7卷3期

• Link 原著 Original Article
• 台灣地區婦女之生育年齡、懷孕次序、生育間隔與胎兒死流產危險性之關係研究A Study on the Risk of Pregnancy Outcomes by Pregnancy Order, Maternal Age and Birth Interval in Taiwan Area
• 姜錦燁
  Chin-Yeh Chiang
• 無
  maternal age ; pregancy order ; birth interval ; stillbirth ; miscarriage
• 根據文獻報告，生育型態對婦幼健康有顯著影響力。尤其是亞、非、拉丁美洲等國家，此影響關係是：懷孕次數太多（四胎以上）、母親生育年齡太小或太大（小於18歲、大於35歲，不包括8歲和35歲）、生育間隔太密（低於兩年），則發生早產、死產、流產、嬰幼兒夭折及傷害母體使康的危險性愈大。本研究擷取上述部份關係，探討台灣地區婦女的生育型態（指母說生育年齡、懷孕次序、生育間隔）與胎兒死流產的關係。研究資料取自台灣省家庭計畫研究所所做：台灣地區第四次家庭與生育力調查和第五次家庭與生育力調查資料，以台灣地區20-39歲有偶婦女?母群體。 結果只有生育間隔對自然流產的發生有些微影響力，以間隔兩年以上時的危險性最低，第一次懷孕和間隔13-24個月時是間隔25個月以上的1.4-1.6倍，間隔在12個月以內的危險性最大，是間隔25個月以上的4.7倍。由於研究對象是民國二十至四十九年之間出生的婦女，其生育年齡是在民國四十年以後，這意謂著早在民國四十年代時，社會性因素如營養、環境、醫療照護的影響，已超越母親生育年齡、懷孕次序和生育間隔對發生死產、自然流產的影響，其水準可能已具有保護懷孕結果的能力。但也有可能是懷孕的自然結果受到生育型態的影響本來就比較小，而是養育嬰幼兒和母體產後健康與生育型態比較有關，故若以嬰幼、孕產婦死亡率?評估指標，結果是否會跟亞、非、拉丁美洲等其他國家有一玫的結果，值得進一步探討。
  Childbearing patterns have an impact on maternal and child health. According to surveys in Asia, Africa and Latin America, pregnancies may be considered high risk if they are too young (maternal age under 18), too old (maternal age over 35), too many (pregnancy after four births), too close (less than two years apart). To evaluate the impact, pregnancy outcomes, infant, child and maternal mortality are usually used as evaluation indices. This paper studied on the relationship between childbearing patterns and pregnancy outcomes (whether miscarried or stillbirthed). Data were drawn from KAP-4 (1973) and KAP-5 (1980) surveys that were conducted by Taiwan Provincial Institute of Family planning. The relationship in Taiwan Area did not show the similarity and consistency as those in other countries of Asia, Africa and Latin America. Only birth interval had a little influence on the happening of miscarriage. The ratios of miscarriage rates stratified by birth interval were: firth pregnancy: less than 1 year 1-2 years: over 2 years=1.6:4.7:1.4:1. It was concluded that social economic factors so dominantly confounded the relationship that pregnancy outcomes had been protected beyond the influences of childbearing patterns; otherwise the fact was that childbearing patterns had more association with infant, child and maternal mortality than with pregnancy outcomes. The latter needs to be studied further
• 113 - 124
• 10.6288/JNPHARC1987-07-03-01

• Link 原著 Original Article
• 已開發國家之男女死亡差異之探討Sex Mortality Differentials in Developed Countries
• 胡幼慧
  Yow-Hwey Hu
• 無
  mortality ; sex differentials
• 男女死亡差異之增大乃?本世紀已開發國家之普遍經驗，人口學、生物學及社會學家曾就不同死因別死亡現象提出生物決定論與環境決定論兩大爭論。本文才根據各個研究結果之整理，認?生物遺傳因素能影響到男女在一般性感染疾病的抵抗力，然而在慢性病與人?死亡方面的解釋卻有限。有些學者認?生物遺傳因素可經由行?（如抽菸）及人格待質（如A型人格）之途徑與環境產生交亙作用而影響到男女死亡經臉。由於生物影響模式本身之限制，加上國際間與各國內之男女死亡差異幅度之變異相當大，使得社會學者建議由文化社會之角度（例如男女角色、社會支持）來探討男女死亡差異之成因，並提出了多項因素交互作用之模式。台灣地區之死亡業已達已開發國家之水率，其男女死亡差異的趨勢之初步分折卻顯示出偏異於西方之型態。自國際比較之意義而言，台灣地區之文化特質（例如家庭中心文化與生活型態、人格特質）及種族之生物特性將成?進一步比較男女死亡差異之成因之重要資料。
  The widening of sex mortality differentials accompanied with mortality decline is a well-known mortality experience in Western countries during this century. Biological and behavioral/environmental perspectives on these sex differences are two main explanatory approaches. This paper reviews supporting evidences as well as their limitations of these two approaches. It appears that biological reasons are more important in explaining sex differences in infectious diseases, particularly for the very young age groups. For other major causes of death which cuase the mortality discrepancies between men and women (such as CHD, lung cancer, and accident), behavioral factors seem to be the determinants. In this paper, more recent sociological models which integrate social, psychological and biological factors are introduced for future investigations. Also, pattern of sex mortality differentials in Taiwan is also briefly summarized in the boader international context.
• 125 - 140
• 10.6288/JNPHARC1987-07-03-02

• Link 原著 Original Article
• 評估衛生所糖尿病患對疾病的認知An Evaluation of Diabetic Patients' Knowledge on Diabetes
• 傅振宗、謝舜婉
  Chen-Chung Fu, Swan Hsieh
• 無
  Diabetes Mellitus ; Home Care
• 民國七十二年政府在衛生所推動糖尿病居家護理照顧，?了探討衛生所糖尿病患對於疾病認知的影響因素以及病忠在有無居家護理照顧下對於疾病認知是否有所不同，所以各選取受過居家護理的病患一百名?實驗組，沒有受過居家護理的病患一百名?對照組，以結構式問卷測試之，並且用複迴歸方法分析，結果發現病患曾經閱讀糖尿病書籍與否、職業、罹病時間長短、是否接受過居家護理，曾經接受其他衛教與否及教育程度等因素可預測總變異量的30.0%，這六個因素和疾病認知情形均?正相關，亦即曾經閱讀糖尿病書籍、罹病時間愈長，曾經接受居家護理，曾經接受其他衛教及教育程度念高的病患認知情形較佳。至於職業方面，病患沒有職業（包括家庭主婦）的認知情形較差。 我們用t-test發現居家護理病患在小便試紙檢查、足部照顧及低血糖等項目得分高於無居家護理病患，但是兩組在口服藥物及飲食方面的答對率甚低，未來的重點應是加強這方面的衛教。
  The government in Taiwan started a home care program in the health centers for the diabetic patients in 1984. To evaluate diabetic patients' knowledege of diabetes, 100 patients under home care program (group A) and 100 patients without home care program (group B) were chosen. Those patients’ knowledge on diet, medication, foot care, hypoglycemia, urine test, etc was evaluated. The patients in group A scored better than group B. The scores on diet and medication were quite low in both groups. The multiple regression model was applied to test the factors influencing the scores of patients' knowledge. It was found that previous reading of diabetic books, occupation, disease duration, home care, previous health education and general educational level could explain 30.0% of the variance of the total score
• 141 - 150
• 10.6288/JNPHARC1987-07-03-03

• Link 原著 Original Article
• 新莊地區開業醫師參與轉診制度之初步研究A Pilot Study of General Practitioners Participating the Patient-Referral System in Shin-Chuan Area
• 陳慶餘、 王英偉、謝維銓、呂鴻基
  Ching-Yu Chen, Ying-Wai Wong, Wei-Chuan Hsieh, Hung-Chi Lue
• 無
  general practitioner ; referral system
• 本實驗計畫以在台北縣衛生局登記之新莊地區155名開業醫師?對象，首先歡求開業醫師同意參與轉診病人至省立台北醫院（省北），並由專人負責轉診資料的收集與病人之追綜，然後再以問卷調查開業醫師之轉診情況以及對此實驗性計畫中擔任轉診醫院之建議，以做?省北推動轉診制度的參考。 在參與轉診制度意願調查中，155名開業醫師有53名同意；影響參與意願的因素包括在新莊市內開業，醫學系畢業之醫師資格，年齡在50歲以下和以回信方式表示態度者。在其後的兩個月內病人持轉介單來省北共11名，住院病人有9名，出院後能夠回開業醫師處追?有7名。 對53名同意參與的開業醫師再以問卷調查過去兩個月內之轉診情況。結果?：共轉人數285人，轉診率在5%以下占66.0%，2/3病人轉至其它私人醫院，1/3轉至公立醫院，轉診目的主要?安排往院和急診照會共占68.3%。開業醫師對省北辦理轉診制度之建議事項主要?轉診管道的暢通、改喜醫院病人服務品質、開放設備給開業醫師、指派專家前往診所指導，辦理繼續性教育以及雙向的轉診制度之實施等。 本文針對上述之結果就開業醫師和醫院管道的立場分析討論。
  The objectives of this study intend to find out the problems for a patient-referral system between general practitioners (GPs) and hospital specialists established in Shin-Chuan area, Taipei county. At first GPs were recruited to participate the plan for their patients referred to Taipei Provincial Hospital (TPH). GPs who agreed to involve were contacted later. In the following 2 months, their patients referral to the TPH were collected. Then, the actual patient referral during these periods in their practice was investigated by questionare. There were 53 among 155 GPs in Shin-Chuan area agreed to participate. The significant influencing factors were the practicing site near TPH, graduates from medical schools, age less than 50 years old and quick response by questionare-answer letter. In the following 2 months. 11 patients were referred to TPH. Nine of them were admitted and 7 were able to be followed by their GPs after discharge. The actual referral situation by questionare during the observation period were 285 patients referred by 50 GPs. The referral rate below 5% was 66%. Two third patients were referred to private hospitals in Taipei city and the others went to public hospitals. The major requirements for referral were arrangement for admission (49%) and emergency consultation (19%). The opnions to highlight the referral system between GPs and specialists at TPH included to use direct communication, to improve care quality in hospital, to permit GPs to use hospital facility and to conduct continuing medical education as well as to carry out two-way referral.
• 151 - 160
• 10.6288/JNPHARC1987-07-03-04

• Link 原著 Original Article
• 中美醫師對保健行爲的信念之比較研究Comparision of Health Behavior Beliefs between Chinese and American Physicians
• 邱清華、林弘崇
  Ching-Hwa Chiu, Hong-Chung Lin
• 無
  physicians' beliefs ; health promoting behariors ; Chinese and American
• 促進健康的行?與罹病率及死亡率的降低有關連。而醫師被認?是衛生保健諮詢的最佳、最可靠的來源之一。因此，醫師本身的觀念如何，頗值得令人關心。 美國馬利蘭大學醫學院於1983年，曾對1,040位醫師進行25項促使行?的信念做調查研究，並依其重要性作先後排列比較，頗饒趣味。 本研究係依照同樣的25項保健行?，稍加修正以符合國情，對全台灣地區醫師（12,710名）中，按縣市別各隨機抽出15.3%?樣本，合計1,950人，寄出問巷調查，回收者有382人，回收丰?19.6%。在回收的382人中，男性佔了96%；乎均年齡?53歲；執業科別以內、兒科最多，佔21.2%，而內科次之，?19.6%；乎均執業年數?18.7年。 中美雙方醫師比較結果，二者情形頗?相近(r(下標 s)=0.71)。我方認?最重要的前四分之一（六項）依次?：?維持攝食均衡的食物、?使用汽車安全帶、?對有害物質應加裝防範設備、?連免過度精神壓力、?對藥物的常識、及?戒抽香菸。而美方最重要的六項與我方相同的便有五項之多。至於最不重要的六項，中美雙方竟然完全相同，僅先後次序稍有差異而已。 由上可知，在相同的西醫教育系統下，中美雙方醫師對於衛生保健觀念，如出一轍，頗?相似。
  It is generally regarded that physicians are the best and most credible source of health information. A variety of health promoting behaviors have been shown to be associated with decreased mortality and morbidity. It is interesting to know about physicians' beliefs regarding the importance of health promoting behaviors. In 1983, 1,040 primary care physicians in the US (Maryland) rated their beliefs about the importance of 25 behaviors for promoting the health of the average person. We conducted a mailed questionaire survey in July 1987 by a stratified random sample (15.3%) out of 12,710 physicians in Taiwan. We obtained a response rate of 19.6% (n=382). Comparing the Chinese physicians with the American ones, it was found that they share a similar pattern (r(subscript s)=0.7 1). The most important 6 behaviors listed by the Chinese respondents were: (1) Eat a balanced diet, (2) Always use seat belts or wear helmets, (3) Protective equipment against harmful substances, (4) Avoid undue stress, (5) Knowledge about drugs, and (6) Eliminate cigarette smoking. The US physicians also regarded 5 out of these 6 items as most important except the item of ”Avoid undue stress”. Both Chinese and American physicians agreed at the 6 ”very unimportant” behaviors, except difference in their orders of ranking. This study indicated that there is probably no significant difference in weighting the importance of health behavior beliefs between Chinese and American physicians.
• 161 - 167
• 10.6288/JNPHARC1987-07-03-05

• Link 其他 Others
• 台灣有職業癌嗎？Is There Occupational Cancer in Taiwan?
• 張常勝、王榮德
  Chang-Sheng Jang, Jung-Der Wang
• 無
  occupational cancer ; chemical carcinogen ; risk factor ; manufacturing
• 本文是以官方資料及過去有關職業癌在國外及國內的文獻?基礎，對現今台灣的工業環境及職業癌的狀況作一大概的了解。並且對今後台灣地區的職業癌作一個大膽的推測。台灣地區的癌症死亡率自從1982年以來，一直高居第一位，並且逐年增加。我們發現台灣製造業人口超過二百五十萬，工廠數超過九萬，99%?三百人以下之小工廠，而且常引進高污染之工業；極可能工業衛生能力差。根據現有資料，氯已烯（肝血管肉瘤）、石綿（肺癌及間皮瘤）、煉焦（肺癌）、苯（白血病）、木屑（鼻竇癌）在本國今後幾年內可能發現相關職業癌。本國在早期診治、培養人才、傳播知識與立法上均需努力，以作防治。
  The purpose of this commentary is to predict possible occupational cancers in Taiwan based on available governmental records. The crude mortality rate of total cancer has increased and climbed up to the first mortality in Taiwan since 1982, and its proportionate mortality has exceeded 17.64% since 1986. In Taiwan, manufacturing workers exceed 2.5 million; factories are more than 90,000. 99% of these factories are all small factories in which less than 300 workers are employed in each of them. The first occupational cancer discovered was skin cancer induced by bipyridyl manufacturing. It reveals that the manufacturing process which they used were usually those with high occupational exposures or poor control of environmental contaminants. According to the previous production data, we shall be alert to following candidates: vinyl chloride induced angiosarcoma of the liver, asbestos related mesothelioma and lung cancer, coke oven associated lung cancer, benzene induced leukemia, and hardwood dust associated cancer of the nasal sinus. We shall also focus our efforts on early diagnosis, manpower promotion, information distribution and legislation to prevent occupational cancer.
• 168 - 176
• 10.6288/JNPHARC1987-07-03-06