4卷1期

• Link 原著 Original Article
• 中華民國公共衛生學會七十三年度會員大會來實致辭　李政務委員國鼎書面致辭中華民國公共衛生學會七十三年度會員大會來實致辭　李政務委員國鼎書面致辭
• 
  
• 無
  none
• 無
  none
• 2-6
• 10.6288/JNPHARC1984-04-01-01

• Link 原著 Original Article
• 以現代化訓練方式訓練基層保健工作人員Modernizing the Training of Trainers in Primary Health Care
• 陳喬治
  George P. Cernada, Dr. PH
• 無
  none
• 目前在開發中國家，如要提高全民的生活素質，則有效的訓練基層保健工作人員，是不可或缺的工作。這類訓練工作常遺遇兩點困難：其一是訓練者（常?醫師等執會高階層人士）與受訓者（常?中下層人士）之社會差距遠大；其二是一般使用的傳統式說教教育方式效果不佳。如要解除此二缺點，需盡力採用以實地訓練?主，受訓者?中心的方式，使受訓者由訓練準備之始，即積極參與於其計畫、執行及評估各階段工作。本文即對以自發性改進?基礎的學習哲學，與計畫、組織、執行及評估有關之教育目標及利用非傳統教學技巧、實地經驗、連續回輸（回饋）及受訓者參與教學的學習方式加以探討。這些方法包括：角色扮演、講故事方式、個案研究、自我學習、模擬練習及使用輕便的視聽教村等。
  Training community-based health care workers in ”Developing” countries is essential to improving the quality of life in both rural and urban areas. Two major obstacles to such training are the social distance gap between these community workers and their more highly-educated and upper class trainers (often medical officers and also the influence of the almost universal overly didactic, formal educational system. Bridging this gap demands a participant-centered, field-oriented app roach which actively involves the trainee in the design, implementation and evaluation of the training program. A philosophic learning approach based on self-initiated change, educational objectives related to planning, organizing, conducting and evaluating training and specific learning methodologies using participatory learning, non-formal educational techniques, field experience, continuing feedback are reviwed. Included are: structured experiences, flow charts, role playing, story telling, case studies, self-learning exercises, simulation exercises, Portapak videotape, visual illuatrations and models/teaching aids. The educational objectives set forth in this planned course for trainers of trainers, however, can be achieved only if they are carried out in a setting similar to the on e in which the primary health care worker will be in the future. This means that at least half the training ought to take place in the village or neighborhood -setting and the training officer should spend his evenings as well as days, intermingling with local people, sleeping. in similar housing, and eating local food: Such total immersion may violate some of the class orientations of the future trainers but should result in at least a minimal empathy with local conditions trainees will have to face. The means of providing sufficient creature comforts to keep the immersion approach from drowning the future trainers remains the job of the master trainer of trainers who will conduct this course.
• 7 - 18
• 10.6288/JNPHARC1984-04-01-02

• Link 原著 Original Article
• 自述性之健康測量自述性之健康測量
• 吳淑瓊
  吳淑瓊
• 無
  none
• 無
  none
• 19 - 25
• 10.6288/JNPHARC1984-04-01-03

• Link 原著 Original Article
• 機車意外傷害　台北市大型醫院急診傷患之流行病學研究Motorcycle Injuries an Epidemiologic Study of Clinically Emergent Cases
• 趙秀雄、譚開元
  Shiu-Hsiung Chao, Kai-Yun Tan
• 無
  none
• 以台北市居民在71年5月至72年4月期間因機車車禍受傷被送往台北市的台大，榮總，三總，長庾，馬偕，國泰，仁愛，和平，中興，空總，台灣療養院及徐外科等十二所醫院急診者為對象，以已擬妥的問卷調查記錄與機車意外傷害發生有關之資料，調查工作由各醫院急診室之護理人員擔任，獲下列結論： 1.在一年研究期間，共有4299位機車意外傷害者，其致死率為0.40%，意外傷害者的死亡數與發生數之比為1:252。 2.機車意外傷害的發生較多見於5-8月，每日下午的1-4時。 3.機車意外傷害者中，男多於女，受傷的機車駕駛人及附載人較為年輕，受傷的行人及腳踏車騎士較為年長。 4.也受傷的機車駕駛人及附載人大多從事於工、商業工作，學生居次，受傷的行人則多為無業人員。 5.機車意外傷害之發生，多見於汽缸小於125cc。之機車及車速在每小時15-40公里之間。 6.受傷機車駕駛人中，18.02%沒有駕照，88.29%沒有戴安全帽；受傷的機車附載人中，95.14%亦未戴安全帽。 7.未戴用安全帽的受傷駕駛人，大多為年輕、未婚之人，其中約三分之一受過高中（職）教育。 8.近半數的機車意外傷害發生在慢車道，20.17%發生在十字路口。 9.優傷害的部位主要發生在四肢尤以下肢；發生在頭頸及顏面部者亦僅三分之一強。 10.導致機車意外傷害發生的原因，主要為煞車不及，其次為超車不慎。因酒後駕駛而發生者亦佔7.19%。 11.71.18的機車意外傷害者於傷害發生後的20分鐘內放送到醫院救治；9.88%的受傷者於傷後半小時才被送往醫院，3.88%的受傷者於傷後2小時以上才被送往醫院救治。 12.台北市的機車意外傷害已相當嚴重，除應積極加強急救醫療工作，尤其是受傷現場之急救外，需加強對「人」「車」之管理，改善道路系統與設施。同時，亦宜應採取某些措施對機車數目作適當之限制。
  From May 1982 through April of 1983, a total number of 4,299 casualties were used as subjects for study to compile data concerning injuries and their related factors resulted from motorcycle accidents. They were brought to emergency rooms of twelve leading hospitals within Taipei City. The Investigative work was performed by emergency room nurses of respective hospitals, namely National Taiwan University Hospital, Taipei Veterans General Hospital., Chang Gung Memorial, Mackay Memorial, Taipei Municipal Jen Ai, Taipei Municipal Ho Ping, Tri-Service General, Cathay General, Municipal Chung-Hsin, Taipei Air Force General, Taiwan Adventist Hospital and the Hsu Surgical Hospital. Conclusion of this study is as follows: 1. In a period of one-year study, it was found that the fatality rate of motorcycle accident is 0.40%. The number of death against the number of injuries is 1 to 252. 2. The frequent occurrence of motorcycle accident is within the period of May through August from 13 to 16 o'clock especially of fine days. 3. Male casualties out numbered female ones; either drivers or riders. Their average age is 29.18 and 26.09 respectively. Pedestrians or bicycle riders injured by motorcyclists were older than motorcycle drivers. Their average age at occurrence is 33.03 and 36.10 accordingly. 4. Most of the motorcycle drivers and riders belong to industrial or business working class; students being listed secondary. The injured pedestrians belong to largely jobless groups. 5. A large number of the accidents were from motorcycles with cylinder volume less than 125 cubic centimeters at a speed of 15 to 40 kilometers per hour. 6. 18.02 per cent of the drivers suffered injuries from accident had no licenses; 88.29 per cent of them and 95.14 per cent of the injured riders did not wear protective helmets. 7. Most of the injured drivers were young and single; one third of them had finished high school education. 8. Almost half of the accidents occured at a slow speed vehicle lane, of road; 20.17 per cent at cross sections. 9. 54.69 per cent of injuries were seen at extremities especially the lower extremities (32.02%); 36.56% at head, neck or face. 10. The major cause of motorcycle accident is failure to stop in time, carreless overpass to be secondary, driving after alcoholic drinking being 7.l9 per cent. 11. 74.18 per cent of causalities were brought to hospitals for emergent management within 20 minutes after accident occurred; 9.88% of them being under emergency medical care after a 30-minute lapse; 3.88% arrived at a hospital two hours later after accident occurrence. 13.48 per cent of motorcycle causalties require hospitalization for treatment. 12. Motorcycle injury has become a serious problem to residents of Taipei City. Emergency medical care service should be strengthened and amplified, especially on-site life-saving techniques. Administrative measures related to traffic should be improved.
• 26 - 43
• 10.6288/JNPHARC1984-04-01-05

• Link 原著 Original Article
• 血清流行病學在鳥型流行性感冒上之研究Application of Seroepidemiology to Prospective Studies of Avian Influenza
• 高宛珍、錢佑
  Wang-Jane Kao, You Chan
• 無
  none
• 無
  This study was conducted to evaluate the usefulness of the single radial haemolysis (SRH) technique for the detection of antibodies to avian influenza viruses in sera from people in the geographic regions of Pearl River Delta and Taiwan. Antibodies were found to all known avian virus haemagglutinin subtypes and populations from rural areas showed different extents of exposure from those in urban environments (p<0.05). Additionally, people from the rural areas showed evidence of multiple infection by these avian influenza viruses. The importance of these findings is discussed in the context of the hypothesis that human pandemic influenza has its origin in a non-human species. The fact that viruses of a particular subtype are more frequently isolated from animals especially ducks is H4, and in this study antibody to the H4 subtypes were jointly the most common antibodies (except H3) detected occurring in 10% of the rural area sera.
• 44 - 55
• 10.6288/JNPHARC1984-04-01-06

• Link 原著 Original Article
• 台北市自來水生飲可行性之調查研究A Study on the Potability of Unboiled Tap Water in Taipei City
• 林宜長
  Yi-Chang Lin
• 無
  none
• 為採討現階段台北市自來水水質是否可以生飲，於民國71年9月到72年2月間筆者曾對台北市十六個行政區中之903個自來水用戶（內含九所國民中小學）做實地調查訪問，所得知見如下： 1. 有相當比例的被訪樣本戶，其龍頭水中之游離餘氯濃度低於決定標準之下限（即小於0.2ppm）。 2. 有相當部分的受訪戶，其水表後之用水設備不是使用不當就是維護不良。 3. 推論台北市自來水用戶之龍頭水水質目前尚難全面符合生飲的要求。 4. 也建議主管單位善用大眾傳播媒體，使用戶瞭解到良好而清淨的用水設備以及節約用水是決定自來水是否可以生飲的先決條件。
  In order to evaluate if municipal tap water can be drunk safely without boiling, a field survey of water-sanitation practices of the public was conducted from September 1982 to February 1983. The total number of the interviewees, who were distributed in 16 districts of Taipei,was 903 and among them 9 were school officials and 894 were from the general population. In this survey, both the free residual chlorine levels and the physical features of water-supply facilities as well as sanitary safeguards were observed by 9 competent persons. Before the start of the survey, a meeting was held to systematize the method and manner of the interviewers. The main findings are summerized as follows: 1. There is a considerable proportion from the interviewed house-holds, whose tap water has a free residual chlorine concentration under the standard limit. (that is, the concentration is bellow 0.2 ppm) 2. There is a considerable proportion of the interviewees, whose water supply facilities after the water gauge have poor maintainance and/or are used incorrectly. 3. We conclude that at present, tap water in Taipei can not fully meet the requirements for directly drinking without boiling. 4. we recommend that the appropriate offices utilize the mass media to educate the public about tap water use. Then, they will know that a clean and proper water supply facilities as well a water conservation progran will result in the goal of obtaining potable water without boiling.
• 56 - 74
• 10.6288/JNPHARC1984-04-01-07

• Link 原著 Original Article
• 台北市70歲以上老人健康與生活現況之研究Study of the Health and Living Conditions of the People Aged 70 and Above in Taipei City
• 魏登賢、吳康文、朱允綺
  TengHsien Wei, Kang-Wen Wu, Yuen-Chii Ju
• 無
  none
• 設籍於台北市70歲以上老人，由地段公共衛生護士，以挨戶訪視方式，按調查之健康管理卡內容逐項調查，並測量老人的血壓、測試尿蛋白及尿糖，並了解70歲以上高齡老人的健康和生活狀況，作為照顧旁人健康之重要依據。 完成建卡訪視共22857人，其中70-74歲佔31.5%，75-79歲佔39.4%，80-84歲佔19%，85-89歲佔7.3%，90歲以上2.7%，女性越高年齡之比率比男性為多。男性之配偶健在率比女性的高。老人和家族，夫婦一起生活者佔83.9%。老人之生活費66.5%由別人供給。生活情趣以看電視、散步為多。疾病方面以高血壓，老年性退化為多。參加健康檢查只有49.2%，檢查地點以公立或綜合醫院或衛生所為多。高血壓之發生率為17.3%，邊際高血壓為27.4%，尿糖陽性佔6.4%，尿蛋白陽性佔8.6%。 由本調查發現女性較長壽，喪偶之比率高，因此提高男性之平均餘命，使夫婦能白頭偕老，或使?寡皆能與其家人生活在一起，共享天倫之樂則是我們希望能做到的，旁人的日常消遣以靜態的看電為最多，然而老人之養生之道應該兼顧動態，活動身體的休閒活動要多舉辦。 建卡工作從訪為中了解老人的健康情形，發現其健康需要應鼓勵老人及早參加健康檢查，依老人的死因調查以心臟病、腦血管疾病為主，所以對於老人的健康應重視前述之疾病以及其誘導的疾病。 綜上結果：近年來，由於公共衛生的進步，台北市70歲以上之旁人亦有日漸增多之趨勢，因此，及早了解旁人之健康情形與需要，給予其更妥善之照顧與服務，遂成為我們今次應努力之方向。
  In order to understand the health status and living condition of the elderly above 70 years in Taipei City, a survey was carried out by public health nurses. Through home visits, the items on the ”health control card” were completed, blood pressure, urine protein and sugar tests were also recorded. In 27,857 visits, 31.5% of the elderly were 70-74 years of age, 39.4% were 75-79 years of age, 19% were 80-84 years of age, 7.3% were 85-89 years of age, and 2.7% were above 90. The proportion of females increased as the age increased. There were more widows than widowers. 83.9% of the elderly were living with their family or spouses. 66.5% of the aged were financially dependent. Watching TV and taking walks were the most often and interesting activities they participated in. The most common health problems were hypertension and aging degeneration, only 49.2% had regular physical check-ups, most at general city hospitals or health stations. The incidence of hypertension was 17.3% and 27.4% had marginal hypertension. Positive reactions of urine sugar and urine protein were 6.4% and 8.6% respectively. The survey showed that females have a longer life expectancy than males. The way to increase the life expectancy of males and to decrease the number of widows, and to have widows and widowers live with their families and enjoy a happy family life is where we should make efforts. In the mean time, encouraging and holding more outdoor activities for the elderly will be our main goal. The survey revealed that heart diseases and cerebrovascular diseases are the main causes of death in elderly people. In order to prevent these diseases and their induced diseases, routine physical check-ups for the elderly should be encouraged. Due to the improvement of public health, aged people above 70 years in Taipei are increasing. To understand the needs and the health status of the elderly and offer appropriate care and services has become one of the most important subjects in public health.
• 75 - 85
• 10.6288/JNPHARC1984-04-01-08

• Link 原著 Original Article
• 農村醫療需求之調查研究第I報：農村醫療行為、疾病型態，醫療費用以及參加預付醫療保險制度意願之初步探討A Survey of the Demands for Medical Care in Rural Area I: A Preliminary Study of the Medica Behavior, Morbidity Patterns, Medical Expenditures and the Willingness to Pay for Prepaid Health Insurance
• 張永源、張博雅、 張坤崗、謝獻臣、王金茂
  Yong-Yuan Chang, Po-Ya Chang, Kung-Kong Chang, Hsien-Chen Hsieh, Chin-Mao Wang
• 無
  none
• 為探討農村地區居民的醫療需求，特選定屏東縣高樹鄉，從民國71年8月30日至9月8日，以多段、系統隨機抽樣方法，共計調查l,008戶（佔抽樣家戶之98.25%)，完成個人健康檢查2,834人（佔抽樣健康人數之71.31%）。調查結果如下： 1. 未加入健康保險家戶佔89.98%，而最近一月內184位病患中未加入健康體檢者佔95.10%。 2. 家戶自覺有病最常使用的求醫方式是找西醫，佔71.66%；其次是至西藥房購買成鷓，佔23.13%。家戶社會經濟地位愈高者，找西醫看病的比例也愈高。 3. 家戶在本鄉平均每看一次病或買一次藥花費約153元，至外地屏東地區看病之平均花費是214元，顯著高於在本鄉之花費（不包括來回之旅費）；其他如至高雄及高屏以外地區看病之花費也高於本鄉及屏東。 4. 病患一月內求醫地點以選譯診所最多，佔44.56%；其次是醫院，佔29.35%。平均每人一月內求醫次數以中醫（含中藥房）最多，3.6次；其次是醫院、診所，各為3次。平均每人每次求醫所花時間以至醫院看病最久，平均2.78小時；其次是至診所，平均2.39小時。平均每人每次求醫費用，以醫院最貴，400元／次；其次是中醫，300元／次；再其次是診所，180元／次；西藥房是70元／次。 5. 平均每人每日之住院費用是4,500元；每次平均之住院時間為9.5天。最近一月內婦女生育場所以在醫院最多，佔43.10%；其次是在他鄉診所，佔20.68%。生育費用以3,000至6,000元／次的比例最高，佔48.28%；其次是3,000元以下，佔36.21%。 6. 最近一月內患病之184位居民，以罹患循環器系疾病佔第一位(19.02%)，消化器系疾病佔第2位(17.93%)；呼吸器系疾病佔第3位(17.39%)。測量2,157位15歲以上居民血壓之結果，發現高血壓之罹急率為15.72%。若將長期在外求學與年輕工作者也一併考應在內，則實際15歲以上高血壓之羅忠率應略低於15.72%。經年齡標準化後，男性15歲以上高血壓之罹息率為11.29%，女性為10.62%。 7. 以預付健康保險方式，每戶每人每月固定斟收保險費100元，而願意加入在本鄉新設置醫療單位門診的家戶佔71.43%；如固定收保險費200元，顯意加入新醫療單位門診與住院的家戶佔51.89%。 8. 家戶各項收入與支虫調查結果，平均每戶每人每年收入為32,692元，支出為25,138元，比行政院主計處71年統計平均農家每人所得60,003元，支出30,953元及台灣省家庭收支調查報告平均每人每年所得44,949元，支出26,928元要低。醫療保健費用支出，每戶每年約6,000元，平均每人約1,154元，佔總消費支出的4.59%，此數字比台灣省家庭收支調查報告平冷每人醫療保健支出1,425元，也要低些。
  In order to study the demands for medical care in rural area, a questionnaire-interviewed survey was undertaken in Kao-Hsu Hsiang, Ping-Tung county with multi-stage and systematic random sampling method. A total of 1,008 households were surveyed and interviewed, and 2,834 individuals' health exams were completed. The results of the interviewed survey were summarized as followings 1. The % of the households not covered by health insurance was 89.98, and in 184 sick persons within one month of surveying period, 95.10% were not covered in health insurance. 2. 71.66% of households went to see modern physicians when they were selfawared of illnes, which was the most common way used for seeking medical care; 23.13% of the households went to drug store for medication was the second in frequency. The families with higher socioeconomic status had high frequencies of usuage for seeing a modern physician. 3. The average medical expenditures spent on medical care per person each' time by the households was NT $ 153 in local area, but the average medical expenditures spent was WT $ 214 in Ping-Tung area, which was significantly higher than that in local area, (The medical expenditures did not include round traveling fees), and the average medical expenditures spent in kaohsiung and other areas except local and Ping-Tung areas were also higher than that in local area. 4. About 44.56% of the sick individuals sought medical care within one month of surveyed period in clinics, which were the most frequent places selected for medical care. Seeking medical care in hospitals were the second, about 29.35%. The median frequencies of seeking medical care per person within one month in herb medication was 3.6 times; three times respectively in hospital and clinic, were the second. The median time costs for seeking medical care in hospital were the longest, 2.78 hours per person each time; in clinic were the second, the median time costs in clinic were 2.39 hours per person each time. The median medical expenditure per person each time, hospital was the most expensive, NT $ 400; herb medication was the second. NT $ 300, and then the less were clinic and drug store, NT $ 180 and NT $ 70 respectively. 5. The median hospital stay expenditures per person per day was NT $ 4,500 the median hospital day was 9.5 days per hospital stay. The most frequent birth place of the women in child rearing age within one month of the surveyed period was in hospital, abaut 43.10% to all birth places. Birth in clinic was the second, about 20.68% to all birth places. The highest proportion of the birth expenditures was between NT $ 3,000-6,000/perbirth, about 48.28%; birth expenditures below NT $ 3,000/per birth was the second, about 36.21%. 6. The 184 individuals who were sick within one month during the surveyed period revealed illness of circulatory system was the most common in all illnesses which they had been attacked. (19.02%); illness of gastrointestinal system was the second (17.93%); and illness of respiratory system was the third (17.39%). The morbidity rate of hypertension in 2,157 inhabitants. aged above 15 years old was 15.72% The actural morbidity rate of hypertension would be slightly less than 15.72% after including the young inhabitants of long term schooling and working in urban areas. 7. If the insurance premium in prepaid form of group pratice was defined NT $ 100 per capita per month, then the households had the willingness to enroll in OPD medical care of the new medical care unit set up by Kaohsiung medical college affiliated hospital in Kao-Hsu Hsiang was 71.43% to all households surveyed. If the insurance premium in prepaid was defined in NT$ 200, the willingness of the households that could be served for medical care in OPD and hospital stay was 51.89% to all households surveyed.
• 86 - 105
• 10.6288/JNPHARC1984-04-01-09