3卷1期

• Link 原著 Original Article
• 癌症流行病學癌症流行病學
• Brian MacMahon、玉榮德、季瑋珠
  Brian MacMahon、玉榮德、季瑋珠
• 無
  none
• 無
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• 2-9
• 10.6288/JNPHARC1984-03-01-01

• Link 原著 Original Article
• 公共衛生與人類生態Public Health and Human Ecology
• 小泉明
  Akira Koizumi
• 無
  none
• 無
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• 10 - 18
• 10.6288/JNPHARC1984-03-01-02

• Link 原著 Original Article
• 社區醫學訓練A Program for Teaching of Community Medicine
• 陳慶餘、 謝維銓
  Ching-Yu Chen, Wei-Chuan Hsieh
• 無
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• 澳底保健站為全省首創社區醫學中心，做為家庭醫師訓練的場所。自民國70年12月起，執行社區醫學訓練計劃，使學員經由實地工作，以確認社區內居民之健康問題與尋求解決方法。本文闡述其目標、目的、課程、方法內容以及成果和檢討建議，以配合群體醫療執業中心之擴大實施，俾使基本保健醫療政策落實。
  Community Medicine is most commonly defined as a discipline concerned with the identification and the solution of health care problems of communities or other defined populations, A program for teaching of Community Medicine has been carried out at Audi Community Health Center since December, 1981. It is a one-month rotating course in the training program of the first year residents of the departments of Internal Medicine and Family practice, National Taiwan University Hospital. There are four objectives in this program e. g. (1) to work as a first contactor to practice multidisciplinary skills and knowledge especially the preventive medicine in the daily ambulatory clinic, (2) to highlight the concept of family as a care unit through good Doctor-patient relationship and home visit to understand the nature of diseases and illness and its relation with the family and sociocultural background, (3) to collect the data base from the community survey to be a health educator for the residents, (4) to provide comprehensive care via a team approach. It is hoped that the report of this novel program, the rationale presented for building up the department of Family Medicine in medical colleges as well as including Community Medicine in the training course of primary health care personnel and the suggested new channel of community health survalence will further encourage and assist the other involved hospitals to teach Community Medicine in group practice centers to strengthen the national primary health care policy.
• 19 - 26
• 10.6288/JNPHARC1984-03-01-03

• Link 原著 Original Article
• 台灣地區勞保門診病人抗生素使用情形之調查研究A Study on Antibiotics Use among Out-Patient Clinics of Labor Insurers in Taiwan
• 張信男、吳淑瓊、楊志良
  Shin-Lan Chang, Shwu-Chong Wu, Chih-Liang Yaung
• 無
  Drug abuse ; Antibitics ; Labor insurance
• 為瞭解勞保門診病人抗微生物藥劑之使用情形，自了國70年金年2,700多萬張勞保門診處方中，以分層系統隨機抽樣方法，抽得3,567張門診處方，加以分析研究，主要結果如下： 1.超過一半之勞保門診病人均給予至少1種抗生素。約4分之1給予注射型抗生素。 2.在給予抗生素者中，30.7%給予2種及2種以土之抗生素，又同一種抗生素同時給予口服及注射者，亦極為普遍。 3.絕大多數(74.3%)之上呼吸道感染病人均給予至少1種抗生素。 4.Ampicillin是最常用之抗生素，此與其他國家之抗生素使用情形相類同。毒性及副作用較多而應儘量限制使用之氯徵素（為第4最常使用）之抗生素（佔10.6%）。若僅以針劑觀之，則氯徵素之使用率高達第2位(19.4%)。此藥之針劑泛用於上呼吸道感染之病人。 由以上結果顯示抗生素在台灣地區已被濫用。完整的祭品監視系統，執業醫師的用藥繼續教育，公?的用藥衛生教育均急需加強，以促進我國國民健康。
  In order to investigate the use of antimicrobial drugs among labor insurers, a sample of 3567 prescriptions selected by stratified systematic sampling from a total of 27 million out-patient visits in 1981 were studied. Main findings are as follows: (1)About one-half of the OPD patients were prescribed with antibiotics and about a quarter of them were given by injection. (2)Among those given with antibiotics, 30.7% were prescribed with two or more kinds. It was a popular practice that drugs were given in both oral and parenteral administrations. (3)Among those upper respiratory infection (URI) patients, 74.3% were given with antibiotics. (4)Ampicillin was the most commonly used antibiotics, this situation was the same as in many other countries. Chloramphenicol, an antibiotics with high toxicity and many side effects and used under severe restricted conditions in many countries, was the fourth commonly prescribed antibiotics (10.6%). Moreover, it turned out the second commonly used injectable antibiotics (19.4%), and most of the time this drug was given to the URI patients. From the above findings, antibiotics was obviously abused by the medical clinicians in Taiwan. A comprehensive drug surveillance system, continuing education of practictioner on drug use, and health education of general public regarding drug virtues are urgently needed in order to promote the health of public.
• 27 - 36
• 10.6288/JNPHARC1984-03-01-04

• Link 原著 Original Article
• 台灣西南沿海養殖牡蠣中沙門氏菌污染之研究The Study of Detecting Salmonella in Oyster Cultured in the South-West Coast in Taiwan
• 越秀雄、曾惠中、葉志中、陳小梨
  Shin-Hsiung Chao, Huei-Chung Tseng, Chin-Chung Yeh, Show-Li Chen
• 無
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• 本計劃從台灣西南沿岸河口地帶的養殖牡蠣區採樣，共計64件其中16件證實含沙門氏菌，污染率佔25.00%，沙門氏菌的污染集中於五月至七月炎夏之際，其和氣溫高病原菌易滋長有關。 所分離之沙門氏菌中包括了B1，C2，C3，D1，D2，E1，G2等7群，共布13種血清型，其中最多的血清型依次為S. typhimuvium (28.43%)，S. panama (14.70%)，S. Tananarive (10.78%)，S. Worthington (8.82%)與S. benin (5.88%)。在這13種血清型中布S. benin，S. muenchen，S. newlands，S. praha，S. giza, S. Gloucester S. preston 等7發為台灣地區過去未曾分離發現。
  The main purpose of this study is to detect Salmonella in Oyster cultured in the South-West coast along Yun-Lin and Chia-I counties. This area had been found to be polluted or contaminated seriously in recent years. A total of sixty-four oyster samples were collected directly from 6 locations of (the estuaries. There were 16 out of 64 oyster samples found to be contaminated by Salmonella and totally 102 strains of Salmonella were isolated after finishing a series of biochemical and serological tests, The 102 strains were classified into of groups: B1, C1, C3, D1, D2, E1 and G2 Eighty-nine strains of them were verified into 13 serotypes and the rest was R-form. S. typhimurium was isolated with the highest rate (28.4%) then followed by Sc panama (14.7%), S. tananarive (10.78%) S. Worthington (8.82%) and S. benin (5.88%). Seven of the serotypes seemed first time isolated in Taiwan.
• 37 - 45
• 10.6288/JNPHARC1984-03-01-05

• Link 原著 Original Article
• 台灣民間特有的疾病觀念之探討－以四湖鄉爲例A Pilot Study on Twelve Popular Illness Believes in Shu-Hu
• 陳鴻銘、楊志良
  Hong-Ming Chen, Chih-Liang Yaung
• 無
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• 為了探討十二種民間持有的疾病觀念的流傳狀況及其所代表的症狀群，在民國七十二年九月間以隨機集束抽樣法訪視四湖鄉的民?，以瞭解民?對這些疾病觀念的認知與相信的程度，益由民?敘述其所代表的症狀，進行了影響因素和代表症狀群的統計分析。所得到之結果為： 1.民?普遍都認知（89%以上）和相信（70%以上）有這些疾病觀念。教育程度的影響較大，其次依序是都市化程度，年齡及性別。教育程度高或城市型地區的民?比較傾向於沒聽過手。不相信這些觀念；三十歲以下民?比較傾向於沒聽過這些觀念：性別之影響甚小。 2.每個疾病觀念都代表著某一特定的症狀群，可知在民?醫療觀念裏，自有其解釋症狀和病因的理論。而此種解釋理論與正統醫學教育之內容相差頗鉅，必然會對醫師與病人溝通或民?的衛生醫療行為，具有重大的影響力。
  A random cluster sample of 166 households in Shu-nu were interviewed in September 1983 in order to understand the prevelence of knowledge and belief on twelve popular illness concepts of rural people in Taiwan. The studied illness concepts were entirely diffenent from those of modern medicine. Factors influencing the knowledge and belief of those concepts were analyzed. In addition, sympton complex of those believes were described in modern medical terminology tried by the authors. The main results were as following: 1. Among those twelve illness believes. the lowest knowledgement rate is 89% and the rate for belief is 70%. 2. The education level was the most important factor in determining the knowledge and belief of these twelve concepts. Other influential factors are urbanization, age and sex accordingly. Residents with higher educational level, more urbanized living style, and younger age were more likely not knowing and not believing the illness concepts. Nevertheless, there was little difference between males and females. 3. Each illness concepts represented some particular sympton complex. There were some rationale for the syrnptons and etiologies of those popular illness believes. 4. As popular illness concepts have never been discussed or taught in medical schools, the gap of knowledge and belief between health personnel and the puplic are certainly affecting their mutual communication and relationship and causing difficulties for effective diagnosis and treatment.
• 46 - 57
• 10.6288/JNPHARC1984-03-01-06

• Link 原著 Original Article
• 澳底學童血壓之研究－鈉、鉀鹽排泄與血壓Blood Pressure Study in Primary School-Age Population in Audi-Sodium, Potassium Excretion and Blood Pressure
• 賴美淑
  Mei-Shu Lai
• 無
  Na ; K ; Na/K-ratio systolic blood pressure diastolic blood pressure
• 無
  This study described the seated blood pressure distribution of 681 primary school children (6 to 13 years) in Audi village, Taipei County. The systolic and diastolic blood pressure increased with age. There was no significant different both in systolic and diastolic blood pressure between boys and girls. with the first measurements, 95th percentile value curves were defined. Subjects with seated pressures greater than the 95th percentile for shecific age and sex were examined on repeated occasion. 30 subjects found to have persisted elevated blood pressure were defined as hypertension group. One to one matched by sex, age, height and body weight were control group. The mean urinary sodium and potassium excretion of early morning first spot urine did not differ significantly between two groups. The Na/K-ratio showed no difference between two groups. Multiple regression analysis between blood pressure and seven independent variables-sex, age, height, weight, urinary Na, K, Na/K-ratio showed correlation (R=0.41 for systolic, R=0.51 for diastolic, p<0.0l). Stepwised analysis showed body weight was the most important determinant (R=0.37 for systolic. R=0.48 for diastolic).
• 58 - 64
• 10.6288/JNPHARC1984-03-01-07

• Link 原著 Original Article
• 兩所新型態社區醫療保健中心傳染病防治工作分析與展望兩所新型態社區醫療保健中心傳染病防治工作分析與展望
• 季瑋珠、江昭興、陳建仁、楊志良
  季瑋珠、江昭興、陳建仁、楊志良
• 無
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• 澳底與四湖，為近年成立的兩所新型態，示範性及實驗性的鄉村社區醫療倍使中心。澳底社區由台北縣貢寮鄉三個漁村組成，人口約6,000人（約1,000戶）；四湖鄉位於雲林縣西部沿海，人口39,562人（7,687戶），務農為主。傳染病防治在此二中心日常的衛生業務中，佔了相當重要的地位。本研究即針對此二中心的傳染病防治成效加以分析探討，並嘗試討論其優缺點與日後的展望。 如同其他基層醫療保健中心，澳底嘉興四潮的防治首要工作是預防接種，其中以嬰幼兒為主要重點，此外為霍亂、傷寒等全民接種。其次是社區傳染病偵測系統，除規定的報告系統外，二中心各有配合其社區狀況的實驗計畫。 嬰幼兒預防接種工作第一步為建檔，係利用戶政資料，其缺點是漏報與空戶，須靠家訪時的警覺性及社區人士的熱心協助加以補救。接著是家庭訪視，澳底採個別家訪，每遇工作量8戶次，四湖採集體家訪，每週52.3戶次，均?於全民建卡工作中，以為考核根據。每戶次澳底採綜合記錄方法，共須填6份記錄，四期則高達15份之多，其中頗多繁瑣重複，有待簡化之處。預防接種過去均以明信片通知，現改為使用預防接種卡依月齡接種，民?對二者之反應均不佳，往往需要工作人員深入社區宣導追?，亦須社區參與。疫苗包裝方面，大包裝對依月齡接種造成很大的困難，有待改進。接種的實施，二中心相較，四湖效率較高，而澳底的服務較廣泛深入，可同時舉顧健康增進及特殊防護。 傳染病偵測系統，二中心除規定報告系統外，均嘗試採行每日診療記錄資訊處理，盼能從中得到短期時地聚集狀況及長期流行趨勢分析，澳底尚有社區參與，對疫情的掌握頗有助益。 綜合本研究的分析，吾人認為，欲突破基層醫療保健傳染病防治工作現有的困境，必須引入有組織的社區力量，並建立電腦化連棧作業及基層健康資訊系統。
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• 65 - 72
• 10.6288/JNPHARC1984-03-01-08