6卷2期

• Link 綜論 Review Article
• 老年性痴呆的病因探討Etiologic Review of Senile Dementia
• 季瑋珠
  Wei-Chu Chie
• 無
  Senile Dementia ; Alzheimer's type
• 無
  With the aging of populaticn, Senile Dementia became an illness of increasing importance in every society, not only as usual in those developed countries but also in developing ones. In order to identify the possible etiology and mechanism of this degenerative and disabling illness, original and review articles about the tio1ogy of Senile Dementia of Alzheimer's type from epidemiologic as well as neurobiochemistric point of view have been examed. From these information at hand, results show that the incidence and prevalence of Senile Dementia are increasing with age, female sex and some social factors. Those factors related to the onset of illness were hereditary and immunologic chracteristics, head injury history and aluminum deposition. Suggestions focuses on a possible mechanism which need furthur epidemiological and neurobiochemistric investigation.
• 1 - 14
• 10.6288/JNPHARC1986-06-02-01

• Link 原著 Original Article
• 嬰兒出生通報系統之研究A Study on the Birth Registration System
• 吳淑瓊、楊志良
  Shwu-Chong Wu, Chih-Liang Young
• 無
  none
• ?了迅速、正確、且完整掌握人口出生動態，提高婦幼衛生保健服務時效，並提升與嬰兒有關各項人口衛生統計資料－末期胎兒、週產期、新生兒、及嬰兒死亡率等之正確性，本研究特改變目前由嬰兒父母或家人申報嬰兒出生之登記系統，另再設計由接生人員直接通報嬰兒出生及出生結果之通知系統，並以民國73年5月出生，父母籍設台北縣之嬰兒?實驗對象，以實驗本通知系統之可行性。於實驗過程中，本研究並配合戶政單位轉來已申報戶籍者之出生死亡登記資料，及衛生所護士對未申報戶籍個案一年追?訪視所得之死亡資料，而得以分析樣本嬰兒於本研究資料收集期間（一年）內之戶籍申報及死亡情形，茲將主要結果摘述如下： 一、本研究總計由台北市、縣140家接生場所回收2887份嬰兒出生資料；由台北縣29個鄉、?、市衛生所回收來自戶政單位轉來之3768份嬰兒出生登記申請資料；接生場所回收資料少於戶政單位者，顯見在目前尚無法令依據下，向接生場所索取嬰兒資料之困難。 二、樣本嬰兒申報戶籍時間分析：（一）由衛生所回收資料得知，於本研究資料收集期間（自嬰兒出生至一年）內已辦理出生登記之嬰兒中，台於規定辦理出生登記者僅46.74%（出生後15天內辦理者），如再累加一年內尚未申報戶籍者，則估計合於規定者僅35.22%。又如以生命表分析之，於研究期間（一年內）已申報戶籍嬰兒之預期平均申報時間?出生後24、73天，較規定之15天?晚；又如再加入一年內尚未申報戶籍個案，則當更?延長。（二）由接生場所回收資料得知，合於規定辦理出生登記者占41.95%，又由生命表分析，平均預期申報日期?出生後54、83天。 三、樣本嬰兒死亡情形分析：以接生場所各期回收嬰兒出生及死亡資料，配合衛生所回收已申報戶籍嬰兒死亡登記資料，並假設已登記戶籍者之死亡情形與民國72年台北縣者相當，可估算樣本嬰兒各項死亡率如下： 1.末期胎兒死亡率：8.27~12.42%。 2.週產期死亡率：16.55~21.01%。 3.新生兒死亡率：8.60~9.46%。 4.嬰見死亡率：11.12~14.91%。 （較民國72年台北縣嬰兒死亡率6.34%高出甚多） 四、由以上戶籍申報不合規定情形，及死亡率高於目前政府之登記報告可知改善目前出生登記系統之重要性，又由產婦於醫院、診所、助產站生產者占98.75%可知由接生人員直接通報出生以補現行戶政登記系統不足之適當性及可行性，但於實際推廣時，則需考慮如何促進各機關間，包括戶政、衛生、與接生場所間之密切聯繫，如何簡化資料收集流程以求其暢通，更重要的是明確立往規定接生場所之通報責任，方能迅速且完整的收集與傳遞嬰兒出生資料，以收系統改善之效。
  The study was conducted in order to promote the accuracy of vital statistics about infants, and to obtain infant birth information more rapidly and completely. Infants born in Taipei County from May 1, 1984 to May 31, 1984 were selected as our study sample. Both health professionals and officials of household administration agencies in the study area were asked to provide infant birth information. After matching these 2 resources of infant birth information, the unregistered infants were recorded and followed their survivorship up for one year after their birth by public health nurses. Based on the infant birth data collected, we found: I. Under current household registration regulation, most birth registrations were with some delay. II. The estimats of various death rates about infants are as follows: 1. Late Fetal death rate: 8.27%-12.42% 2. Perinatal death rate: 16.55%-21.01% 3. Neonatal death rate: 8.60%-9.46% 4. Infant mortality rate: 11.12%-14.91% The estimated infant mortality rate much higher than official report (6.34% 1983) The findings suggested the necessity of including health professionals to the birth registration system, and the importance of studying the feasibility of implementation of this modified system in the Whole Taiwan Area.
• 15 - 27
• 10.6288/JNPHARC1986-06-02-02

• Link 原著 Original Article
• 醫學統計學之電腦輔助教學Computer-Assisted Instruction for Medical Statistics
• 曾文雄、何國魁、胡淑貞
  Wen-Hsiung R. Tseng, Kuo-Kuei Ho, Shu-Chen Hu
• 無
  none
• 以英文編寫「醫學統計學」的電腦輔助教學之課程體及軟體，供大專院校與醫學、公共衛生有關科系的師生及執業醫護人士，做?自學、參考、複習之用。 硬體設備?16位元微電腦（IBM-PC或共相容性微電腦），具128K以上的記憶量，單色高解析度繪圖卡，軟式磁碟機。程式軟體使用Turbo Pascal 3.0及Turbo Graphix Toolbox。課程體共18章：緒言、變數、取樣、集中及分散量數、常態分布、假設檢定、t分布和檢定、二項分布和檢定、卡方分布和檢定、F分布和檢定、變方分析、?歸、相關、無母數統計、比率和標準化比率、生命表、篩選檢定、相對及相差危險性。 以輔導法編寫課程體及軟體，其流程依序?緒言、呈現教材、提出問題及答案、判斷答案、回饋答案或補救及結束。
  This study designs the coueseware and software of Medical Statistics for students of medical college and medical doctors. According to the structure of medical statistics and principles of learning cognition, eighteen chapters are selected and arranged in order of increasing level of difficulty. The hardware is the 16-bit microcomputer (IBM-Pc or its compatible models), with disk drive, monochromatic screen, Herculus Graphic card. The software is written by PASCAL, a popular, machine-independent language, good in procedure and structure. The courseware is written in English. Tutorial is the main method in presenting information and guiding the student; simulation and instructional game will be used as well in case of need. The chapter titles are: introduction, variables, sampling, statistics of central endency and dispersion, normal distribution, hypothesis testing, t-distribution and t test, binomial distribution and test, chi-square distribution and test, F distribution and test, analysis of variance, regression, correlation, non-parametric statistics, rates and standardized rates, life table, relative and attributable risks. Each chapter includes information presentation and questions for users to do self study or after class reviewing so as to solve practical biostatistical probelms in medicine.
• 28 - 37
• 10.6288/JNPHARC1986-06-02-03

• Link 原著 Original Article
• 台北地區醫院傳染病報告現況之評估Evaluation of the Reporting System for Communicable Diseases in Taipei, 1981-1983
• 吳美滿、陳建仁、李鐘祥
  Meei-Maan Wu, Chien-Jen Chen, Chung-Hsiang Lee
• 傳染病防治 ； 疾病偵測 ； 流行病學方法
  communicable disease control ; surveillance ; epidemiologic method
• ?瞭解台北地區現行傳染病報告通報單的完整性、代表性以及時效性問題，本研究評估民國70年至72年間台北市五家准一級以上教學醫院有關傷寒副傷寒、小兒麻痺、百日咳、志賀氏痢疾等的通報情形，並調查183名住院醫師對傳染病報告的實際行?而提示改進報告系統之建議。研究結果發現：雖然疾病的平均報告率只有42%，但是由報告病例所得之性別、年齡、發病地點的分布，與由住院病例所得之分布相近；但是由於流行初期的病例往往未被報告，以至無法正確而及時掌握流行的時間變化。時效性方面，?要確定病例而過於依賴實驗診斷，以致影響疾病報告的時間。根據評估的結果及對醫師的問卷調查，本研究建議除了按疾病特性增加利用醫院檢驗室?報告的來源，以及加強通報單接報後的追跺調查外，並應有系統定期性地評估各項污染病報告的績效，以確實瞭解報告的內容、方式是否有效被執行。
  In order to evaluate the completeness, accuracy and timeliness of the reports of communicable diseases, we have interviewed 183 resident physicians from five teaching hospitals in Taipei, and reviewed 194 discharge records of typhoid and paratyphoid fever, poliomyelitis, whooping cough and shigellosis during 1981-1983 from these hospitals. Though the percentage of these cases reported averaged 427, the reports were useful as a guide for disease coutrol. But these reports should be improved to be able to recognize the state of the epidemic. Delays in reporting is a serious problem, and more than 60% of the reported cases were not reported within 24 hours as the law required. We recommend following procedures to improve the effectiveness of the reporting system: (1) Feedback reports should be sent to the reporting clinicians, (2) Reports of positive cases could be directly sent from the hospital laboratories, (3) Periodical evaluation of the reporting system should be performed at least once a year.
• 38 - 49
• 10.6288/JNPHARC1986-06-02-04

• Link 原著 Original Article
• 台北市緊急醫療照護系統傷病種類及需求量The Disease Pattern and Demand of the Emergency Medical Services System in Taipei
• 姜錦燁、 王榮德、李鍾祥
  Chin-Yeh Chiang, Jung-Der Wang, Chung-Hsiang Lee
• 急診 ； 傷病型態 ； 需求量 ； 責任醫院
  ?emergency care demand?;?disease pattern?;?responsible hospital
• 從台北市緊急醫療照護系統之十一家責任醫院，分層抽取30．天的急診病人?樣本，摘取其病歷資料來估計本系統內一年急診傷病種類及需求量。總共獲得7,314份病歷，佔預定樣本數之88.9%。如果每個病人只考慮單一個診斷，則本系統一年之急診需求量?277,183人次，約佔台北市一年急診人次之69.2%。 一年數量超過2,500人次的重要傷病有：頭及脊椎傷害、骨折、其它外傷、精神科急症、高血壓疾病、腦血管病變、正常生產、其它婦科病因、新生兒疾病、燒傷和中毒。急診病人中，台北市居民佔63.3%，台北縣居民佔27.3%，其它縣市居民佔9.4%。各家醫院所服務的急診病人，都是以該醫院所在地及附近區域之民眾?多。 建議重視精神急症、頭及脊椎傷害、燒傷的緊急照護問題。建議重新畫分急救責任區，納入三總、空總、私立博仁、市立婦幼與陽明醫院?責任醫院。
  To evaluate the disease pattern and demand quantities of the Taipei Emergency Medical Services System, we drew a 30-day random sample from 11 major responsible hospitals. We successfully obtained 7,314 (response rate=88.9%) medical records and estimated the total emergency visits by disease pattern in a year. The diseases whose quantities exceeded 2,500 visits per year were: orthopedic and other traumas, head and spinal cord injures, psychiatric emergency, normal deliveries, cerebrovascular diseases, hypertensive diseases, newborn diseases, gynecologic diseases, burns, poisonings and toxic effects. 63.3% of the patients lived at Taipei, 27.3% at Taipei County and 9.4% in other arears of Taiwan. Most patients of each responsible hostital were inhabitants of nearby districts of the hospital. The quality of the emergency services of psychiatric emergency, head & spinal cord injures and burns should be further evaluated and planned. There is a need to include other major hospitals into the Taipei Emergency Medical Services System.
• 50 - 63
• 10.6288/JNPHARC1986-06-02-05