閱讀健康訊息的能力」、「他人協助讀寫的需求」、「健康知識」、「自覺健康狀態」進行簡式量表的幅合性效度和已知群組效度檢定，所有相關係數均達到顯著。結論：綜合各種心理計量方法分析，結果確認這份中文健康識能簡式量表可取代原始健康識能評估表，應用於使用華文的族群，進行功能性健康識能相關研究或臨床評估。
  Objectives: A Mandarin Health Literacy Scale (MHLS) has been developed and validated to assess Taiwanese adults' functional health literacy in terms of their ability to read, comprehend, and utilize basic health information in making personal health decisions. The purpose of this study was to develop a shortened version of the MHLS, the short-form Mandarin Health Literacy Scale (s-MHLS), and to examine the psychometric qualities of the shortened instrument. Methods: The study sample consisted of 3491 Taiwanese adults who were randomly selected using the threestage stratified sampling design with a sampling rate proportional-to-size within each stage. The measurement models were examined using AMOS 19.0. Results: Item selection was determined by the correlation between the question sets and the total scores on the MHLS. The MHLS was reduced from 33 text-reading items to 8 and 17 numerical items to 3. Confirmatory factor analysis supported the unidimensionality of s-MHLS. Measurement model analysis revealed that s-MHLS yielded a better fit than MHLS. The Cronbach's correlation between the MHLS and s-MHLS was 0.97, and the s-MHLS had satisfactory internal reliability (Cronbach's alpha=0.94). The s-MHLS was significantly correlated with education, reading ability, need for reading assistance, health knowledge, and perceived health status, suggesting that the shortened instrument had good convergent and known-group validity. Conclusions: The s-MHLS is valid and reliable. It could be employed in clinical and research settings to assess functional health literacy in the Mandarinspeaking population. (Taiwan J Public Health. 2012;31(2):184-194)
• 184 - 194
• 10.6288/TJPH2012-31-02-10

• Link 原著 Original Article
• 台灣酒精性疾病死亡率之空間聚集分析Spatial Clustering of Alcohol-attributed Disease Mortality in Taiwan
• 林志銘、林文苑
  Chih-Ming Lin, Wen-Yen Lin
• 酒精性疾病 ； 性別 ； 空間統計 ； 空間聚集
  alcohol-attributed disease ; gender ; spatial statistics ; spatial clustering
• 目標：建立台灣酒精性疾病死亡之地理分佈與空間聚集型態，並探討男女不同性別之死亡風險聚集差異。方法：採用台灣地區2002－2006年的全國死亡診斷登記系統之電腦資料檔，依據ICD-9CM進行酒精性疾病死亡分類，總計台灣本島349鄉鎮市區有30,669之15歲（含）以上死亡人口，以2002年為標準人口分別計算男女性酒精性疾病標準死亡比（SMR）及進行Global G與Local Gi*空間統計量分析死亡風險之空間聚集分佈。結果：酒精性疾病死亡主要風險族群為男性（佔68%），男女性在各鄉鎮市區年死亡中位數分別為8.8與4.5人。在地理分佈方面，高風險空間聚集區域多位於非都市之偏遠鄉鎮，其中女性死亡風險顯著較高且不同於男性空間聚集之區域，係以宜蘭縣南澳鄉及以雲林縣台西鄉為中心的兩個區域。結論：本研究驗證台灣酒精性疾病死亡風險存在性別與地理城鄉聚集之差異，透過這些地域的鑑別，未來輔以相關社會人口資料變項的分析，將有助於獲得影響男女酒精性疾病死亡風險因子的進一步釐清。
  Objectives: This research analyzed the geographical distribution and spatial clustering of alcohol-attributed disease mortality in Taiwan, and determined the gender differences in this clustering. Methods: Using 2002-2006 data from the national death-diagnosis registration system and categorizing alcohol-attributed disease mortality by ICD-9CM diagnoses, we calculated the number of alcohol-attributed, disease related deaths of those aged 15 and older to be 30,669 in 349 townships on Taiwan's main island. This research utilized 2002 data as the standardized population to calculate the alcohol-attributed disease standard mortality ratio (SMR), and applied the SMR to Global G and Local Gi* statistics to determine the spatial clustering of deaths by geographical distribution. Results: Sixty-eight percent of alcohol-attributed disease related deaths were males, and the median numbers of males and females were 8.8 and 4.5, respectively. From the results of spatial analysis of geographical distribution, statistically significant highnumber pockets tended to cluster in remote townships. There were more females than males in two independent pockets (NanAo and Taisi townships). Conclusions: Results from this research demonstrated that alcohol-attributed disease mortality did show gender and spatial clustering differences in Taiwan. By indentifying the high risk areas and analyzing related demographic variables, we may be able to provide further insight into the alcohol-attributed disease mortality factors for men and women in Taiwan.
• 195 - 204
• 10.6288/TJPH2012-31-02-11