5卷1期

• Link 原著 Original Article
• 醫學生社會化影響因素之探討A Study on Factors Influencing Socialization of Medical Students
• 季瑋珠、楊志良
  Wei-Chu Chie, Chih-Liang Yaung
• 醫學生 ； 社會化
  Medical students ; Socialization
• 為瞭解目前台灣地區醫學生的社會化過程及其影響因素，發掘其中的問題，以對國內的醫學教育提供具體的建議，吾人就以下五方面：(1)學校機構特徵；(2)家庭及個人基本的特徵；(3)習醫過程的生活與適應；(4)價值觀念與態度；(5)專業生涯選擇與期望，以問卷調查了台大與高醫醫學糸一、四、七，三個年級的學生，結果要點如下： 1．學校社會人文科學訓練不足，缺乏生動實用的人道精神教育，過度強調尖端科技及精密儀器，將成就和發展侷限於高度專料分化始教學醫院，尤以台大為然，這些都是致使醫學生與社會需求脫節之因子。 2．醫學生以男性(88.4%)及本地生(70.0%)為主。醫學生多來自地位優越的家庭（例如：出生於都市化程度在省轄市及以上的醫學生占44.4%，家庭之社會經濟地位在Ⅰ及Ⅱ位者，各占19.0%及28.0%），且有醫師之家族聚集傾向（家族中有醫師者占46.7%）此顯示醫學生之生活背景與一般社會大?有相當距離；醫學生入學前多經過激烈的升學競爭與淘汰（高中有40.0%，畢業於建中或北一女中，71.7%參加過補習，有55.3%曾經重考），尤以台大為然。 3．醫學生自覺的人際關係尚稱健全，但休閒活動及壓力適應呈現不少問題。主要的壓力來源在低年級多屬人格發展及生活適應問題，高年級則加上專業問題，適應方法多採自已摸索，次為訴諸關係親密的朋友、家人、或師長、學長。座談討論及課堂講授的方式甚少使用，高醫在習醫過程生活及適應上，較台大略為健全。 4．個人習醫期望隨年級漸趨現實，但仍以教人服務(87.5%)、學術成就(68.1%)與穩定生活(58.6%)為重。醫師角色方面，偏好傳統認定夠醫學與社會角色，但高年級社會角色傾向較高，而台大醫學生之期望較偏離傳統。有97.6%的人認為醫療工作有賴團隊合作，44.4%的人認為領導者不一定須白醫師擔任。醫學生認為理想醫師的社會人文素養應占全部素養的39.1%（標準差12.0%）。 5．80.8%的醫學生在初步專業生涯，80.0%在穩定專業生涯選擇期望從事臨床醫學，且比率隨年級上升（七年級均約90%選譯臨床），服務型態及地點偏好高度都市化地區（68.5%期望在院轄市），醫院性質的工作（公立醫院51.5%私立醫院27.4%），此二方面的集中趨勢台大又較高醫顯著，期望收入平均（對數）每月新台幣8.30（標準差2.14）萬元。科別選擇偏好傳統已認定之分科，新興分科尤其走幕後工作，如麻醉、病理等乏人問津，但家庭醫學則已開始受到重視。 6．初步及穩定專業生涯，期望服務地點及出國的期望程度，可用校別、年級、家庭及個人基本特徵、習醫過程的生活與適應及價值觀念與態度之諸變項加以預測。本研究的結果，和國內外許多學者的研究結果相似，顯示了醫學教育的種種問題，於此，吾人建議： 1．醫學教育，甚至整體教育應有全盤的檢討與改進，宜著重創造力的培養、人道精神的發?及團隊合作的訓練，尋求觀念上、方向上、實際教育工作及出路安排上的突破與創新。 2．多方探討、研究、評價、考核，擴展至各相關醫療保健人力訓練計劃。
  In an effort to understand the process of socialization of medical students and factors affecting it, medical students of 1st, 4th, and 7th grade of National Taiwan University Medical College (NTUMC) and Private Koushiung Medical College (KMC) were investigated. Five aspects of this investigation are (l) Institutional characteristics of the schools, (2) Familial and personal characteristics, (3) Life style and way of adaptation during course taking, (4) Values and attitudes toward medicine, and (5) Professional carrer expectations. The results are summerized as followings 1. It is lack of necessary training on social sciences within medical school, as well as useful education on humanism. The medical education has too much emphasis on high technology and sophiscate instruments, students’ achievements and developments are limited within highly specialized teaching hospital, especially at NTUMC. These are all the factors which hampers the medical students to become physicians who take care of ”human ” patients. 2. The majority of medical students are male (88.4%) on sex, and Taiwanese (70.0%) on domicile. In addition, most of them came from families with high social class, eg. 44% of them were born in urban area (provincial city and above); 19.0% and 28.0% of their families are level ?and ? in socio-economic status (SES), respectively; 46.7% of them have at least one physician among their familial members. These characteristics indicate that medical students have quite a large social distance from ordinary patients. In order to enter medical schools, the medical students experienced very tuft competetion and screening. 40.0 % of them graduated from the ”first class high schools (the best boy or girls' high schools), 71.7% had attended supplementary schools. 55.3% had taken at least twice entrance examinations. This tendency is more prominent at NTUMC. 3. Medical students' self perceived interpersonal relationships are overall not too bad. However, regarding stress adaptation and leisure activity, there are some problems.. The main source of stress among junior students are that of personality development and school life adaptation, and those problems among senior students are mainly career selections. The ways of adaptation are mainly by ones' self, secondly, consulting with close friends and family members, or teachers and senior peers. They seldom hold formal discussions or attended seminars of this sort in the class. In overall, the life style and the way of adaptation of KMC students are healthier than that of thieir NTUMC peers. 4. Personal expectations are toward more practical rather than idealism while getting senior. However, the main expectations reported are still to save people and to serve the society (87.5%), to acquire academic achievements (68.1%), and to have stable life (58.6%). Comparing with students of KMC, those of NTUMC have lessened criteria on what are bads of physicians. Regarding Physicians' social roles, most medical students prefer traditionally recognized ones, but senior students are more willing to parcitipate societal activities. 97.6% of them recognize the necessity of team-work in medical care, and 44.4% of them regard that the leaders of the team need not to be physicians. The average amount of social science knowlege of an ideal physician is 39.1±12.0%. 5. 80.8% and 80.0% of them, chose to be a clinician at the beginning of their career, and the final goal, respectively. And this rate become higher while getting senior. Regarding working locality, most medical students prefer highly urbanized areas and to practice in large hospitals-68.5% wish to work in National metropolitan area, 51.5% prefer public hospitals and 27.4% private hospitals. The tendency is more prominant at NTUMC. Average expected income is NT$83,000 ±21,400 per month. Medical students prefer traditionally recognized specialties. New specialties, ”especially those behind-the-scenes” departments, e.g. anesthesia and pathology, are still far from popular. However, more and more students, are paying attention to family medicine. 6. By multivariet analyses, we find that the beginning and final career choice, expected wora place and expectations for going abroad can significantly be predicted by variables such as school, grade, familial and personal basic characteristics, life adaptation during learning process, and values and attitudes. The result of this study is similar with that of many others, and many problems are revealed. Accordingly, we would like to suggest 1. We should review the entire medical and overall education system and necessary improvements must be carried out accodingly. The medical education system must pay more attention to develop the ability of creativeness, the knowledge of humanism, and the concept of team-work, therefore, breakthrough and innovation on the concept, orientation, and practice as well as the career development can be made. 2. Much more and better researches must be done on this issue, and similar studies must be expanded to other medical related training programs.
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• 10.6288/JNPHARC1985-05-01-01

• Link 原著 Original Article
• 絲膿桿菌之研究小白鼠接種綠膿桿菌疫苗所産生之保護作用Studies on Psedomonas Aeruginosa Protection Induced in Mice by Immunization with Pseuclomonas Vacuine
• 除豐生、戴佛香
  Feng-Sheng Chen, Fu-Hsiang Tai
• 無
  none
• 本實驗利用小白鼠實驗性膿桿菌致死性傅染之保護作用以評估二膿桿菌菌疫苗。選?當地最常見，毒力高，且對多教抗生素，包括亞米辛(amikacin)珍他徽素(gentamicin)，特卡西林(ticarcillin)，西福他辛(cefotaxi-me)及多豁?菌素B(polymyxin B)有抗果性菌株，Nll24，製出加熱毅死及福雨馬林處理疫苗，每種疫苗均可刺激小白鼠度生高效價膿桿菌菌凝集素；經追加注射後，其效價更高。?此疫苗接種小白鼠，經一定期間，對同型菌株所?生之致死性傅染有?著之保?作用。其中接種福雨馬林處理疫苗之小白鼠?生之凝集素效價比加熱毅死疫苗高，但對於同型菌株?生致死性傅染之保?作用似無明顯之差異。
  Two pseudonxnas vaccines were evaluated for their capacity to provide protection from experimental pseudomonas fatal infection in mice. The strain of pseudomonas aeruginosa, N1124, with virulence isolated locally, which is fully resistant to most antibiotics, such as amikacin, gentami - cm, ticarcillin, cefotaxime and polymyxin B, was selected for preparation of vaccine. Two vaccines: the heat killed and formalin treated, each produced high titer of pseudomonas agglutinin in mice by immunization, and higher titer of agglutinin was produced after booster injection. Significant protection against the same pseudomonas strain challenged was conferred by vaccination with these products. Of the two vaccines, higher titer of agglutinin was induced by formalin treated vaccine than the heat killed vaccine. But protection effect seemed to be no significant difference. Since the immunity of pseudomonas aeruginosa is rather type specific, it is required to use polyvalent vaccine for general preventive purpose.
• 24 - 37
• 10.6288/JNPHARC1985-05-01-02

• Link 原著 Original Article
• 台北市智能不足兒童危險因素之初步探討台北市智能不足兒童危險因素之初步探討
• 魏登賢、林武雄、李鍾祥、陳玉華
  Teng-Hsien Wei, Wu-SHuang Lin, Jwang-Hsiang Lee, Yui-Hwa Chen
• 無
  none
• 為了初步探討造成智能不足兒童之危險因素，及了解智能不足兒童接受治療、復健、及教育舫情形，我們對台北市收容輕度智能不足的國民中、小學抽選樣本舉辦家長問卷調查，及對失學的中度及重度智能不足兒童到收容的育幼院實施採血樣檢查。 從調查結果顯示，智能不足兒童之母觀於懷孕期間曾經遭受之危險因子以照射X光最多，佔5.5%，其次為產前出血，佔5.1%，再者為德國麻疹0.7%，孕毒症0.3%：而兒童在出生一個月內曾經發生的疾病以發燒39℃以上為最多，佔15.4%，其次為生產過程中受傷而引起缺氧，8.6%，再者為抽痞5.8%，黃疸5.1%，腦炎2.4%，腦受傷2.4%；孩童在出生一個月以復曾經發生過飴疾病仍以發燒在39℃以上者為最多，佔14.4%，其次為腦受傷7.9%，再者為痙孿7.5%，腦炎2.4%，發紺1.0%，甲狀腺功能不足1.0%。而抽血檢驗的結果，只發現2名個業疑似甲狀腺功能低下。 由於所採樣本數不多，因此本研究所得結果僅可作初步之參考，無法對相關因素作推論性的判斷。
  A Preliminary Study of Risk Factors of Mental Refarded Children in Taipei In order to elucidate the risk factors of mental retardation, a total 292 mildly retarded children and 275 moderately and severely retarded children were studied. For those mildly retarded children, a carefully edited questionnaire. was employed to inquire mothers with regards to the possible risk factors in the development of the retardation. For those moderately and severely retarded institutionalized children, blood specimens were obtained to examine the association between inborn error metabolism and moderate or severe retardation. The main results are as followings: 1. During the pre-natal period irradiation (5.5%), pre-natal bleeding (5.1%), German Measles (0.7%), and eclampsia (0.3%) was found to be associated with the mild retardation. 2. Within the first month after birth, the following possible risk events of mild retardation were observed, fever over 39? (15.4%), hypoxia (8.6%) convulsion (5.8%), jaundice (5.1%), meningitis (2.4%), and brain injury (2.4%). 3.After the age of one month, fever over 39? (14.4%), brain injury (7.9%), convulsion (7.5%), meningitis (2.4%), cyanosis (1.0%), and hypothyroidism (1.0%) were related to the mild retardation. 4. Only t of the 275 moderately and severely retarded chi ldren's blood specimens were suspected to have hypothyroidism. This retrospective preliminary findings may serve as a pilot study of a larger, more sophisticated, better designed and better defined prospective study ot the risk factors of mental retadation in Taiwan.
• 38 - 47
• 10.6288/JNPHARC1985-05-01-03

• Link 原著 Original Article
• 日、韓兩國癩病防治考察報告日、韓兩國癩病防治考察報告
• 陳柯秀貞
  陳柯秀貞
• 無
  none
• 無
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• 48 - 50
• 10.6288/JNPHARC1985-05-01-04

• Link 原著 Original Article
• 設立全國醫療綱之展望設立全國醫療綱之展望
• 藍忠孚
  藍忠孚
• 無
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• 無
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• 51 - 55
• 10.6288/JNPHARC1985-05-01-05

• Link 原著 Original Article
• 地區醫院於醫療網之角色與功能地區醫院於醫療網之角色與功能
• 許國敏
  許國敏
• 無
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• 無
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• 56 - 57
• 10.6288/JNPHARC1985-05-01-06

• Link 原著 Original Article
• 基層醫療院所於醫療網之角色與功能基層醫療院所於醫療網之角色與功能
• 李建廷
  李建廷
• 無
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• 無
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• 58 - 59
• 10.6288/JNPHARC1985-05-01-07

• Link 原著 Original Article
• 農民健康保險與地區醫療農民健康保險與地區醫療
• 前田信雄 ； 吳凱勲
  前田信雄 ； 吳凱勲
• 無
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• 無
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• 60 - 62
• 10.6288/JNPHARC1985-05-01-08

• Link 原著 Original Article
• 配合農民健康保險，試辦社區醫療保健方案配合農民健康保險，試辦社區醫療保健方案
• 楊志良
  楊志良
• 無
  none
• 無
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• 63 - 66
• 10.6288/JNPHARC1985-05-01-09