9卷1期

• Link 原著 Original Article
• 家庭結構，年齡和性別影響成人健康行爲之探討Family Structure, Age, and Gender as Determinants of Adult Health Behavior
• 李蘭、季瑋珠、江永盛、 楊志良、呂槃
  Lee-Lan Yen, Wei-Chu Chie, Yung-Sheng Chung, Chih-Liang Yaung, Laura P. Lu
• 無
  muclear family ; behavior
• 一個以『家庭』?基礎的健康調查，自民國76年7月迄民國77年6月止，共完訪1,580個家戶和2,656位18歲以上成人。據本家戶係按人口比例以系統集束抽樣步驟，從台灣北部地區選出，共計50個村里。經臺灣省政府衛生處支援，調派16位訓練有素的公共衛生護士，於接受?期三天的訓練後，每二人編成一組分別前往預定地點進行家戶訪視工作。 本研究目的在探討成人的健康行?和家庭結構，年齡組，及性別等變項之間的關聯性。重要結果歸納如下：(1)調查對象屬擴大家庭者比核心家庭者吃早餐的頻率高，而且年長者比年輕者吃早餐的頻率高；(2)男性比女性攝取高鈉食物的頻率高，而且年輕者比年長者的攝取鈉的頻率也高；(3)就65歲以上的調查對象而言，屬擴大家庭者較核心家庭者從事運動的頻率高，同時男性所報告的運動頻率也比女性高；(4)從事休閒活動的頻率隨年齡臉增長而遞減，30歲以上的調查對象中，男性的參與頻率顯著高於女性；低年輕者比年長者的睡眠時間長；(6)男性比女性目前有抽菸的比率高；(7)男性目前有喝酒的比率較女性?高。 『家庭結構』變項對於成人健康行?的影響力在本研究中發現甚微，與預期結果相去甚遠。若按『成員組成』將家庭分成『擴大家庭』或『核心家庭』的類別時，家庭功能（如家人支持）無法有效地被偵測出來。欲瞭解家庭對成員的健康行?是否具有影響力，需對反應家庭功能的指標（建議利用『家庭關懷』指數）再做探討。整體來說，成人健康行?中需加強的項目?規律地運動，減少高鈉食物的攝取，除去抽菸和喝酒的習慣。
  A family-based health survey in northern Taiwan was conducted from July 1987 to June 1989, in order to determine whether adult health behavior is associated with family structure, age category, and gender. 1,580 households (2,656 adults) were selected from 50 subwards, proportionally according to population size. Trained public health nurses from the Taiwan Provincial Health Department were assigned to administer health surveys and take physical measurements according to standardized protocols. The results can be summarized as follows: (1) Subjects in extended families had breakfast more frequently than those in nuclear families, while young subjects tended to have breakfast less frequently than older ones. (2) Male and younger subjects reported higher frequencies of sodium consumption than female and older subjects. (3) Subjects over 65 living in extended families performed physical exercise more often than their counterparts in nuclear families; males reported exercising more frequently than females. (4) Recreational activity decreased with age: among subjects over the age of 30, males reported significantly greater recreational activity than females. (5) Young subjects tended to sleep more than older ones. (6) Smoking was more prevalent among males than females. (7) Drinking was more prevalent among males than females. The study indicates that family structure plays a weak role in determination of adult health behavior; using the classifications of ”nuclear” or ”extended” families for household structure, no significant effect on health behavior could be detected. In order to understand the effect of family on the health behavior of individuals, additional indicators of family characteristics which may influence health behavior need to be investigated.
• 1-13
• 10.6288/JNPHARC1989-09-01-01

• Link 原著 Original Article
• 台灣地區醫療社會工作人員工作壓力、社會支持與職業倦怠之研究Work Stress, Social Support and Burnout among Medical Social Workers
• 楊蓓
  Pei Yang
• 無
  Social work ; Stress ; Social Support ; Professional Burnout
• 本研究以郵寄問卷對各級教學醫院和中華民國醫務社會協會之團體會員，以社會工作人員工作壓力量表、社會支持量表和職業倦怠量表施測，填答後分別各自寄回，共發出問卷224份，回收率75.5%，其中有效問卷157份。 研究發現，（一）醫療社會工作者的工作壓力主要來自制度與組織方面，其中尤以缺乏陞遷管道、專業缺乏社會認同、組織缺乏長程目標?著。（二）醫療社會工作者的社會支持主要得自同事和朋友，來自督導和家人的支持較差。且女性工作者所得之整體社會支持與同事支持顯著高於男性工作者。其中已婚工作者的家人支持甚?顯著，而本科系畢業之工作者的朋友支持甚?顯著。（三）醫療社會工作者在職業倦怠方面呈現出工作情緒低落、有無力挫折感、常盼望有假期，想另外換他職或想休息一陣子，覺得不被瞭解，工作投入較差。其中以30歲以下的工作者倦怠感十分顯著。（四）醫療社會工作者的工作壓力與職業倦怠感呈顯著正相關；工作壓力與社會支持呈顯著負相關；職業倦怠與社會支持呈顯著負相關。其中，督導支持高者，整體工作壓力低，職業倦怠感亦低；同事支持高者，人際壓力低，職業倦怠感亦低。而社會支持無法證實在工作壓力與職業倦怠之間造成緩衝效果，但是工作壓力與社會支持都對職業倦怠有主效應，二者同時出現時，對倦怠的預測力增高。
  This study has examined the strength and relationship of work stress, social support and burnout, and the buffering effect of social support between work stress and burnout among medical social workers. 224 medical social workers including psychiatric social workers were studied, and the effective cases returned were 157. The study revealed that most work stress of medical social workers came from the lack of professional system in poorly designed organizations. Most of their social support was received from colleages and friends, but support from families and supervisors were less. The female workers' support were significantly higher than the male workers. Family support of married workers and friend support of workers who were graduated from social work Dept. were significantly higher. Younge workers who were less than 30 years old experienced higher burnout. Work stress was positively correlated with burnout and negatively correlated with social support which was negatively correlated with burnout. Workers who have higher supervisor's support revealed lower work stress and burnout. Higher colleage support revealed lower interpersonal stress and burnout. Work stress and social support have significant main effect on burnout, but the buffering effect of social support has not been proved in this study.
• 14 - 28
• 10.6288/JNPHARC1989-09-01-02

• Link 原著 Original Article
• 單胞與雙胞胎產婦產後焦慮的比較Postpartum Anxiety among Mothers of Twins and Singletons
• 張珏
  Chueh Chang
• 無
  anxiety neuroses ; twins
• ?了明瞭雙胞胎產婦是否比其他單胞胎產婦承受較多的產後焦慮，特別針對40位雙胞胎產婦與24位單胞胎產婦在產後3-5天內進行問卷訪問。然後根據Spielberger的情境－特質焦慮問卷與其出生別、生產方式等資料進行分析比較。結果發現單純比較胎性（單胞胎與雙胞胎）在特質焦慮與產後情境焦慮上的差別，都無明顯不同，只是情境焦慮得分都比特質焦慮?低。在生產方式，胎次別上，不論特質或產後焦慮也都無差別，在足月與否上，體重是否大於2500公克以上，則發現在特質焦慮上二組無差別，但在產後焦慮則不足月的高於足月的，而體重不足者高於體重足者（其間祛除雙胞胎一?足月一?不足月者）。進一步用單變項變異數分析，則在雙胞胎中，不足體重者產後焦慮，明顯高於體重足與有一個不足者。然進一步用配對t檢驗方式比較胎兒體重、出生別、生產方式上單雙胞胎產婦的差異時，則發現雙胞胎?自然分娩者，產後情境焦慮有顯著下降，而剖腹者則無。單胞胎則皆無差別。在胎次方面不論單胞或雙胞，特質與情境焦慮在第二胎有顯著下降。雙胞胎體重大於2500公克者，產後情境焦慮亦下降很多，懷孕週數足月的雙胞胎，其產後焦慮下降很多。最後對本研究結果，提出研究限制、討論與未來展望。
  In order to examine the level of postpartum anxiety between mothers of twins and of singletons, Spielberger's State-Trait Anxiety Inventory was taken of 40 mothers of twins and 24 mothers of singletons 3-5 days postpartum. No differences between mothers of singletons and of twins were found for state or trait anxiety. However, the scores for state anxiety were overall lower than those for trait anxiety. Paired t-test was applied to examine associations of different factors with trait and state anxiety. Postpartum anxiety was significantly lower than trait anxiety in mothers of twins who had normal deliveries, in mothers (both of twins and of singletons) experiencing their second delivery, and in mothers of twins who had full-term pregnancies delivering infants weighing more than 2500 g. Possible explanations for these results, limitations, and further study of these issues are discussed.
• 29 - 37
• 10.6288/JNPHARC1989-09-01-03

• Link 原著 Original Article
• 社區民眾對基層醫療保健服務利用與需求之研究簡報A Study on Demands and Use for Primary Health Care of Communities
• 鍾蝶起、黃麗鈴
  Dye-Chii Chung, Li-Ung Huang
• 無
  none
• 無
  none
• 38 - 45
• 10.6288/JNPHARC1989-09-01-04

• Link 其他 Others
• 台灣地區惡性腫瘤之流行病學特徵：Ⅱ鼻咽癌Epidemiologic Characteristics of Malignant Neoplasms in Taiwan: V. Nasopharyngeal Carcinoma
• 王玉芬、蔡淑芳、許光宏、游山林、李心馨、 林東明、陳建仁
  Yue-Fen Wang, Shu-Fang Tsai, Kuang-Hung Hsu, San-Lin You, Shin-Shin Lee, Tong-Ming Lin, Chien-Jen Chen
• 無
  nasopharyngeal neoplasms ; epidemiology ; Taiwan
• 本研究利用台灣地區1967年至1986年之鼻咽癌死亡率與1983年至1985年間鼻咽癌發生率，以探討台灣地區近20年來鼻咽癌之年齡曲線、性別比例、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。分析結果顯示台灣地區1967年至1986年間男性與女性之年齡標準化死亡率均有顯著的上升，但是男女性別比例則維持在2至3倍間沒有顯著差異。觀察近20年來各年齡層之鼻咽癌死亡率，發現自15-19歲以後死亡率急遽上升，至40-44歲時達高岑，50歲以後則呈現高原狀態。國際比較和移民研究均顯示中國人罹患鼻咽癌之危險性遠高於其他種族，但在香港、新加坡和舊金山的中國人鼻咽癌發生率卻高於台灣。由研究結果顯示鼻咽癌之發生遺傳因素佔有很重要的地位，而人生早期暴露的環境危險因子亦可能對鼻咽癌之發展有相當的作用。
  Epidemiological characteristics of nasopharyngeal carcinoma were studied by examining mortality rates from 1967 to 1986 and incidence rates from 1983 to 1985. A significant increase in age-adjusted mortality rates from 1967 to 1986 was observed for both males and females, with a constant male-to-female ratio of 2:1 to 3:1. Age-specific mortality and incidence rates rose prominently from age 15-19 and peaked at age 50. Both international and migrant comparisons showed a higher risk of nasopharyngeal cancer among Chinese than among other populations. Chinese in Hong Kong, Singapore and San Francisco had significantly higher NPC incidence rates than Chinese in Taiwan. These observations suggest that genetic composition may play an important role in the determination of nasopharyngeal cancer, and that environmental risk factors which may contribute to the development of this cancer probably have their effects early in the individual's life.
• 46 - 57
• 10.6288/JNPHARC1989-09-01-05