8卷1期

• Link 原著 Original Article
• 糖尿病患在社區醫院急診處的使用情形之分析A Study on the Use of a Community Hospital Emergency Room by Diabetic Patients
• 傳振宗、羅世慧、陳鴻銘、戴東原
  Chen-Chung Fu, Su-Huey Lo, Hong-Ming Chen, Tong-Yuan Tai
• 無
  diabetes mellitus ; emergency service ; community hospital
• ?了明瞭糖尿病患在一個社區醫院急診處的使用情形及醫療費用，我們從民國七十五年七月一日至民國七十六年六月三十日，在省立桃園醫院急診處收集了全部糖尿病急診個案的資料，總共有332位，占所有急診個案的1.05形，病患以中老年人居多，平均年齡?63.6歲，其中34.9%?七十歲以上老人；所有病患以距離醫院最近且交通方便的桃園市及中壢市居民最多占43.0%。332個病例中，?急診的比例非常高，占84%，所以臨床醫師在急診處碰到糖尿病患時應該特別留意病人情況。 糖尿病患的急診，除了4.5%屬於外科，其餘皆?內科；急診問題以新陳代謝、腸胃和泌尿系統的問題最常見、其中低血糖是病患來診最常見的原因，有65.1%是發生在服用口服降糖劑的病人，未來對於病人的衛教應加強這一方面的預防及症狀的認知與處理。在所有病患中，有33.4%由急診轉入病房接受進一步治療，而其平均醫療費用也比只在急診處接受治療的病患高出甚多（83856元比3634元）。來急診的糖尿病患中，有18.7%根本沒有接受藥物治療，即使是接受治療的患者，高達40.1%沒有規則治療，因此醫護人員應努力研究如何提高病患的遵囑性。
  In order to find out the frequency and cost of diabetic patients visited the emergency room (ER) of a community hospital, we collected data of Provincial Tao-yuan Hospital from July 1, 1986 through June 30, 1987. There were 332 visits of diabetic patients, which occupied 1.05% of the total ER visits. The mean age of patients was 63.6 years and 34.9% of them were above the age of 70. About 43.0% of diabetics in this study resided in Tao-yuan and Chung-li cities, where the transportation between these two cities and the hospital was very convenient. The true emergency rate was extremely high among diabetic patients (84%), especially in the older age group. It reminded the doctors to pay more attention to the diabetic patients in the ER service. Among the diabetics, except 15 cases (4.5%) of surgical problem, the remaining 317 cases (95.5%) were related with problems of internal medicine. Metabolic, gastrointestinal and urological disorders were the three most important disease categories led diabetic patients to visit ER. Hypoglycemia was the first leading diagnosis of visits and 65.1% of them occurred in the patients treated with oral hypoglycemic agents. Health education in this field including prevention, recognizing symptoms, early detection and management should be strengthened. About 33.4% of patients were admitted to ward for further care and their medical cost was significantly higher than those treated at ER only. Among the diabetics visited ER, 18.7% did not receive any treatment before, and 40.1% of the diabetic patients having treated with oral hypoglycemic agent or insulin did not receive regular follow-up. How to upgrade the compliance of diabetic patients is a challenging issue to all of the medical personnels.
• 1-11
• 10.6288/JNPHARC1988-08-01-01

• Link 原著 Original Article
• 社會變遷與健康照顧型態之研究－以台灣地區特有之社會變遷背景驗證社會學理論在家庭健康照顧上之適用性A Study on Social Change and Health Care Pattern on the Family
• 季瑋珠、楊志良
  Wei-Chu Chie, Chih-Liang Yaung
• 無
  health care ; family pattern ; urbanization
• ?了解家庭使庫照顧的型態，並驗證社會學理論的適用性，本所究在台灣北部地區以立意取樣選取鄉村地區（限居住十年以上者）、衛星城市（限五年內遷入者）、及大都市，各二村里，又以分層系統集束抽樣，每地區抽取核必、擴大家庭名40戶，以結構問巷進行家庭訪視，戶內所有成員的個人資料均予記錄。根據文獻，社會變遷程度分別以地區別和家庭經濟狀況加以測量。結果顯示家庭是病人健康照顧的基本單位，且幾乎完全可由自己及同住的家人負擔。在個人層次，家庭健康照顧的分工，若以社區都市化程度作社會變遷指標，其社區間的差異，較符合Goode「社會變遷造成夫妻平權、分工合作」的預測，若以家庭經濟狀況作指標，則看不出差異。本研究從理論、概念及測量上討論了這些結果，最後並提出對醫療保健政策和計畫的建議。
  For the purpose of understanding the styles of health care in the families, and testing social change theories, a cross-sectional study was carried out in Taipei area in 1987. Under purposeful sampling, one rural, one satellite city, and one metropolitan community were selected. In each area, stratified systematic sampling was used to select 40 nuclear, and 40 extended families. A structured questionnaire interview with home visit was performed. The degree of social change were measured by two indices, the degree of urbanization of the community, and economic status of the family. At the family level, the family is truly a basic unit of health care to its members. At the in-duvidual level or the labor division of health care, Goode’s theory of ”harmony & fit” or more equal responsibility between husband and wife can fit better according to degree of urbanzation as the index of modernization. However, according to economic index, there's no such a finding; the policy implication was also discussed.
• 12-27
• 10.6288/JNPHARC1988-08-01-02

• Link 原著 Original Article
• 臺灣地區石綿工廠空氣中石綿濃度測定Airborne Asbestos Concentration in Asbestos-Related Factories in Taiwan
• 張火炎、王榮德、張錦輝、陳誠仁、吳敏鑑
  HY Chang, JD Wang, JW Chang, CR Chen, MC Wu
• 無
  asbestos ; air concentration
• 本研究目的是對本省石綿工廠空氣中石綿濃度作一測量。以全省33家石綿工廠?對象，根據美國職業安全衛生研究院所建議的最危險工作群，以定點採樣?主，個人採隊?輔，作空氣中石綿濃度採樣，而以位相差顯微鏡作鏡檢分析，共得有效樣才67件。根據各採樣點單一樣本（定點採樣時間30~50分鐘）之偵測，結果發現本省石綿相關工廠中，加料口所測空氣中石綿濃度以石綿紡織業最高：6.25 fiber/c.c，依次是石綿耐磨業：3.57±1.91 fiber/c.c.（算術平均數±標率差），石綿絕緣業：2.23±0.40 fiber/c.c.。石綿水泥業，最低：2.13±2.69 fiber/c.c.。如果區分乾、溼作業，發現加料口空氣中石綿濃度，溼式作業?2.13±2.69 fiber/c.c.，乾式作業?3.56±1.91 fiber/c.c.。作業現場空氣中石綿濃度，溼式作業?2.02±2.60 fiber/c.c.，乾式作業?2.89±1.60 fiber/c.c.。以局部排氣之有無作比較，溼式作業加料口空氣中石綿濃度有加裝局部排氣者：1.59±1.23 fiber/c.c.，無局部排氣者：2.89±3.82 fiber/c.c.。此次研究發現與作業現場隔絕之辦公室空氣中石綿測試中，亦發現有石綿纖維的存在：0.19 fiber/c.c.，根據推斷可能?作業現場工人攜入所致。
  The objective of this study was to determine the concentration of airborne asbestos inside asbestos-related factories in Taiwan. Besides performing personal sampling on the maximum risk groups, we also collected area samples. On the basis of the single simple sample (area sampling duration: 30-50 mm, the results were as follows: Among the four kinds of asbestos-related factories, the concentration of airborne asbestos in textile was the highest, 6.25 fibers/c.c.; followed by the brake-lining factories, which was 3.57 ± 1.91 fibers/c.c. And that of the insulating factories was 2.23 ± 0.4 fibers/c.c. and that of the cement factories was 2.13 ± 2.69 fibers/c.c. The air concentration of asbestes was higher in a factory with wet process than that in a dry process; and the lower under veiitilation control than without control at the cement manufacturing process. Asbestos concentration in a randomly selected office, which was just next to the cement manufacturing area, was found to be 0.19 fiber/c.c.
• 28 - 35
• 10.6288/JNPHARC1988-08-01-03

• Link 原著 Original Article
• 護理人員時間分配The Time Allocation of Nursing Personnel
• 蘇喜、 劉慧俐、楊麗瑟、周照芳
  Syi Su, Hw-Li Leiu, Li-Se Young, Chao-Fang Chaw
• 無
  Allocation ; primary care ; total care ; work sampling ; snapshot observation
• 由於護理活動影響醫療品質甚鉅，故研究護理活動及護理人員工作時間的分佈。茲將護理活動分?四類：直接護理、間接護理、與單位有關的活動、私人時間。採用工作樣本研究法，觀察二個病房。結果被觀察的兩個病房，其護理活動分佈皆以間接護理?最主要；每星期不同上班日(week day)，其護理活動的分佈亦有所不同；病房工作的尖峰時間在上午9~10點、下午1~3點；與單位有關的活動是護理長最主要的活動，而個別護理人員的私人時間的分佈，除少數護士外，其餘大致相同。除此之外，本研究並討論施行主護護理(Primary care)的甲病房，與施行全責護理(total care)的乙病房之不同的護理活動分佈。本研究乃是國內第一個正式的護理人員時間分佈研究，期望對今後同類的護理研究，有?磚引玉的作用，期能建立護理人員對時間分配的標準。
  The pattern of nursing services is an important factor to affect the quality of medical services. Acknowledging of this, the anthor was motivated to conduct research on the time allocation of nursing personnel. Nursing activities were categorized into tour mutually exclusive and collectively exhaustive groups: direct care, indirect care, unit related activities and personal activities Work sampling method was used and two nursing units were selected. The results revealed that: 1. Indirect activity is the most important activity (according to the time allocation). 2. The activity distributions vary with week days. 3. The two peaks of workload appear at 9-10 AM and 1-3 PM. 4. Unit related activies dominate head nurse's time allocation. Except few deviant nurses, all the other personnel have about the same time allocation on personal activities. 5. There are significant differences in between two nursing units. This study represents the first formal effort toward nursing operation. It is expected to arouse more similar and related studies to be done and thus the standards of nursing time allocation pattern can be established
• 36 - 50
• 10.6288/JNPHARC1988-08-01-04

• Link 原著 Original Article
• 醫院餐飲服務職業危害可能性評估Evaluation of Occupational Hazard of Food Service
• 章樂綺
  Leh-Chii Chwang
• 無
  occupational hazard ; food service
• 餐飲服務應兼顧營養、美味、衛生及安全等因素，但有關其職業之安全考慮，似未受到應有之重視。基於保障勞工安全及健康，提升營養作業管理效能，本研究特將醫院營養部門之餐飲製備過程，作危機鑑別與分析，並提出職業危害之預防對策。 危機分析之順序乃依作業流程，即驗收、前處理、儲存、生產、配膳、供應、清潔與維修。背痛、扭傷、跌倒及噪音?最常見之危害。其發生之原因，主要?不當操作、環境與設備。預防之計，可由工作環境與設備之改進，及工作過程與操作之訓練等方面著手。
  The nutritional, aesthetic, economical, sanitary and safety aspects should all be considered for quality food production. However, occupational safety has usually been overlooked in food service management. The purpose of this paper is to identify major occupational hazards in a hopsital dietary department and to develop safety program accordingly. Risk is analyzed by inspection at each step of operation. Fall, pulled muscle, back strain, and noise are the most commonly identified potential hazards, which are mainly due to improper practice, as well as inadequate working condition and equipment. Safety program of hazard control by problem-oriented on-job and in-service training and improvement in workplace, equipment and facilities are imperative.
• 51 - 58
• 10.6288/JNPHARC1988-08-01-05

• Link 其他 Others
• 台灣地區惡性腫瘤之流行病學特性：Ⅰ.全部癌症Epidemiologic Characteristics of Malignant Neoplasms in Taiwan: ?. All Cancer Sites
• 陳建仁、李心馨、許光宏、蔡淑芳、游山林、林東明
  Chien-Jen Chen, Shin-Shin Lee, Kuang-Hung Hsu, Shu-Fan Tsai, San-Lin You, Tong-Ming Lin
• 無
  none
• 太研究分析1954年至1985年台灣地區的癌症死亡率，以期瞭解其長期趨勢、性比例、地理聚集、國際差異和移民變化。台灣地區男女性的癌症死亡率自1957年起，即呈明顯之增加趨勢，性比例也隨著年代而增高；而且自1982年起癌症即躍居十大死因之首位。癌症的年齡別死亡率係呈丁字型曲線，自15歲起即有明顯的等比增加，而在80歲以上達高舉。在與十五個國家地區的比較當中，台灣地區居民的男女性癌症累積死亡率均最低。就移民變化而言，台灣地區的年齡別癌症死亡率較香港、新加坡?低。偏高的年齡調整化死亡率，有明顯聚集在烏腳病流行地區、都會區、北宜兩縣和東部山地鄉的現象，且男女皆然。在1985年，台灣地區男性的五大癌症死因是肝癌、肺癌、胃癌、食道癌和鼻咽癌，女性的五大癌症死因則是子宮頸癌、肺癌、肝癌、胃癌和乳癌。十大癌症的性比例，最低是結腸癌之1.2，而最高是食道癌的5.4。白血病、鼻咽癌、乳癌、子宮頸癌與肝癌的死亡年齡較肺癌、食道癌、胃癌、結腸癌和膊胱癌偏早。僅只1985年的癌症死亡所帶來的損失，即高達116,959工作人年，相當於150-200億的國民生產所得。有效控制癌症的危害是刻不容緩的衛生保健工作。
  Cancer mortality rates in Taiwan from 1954 to 1985 were analyzed in order to examine the secular trend, sex ratio, geographical distribution, international variation, and migrant difference of the disease. Cancer has become the leading cause of death in Taiwan since 1982. The age-adjusted cancer mortality increased significantly from 1957 to 1985 for both males and females, the sex ratio of age-adjusted cancer mortality also increased during this period. A J-shaped age curve indicating the exponential increase of cancer mortality from age of 15-19 to age of 80 or more was observed. Cummulative cancer mortality in Taiwan was the lowest for both males and females among the 16 developed countries compared. Males and females in Taiwan had lower cancer mortality rates by age than those in Singapore and Hong Kong. High age-adjusted cancer mortality rates for both males and females were found to cluster in the blackfoot disease endemic areas, metropolitan precincts of Keelung, Taipei, Tainan and Kaohsiung, twonships of Ilan and Taipei counties as well as aborigninal townships. While cancers of the liver, lung, stomach, esophagus and nasopharynx were the five leading cancer deaths in males; cancers of the uterine cervix, lung, liver, stomach and breast were the top five in females. The sex ratio of age-adjusted mortality rate for ten leading cancers ranged from 1.20 for colon cancer to 5.41 for esophageal cancer. Leukemia and cancers of the nasopharynx, breast, cervix and liver had more proportion died before age of 65 than cancers of the lung, esophagus, stomach, colon, and bladder. With regards to its socioeconomic impact, cancer deaths caused a total of 116,595 work-years loss in 1985.
• 59 - 71
• 10.6288/JNPHARC1988-08-01-06