8卷2期

• Link 綜論 Review Article
• 台灣地區醫療照護的發展與問題Health Care Delivery in Taiwan: Progress and Problems
• 江東亮
  T. L. Chiang
• 無
  Health Care Delivery ; Access ; Cost ; Quality
• 自1865年馬雅各醫師到台南開業行醫算起，西醫被引進台灣有120年以上的歷史。在這120多年之間，台灣地區醫療照護的進步非常迅速。隨著醫學教育的發展，特別是光復以彼，醫事人力和醫院診所都不斷的增加，而民眾醫療照護的可近性也因此明顯的提高。但儘管這樣，在醫療照護上仍然有許多值得我們再努力的地方（例如：改善不同社會經濟階層間利用醫療照護的差異，節制急遽上升的醫療費用，以及管理與提升醫療服務的品質）。本文將說明過去120多年來台灣地區發展醫學教育與醫療照顧資源的歷史與成就，並進一步探討目前我們迫切需要解決的醫療照護問題。
  Western medicine was first introduced to Taiwan in 1865 when James L. Maxwell started his medical practice in Tainan. Over the past 120 years health care delivery in Taiwan has remarkably progressed. With the development of medical education, especially after World War II, the supply of health care manpower and organizations has rapidly increased, and consequently the access to health care in Taiwan has been greatly improved. Nevertheless, there remain problems to be solved in the field of health care delivery such as socio-economic differentials in use of health services, rapid growth of health care costs, and inadequacy of the quality of health care. This paper accounts the historical development of medical education and health care resources, and discusses the current issues of access, cost, and quality in health care delivery in Taiwan.
• 75 - 90
• 10.6288/JNPHARC1988-08-02-01

• Link 原著 Original Article
• 台灣之肝癌Hepatoma in Taiwan
• 林東明、陳建仁、蔡淑芳、蔡德興
  Tong-Ming Lin, Chien-Jen Chen, Shu-Fang Tsai, Te-Hsen Tsai
• 無
  Hepatoma ; Epidemiology ; Etiology ; Prevention
• 由於社會、經濟的進步及醫科學之發展，很多傳染病都被好好的控制了，但非傳染病卻變成了公共衛生的主要問題，而其發生率及死亡率則急速的增加，其中惡性腫瘤是最明顯的例子。在台灣惡性腫瘤在1954年時，占在十大死亡之第七位，在1961年時占在第五位，在1964年時占在第二，但在1982年以後就占在第一位了，惡性腫瘤之年令調整死亡率則由1954年至1983年止，男性由每拾萬人60.35增加到129.54，女性則60.25增加到82.04。男性肝癌則從1965年起占所有惡性腫瘤之死亡中的第一位，而女性肝癌則從1981年起占在第三位。 在台灣關於肝癌之研究很多，本文即敘述肝癌在省灣之流行病學狀況而討論到其病因學及預防之問題。
  Due to the socio-economic progress and the improvement of biomedical sciences, many infectious diseases have been controlled in Taiwan. Non-infectious diseases, however, occupied the major public health problems. The incidence and mortality rates from these non-infectious chronic diseases have been increasing rapdily. Among them, malignant neoplasms are the most evident examples. Malignant neoplasm ranked as the seventh leading causes of death in Taiwan in 1954, in 1961 the fifth, in 1964 the second and since 1982 it has become the leading cause of death. The age-adjusted death rates of malignant neoplasms increased from 60.35 to 129.54 per 100,000 for the male and 60.25 to 82.04 for the female, respectively, from 1954 to 1983. Hepatoma has ranked the first among the deaths of malignant neoplasms in males since 1965, and the third in females since 1981 [1,2,3]. A lot of study on hepatoma has been conducted in Taiwan. The present communication describes epidemiologic feature of hepatoma in Taiwan and discusses the etiologic mechanisms and prevention
• 91 - 100
• 10.6288/JNPHARC1988-08-02-02

• Link 原著 Original Article
• 台北縣雙溪鄕死因資料之分析Analysis of Causes of Death, Shuang-Hsi Township Taipei County
• 李龍騰、賴美淑、陳慶餘、謝維銓
  Long-Teng Lee, Mei-Shu Lai, Chiang-Yu Chen, Wei-Chuan Hsieh
• 無
  mortality rate ; pneumoconiosis
• 無
  In recent three decades, the prosperous economic growth of Taiwan area caused the improvement of living standard and general health conditions of the people. As a result, the major causes of death in Taiwan area have been changed simultaneously. It was especial obvious among the townships where they have experienced the most evident socioeconomic changes. In the last 10 years (1976-1985), pneumoconiosis was still the fifth of the most common causes of death in Shuang-Hsi township. It was unusual as comparing to the figure in the rest of Taiwan area. Among 1033 deaths of Shuang-Hsi township for 1976-85, 26.1% of all death certificates were given by a herb doctor. Consequently, the statistics of causes of death in this township has been affected by his diagnostic ability. After analysis of the data, it was found that there were some discrepancies of the usage of medical terminology in the causes of death between the Chinese herb doctor and the doctors received medical training. Regarding the causes of death of Shuang-Hsi township for 1984-86, it was found 7.3% due to suicide, which was higher than the proportion of Taiwan area (3%). It is of interest for further study. Before the setting up of Shuang-Hsi Group Practice Center, only 45 of 830(5.4%) death certificates between 1976 to 1983 were issued by Shuang-Hsi Health Station, while after setting up of the center, 71 of 287 death certificates (24.9%) from 1984 to 1986 were issued by the health station. It is obvious that after the setting up of the group practice center, residents of Shuang-Hsi township got more service and have more confidence from the health station.
• 101 - 108
• 10.6288/JNPHARC1988-08-02-03

• Link 原著 Original Article
• 乳癌病人的壓力與調適初步探討Priliminary Study on Stressor and Coping of Mastectomy Patients
• 張珏、 黃梅羹、林弘崇
  Chuen Chang, Mei-Gun Huang, Hong-Chung Lin
• 無
  Mastectomy patient ; stressor ; coning style
• 為了明瞭乳癌病人，出院後在一般生活中，不同時期可能會遇見的壓力源及其調適方式，以便在未來可協助乳癌病友去面對壓力源與開創新的調適方式。特以某醫院出院1-5年的乳癌病人60名為研究對象，進行問卷訪視。結果發現： 1．乳癌病友的壓力源因素，經因素分析的結果，可分為“生理反應的壓力”、“人際與自我的壓力”、“手術反應的壓力”、“預後的壓力”、“家庭關係與傷口問題壓力”、“對生殖能力的影響壓力”等六個類別。 2．乳癌病友的調適型態，經因素分析的結果可分為“問題解決的調適”、“情緒處理的調適”、“社會支援”、“藉外物的調適”、“行為與認知的調適”等五種型態。 3．分析乳癌病人壓力源與調適之間的關係、結果發現：病友會出現“人際與自我的壓力”時，愈會以“情緒處理”的調適方法來面對這種壓力。 4．在手術後住院期間與出院後年數，隨時問而有不同的應對行為。出院期越長，採用問題解決方式較多。 5．由“和面臨相同情境的人，交換意見“，的需要，……、可以肯定乳癌病友聯誼會的功能。
  Sixty breast cancer patients after mastectomy have been interviewed in order to understand the stressor they faced as well as the coping behavior they adopted. Results were obtained as follow: 1. After factor analysis, there are six factors have been identified. Those are physiological reaction, self and interpersonal relationship, surgery, prognosis, family relations, and reproductive ability. 2. There are five factors identified from coping scale. Those are problem-solving, emotional management, social support, external dependency, and cognition/behavior. 3. When facing the stressor of self and interpersonal relationship, the emotional management coping style was frequently adopted. 4. At different postoperative period (1-2yr, 3-4yr, 5yr more), the longer the period, the more problem solving coping styles were adopted. 5. When facing problem, 45% will turn to spouse, while 31% to patient herself. 6. The need to exchange information and gain mutual support of patients with of same experience, reflect the importance on organizing selfhlp help group for mastectomy patients.
• 109 - 124
• 10.6288/JNPHARC1988-08-02-04

• Link 其他 Others
• 台灣地區惡性腫瘤之流行病學特徵：Ⅱ肝癌Epidemiologic Characteristics of Malignant Neoplasms in Taiwan: ?. Liver Cancer
• 于明暉、蔡淑芳、 許光宏、游山林、李心聲、林東明、陳建仁
  Ming-Whei Yu, Shu-Fang Tsai, Kuang-Huan Hsu, San-Lin You, Shin-Shin Lee, Tong-Ming Lin, Chien-Jen Chen
• 無
  liver cancer ; epidemiology ; Taiwan
• ?探討肝癌之年齡曲線、性比例、地理分佈、長期變動趨勢、國際比較及移民差異等流行病學特徵，乃以台灣地區1954至1983的肝癌死亡率及發生率?資料來源。分析結果顯示台灣地區男性之肝癌的年齡標準化死亡率顯著的逐漸上升，女性則無明顯的變動趨勢存在。觀察各年齡層之肝癌死亡率在1954-1963，1964-1973及1974-1983三段連續期間的變動情形，發現1954-1963期間至1964-1973期間，不論男性或女性，所有年齡層的肝癌死亡率皆明顯的增加，但1964-1973期間至1974-1983期間，男性20-29歲的年齡層與女性大多數年齡層之肝癌死亡率反而呈現下降。國際比較和移民研究顯示中國人之肝癌死亡率遠高於其它種族，台灣地區男性與女性的肝癌累積死亡率分別?4.83%和1.74%，在世界18個國家及地區中排名?第二位，僅次於香港。肝癌死亡率的地理分佈在台灣地區呈現明顯的差異，高危險鄉鎮集中於澎湖群島、烏腳病流行地區和東部山區。本研究之觀察結果顯示除B型肝炎病毒以外，其它環境因子可能亦在肝癌的發展過程中具有相當重要的作用。
  Mortality and incidence rates of liver cancer were analyzed to examine the epidemiologic characteristics of the disease in Taiwan. A significant upward secular trend for age-adjusted mortality rates from 1954 to 1983 was observed in males but not in females. The mortality rate of liver cancer increased significantly for all the age groups during the interval between two periods of 1954-1963 and 1964-1973. However, the mortality rate decreased for the age group of 20-29 in males and for most age groups in females during the interval between two periods of 1964-1973 and 1974-1983. Both international comparison and migrant study indicated an extraordinarily high risk of liver cancer among Chinese than other populations throughout the world. The cumulative mortality rate of liver cancer was 4.83% and 1.74% for males and females, respectively. The cumulative rate in Taiwan ranked as the second among 18 selected countries and areas compared. Mortality rates of liver cancer in Taiwan were lower than those in Hong Kong and higher than those in Mainland China for most age groups in both males and females. Striking geographical variation of liver cancer mortality was observed in Taiwan with high risk areas clustered in the Penghu Islets, the blackfoot disease endemic area and eastern mountainous aboriginal townships. The observations suggest environmental risk factors in addition to hepatitis B virus infection may be involved in the development of liver cancer.
• 125 - 138
• 10.6288/JNPHARC1988-08-02-05