9卷2期

• Link 原著 Original Article
• 宜蘭縣南澳及大同鄕泰雅族學童頭蝨症之研究A Long-Term Study on Head Louse (Pediculus Humanus Capitis) Infestation Among Atayal Aboriginal Children in Nanao and Tatung Districts, Ilan County, Northeast Taiwan
• 范秉真、鐘文政、詹家璽、吳金正
  Ping-Chin Fan, Wen-Cheng Chung, Chia-Hsi Chan, Chin-Cheng Wu
• 無
  Taiwan aborigines ; Epidemiology ; Pediculus ; Child
• 自1980年2月至1984年3月間應用肉眼觀察及細齒梳檢查法在宜蘭縣南澳及大同鄉2所國民中學及18所國民小學對泰雅族學童頭蝨症連續進行13次流行病學調查。由研究結果顯示，南澳鄉頭蝨傳染率，女學童在1980年2月為49.3%，男學童在1981年5月為0%。大同鄉女學童及男學童1981年5月傳染率分別為42.6%及2.4%。1984年3月傳染率顯較降低，南澳女學童9.9%，男學童仍為0%。大同鄉女學童5%，男學童0%。女性頭蝨傳染率顯較男性為高。傳染率與季節性無關。惟山胞女童(28.3%)則顯較非山胞者(3.3%)為高。南澳檢查212位女學童，42.0%傳染頭蝨（32.5%傳染1-5隻，8.5%傳染11-50隻，0.9%超過50隻）。在787隻頭蝨中，40.3%為雌性成蟲，35.2%為稚蟲，及24.5%?雄性成蟲。女學童平均每人傳染8.8隻頭蝨。本項長期研究顯示衛生教育為預防頭蝨症之合理途徑。無論如何，應用價廉、安全，及有效滅蝨劑乃為防治頭蝨症最佳之方法，雖然目前尚乏無毒性及有效之滅蝨劑。
  Aboriginal school children of the Atayal tribe from one junior high and nine primary schools each in both Nanao and Tatung Districts, Ilan County, Northeast Taiwan, were examined for head louse infestation by ocular and combing methods. Thirteen consecutive surveys were conducted from February 1980 to March 1984. The infestation rate among school girls in Nanao was 49% in February 1980 and 0.0% for boys in May 1981. The rates among girls and boys in Tatung were 43% and 2%, respectively, in May 1981. By March 1984 these rates decreased to 10% among girls but remained 0.0% among boys in Nanao and 5% among girls and 0.0% among boys in Tatung. Significantly higher infection rates were found among girls than boys throughout the study, and no relationship was found between the infestation rate and season. The prevalence among aboriginal girls (28%) was significently higher than for non-aboriginal girls (3%). Of 212 aboriginal school girls examined in Nanao, 42% were found to be infested with head lice (32% with 1-10 lice, 8% with 11-50 lice, and 1% with over 50 lice). Of 787 head lice examined, 40% were adult females, 35% nymphs, and 24% adult males. The average number of head lice in each infested girl was 8.8. The results of this long-term study show that perhaps health education might be a reasonable way to prevent head louse infestation. However, the application of a cheap, safe, and effective pediculicide would be the best way to control of the head louse infestation, although no effective and non-toxic pediculicide is available at present.
• 61 - 68
• 10.6288/JNPHARC1989-09-02-01

• Link 原著 Original Article
• 台北地區老年人調適策略與自評健康的關係Coping and Perceived Health of the Aged in Taipei City
• 張珏、黃茂芳、張素滿
  Chueh Chang, Mao-Fang Huang, Su-Man Chang
• 無
  Aged ; Coping behavior ; Psychosomatic medicine
• 台北縣市1519名65歲以上的老人為分析對象。以期了解目前一般老人，在感到不如意時，通常採取那些調這的行為和策略。並探究老人的基本資料（如年齡、婚姻狀況、教育程度等）與其調適行為之間關係。再者，就老人自評健康與否的結果，配合各人的基本資料，分析兩者之間相互影響的情形：結果發現，在二十一項列舉的調適行為當中，一般最常發現的前五項是；“無論如何要靠自已”，“既然發生了就接受它”，“順其白然”，“休息一下，冷靜後再去面對問題”以及“不想去多想它”。若對此二十一個項目作因素分析，則有四大類型：即情緒取向，解決問題取向，認命接受取向，及尋求社會支援取向。其中情緒取向，以女性或教育程度低者為多。問題解決取向，則以年輕型老人，教育較高者，都市化程度為第一級者為多，女性則以在單親，倆老核心家庭中較多採之。 預測自評健康的因素有：解決問題的調適策略，高教育，有健檢行為，已婚，同居者及較少負面情緒者，其預測力為12.8%。
  In order to understand the coping behaviors and strategies during a crisis as well as those factors related to self-perceived health status, 1519 subjects aged 65 and over, who were noninstitutionalized and resided in Taipei City and Taipei County, were interviewed with a household survey. Results show that: (1) Among 21 items of coping behavior, the most frequent five were ”depend on self anyway”, ”accept it”, ”follow nature”, ”rest awhile, calm down, then face the reality”, and ”not mention it”. (2) Using factor analysis, the four principal factors were being emotionally oriented, problem-solving oriented, accepting, and searching for social support. (3) The seven significant predictors of self-perceived health were identified as having problem-solving oriented coping strategies, higher education, routine health check ups, being married, and being less emotionally oriented.
• 69 - 82
• 10.6288/JNPHARC1989-09-02-02

• Link 原著 Original Article
• 花蓮區域基層醫療之評估Evaluation of Primary Care in Hua-Lien Area
• 陳慶餘、沈友仁
  Ching-Yu Chen, Yu-Zen Shen
• 無
  Primary health care ; Accreditation ; Family physician
• 配合台大醫院輔導花蓮區域醫療網計劃，本研究針對花蓮縣十三鄉鎮市137家基層醫療單位，以自行設計之評量表，進行診所診查。結果顯示：(1)在實際執業的129家負責醫師平均年鈴57歲，各鄉鎮人口診所比差異甚大；(2)醫師類別中，特考及格佔28.7%，醫學院校畢業佔48.8%和具有專科資格佔22.5%；(3)影響評量總分高低的項目包括：「有兩名醫師以上」、「無重複掛號的情形」、「靠完整身體檢查診斷」、「靠儀器診斷」、「靠檢驗診斷」、「相同作用的藥物無重複處方」、「無類固醇之濫用」、「打針的次數無明顯過多」、「服務時間一星期6天以上」、「有預防注射之服務」、「有消毒設備」和「有觀察床」。(4)評量總分為56分；特考及格醫師平均分數為28.6±5.6分，醫學院畢業醫師為34.4±6.3分，專科醫師為38.6±5.1分。(5)專科醫師在「有兩名醫師以上」、「靠儀器診斷」、「靠檢驗診斷」和「有消毒設備」等項目以及接受「繼續教育年次數」得分較高。最後本文根據上述評估結果，討論基層醫療服務品質的提昇策略。
  Hua-Lien County, located on the east coast of Taiwan, occupies about of the Islands' area and has 10% of its population. In the County, there are 11 hospitals and 137 clinics, as well as four large hospitals; the latter are all within Hua-lien city. Shortage of primary care physicians and maldistribution of medical resources can be noted. The Department of Health initiated a Hua-Lien Regional Medical Care Network Plan in fiscal year 1989, and assigned the National Taiwan University Hospital as the responsible medical center. This study focused on evaluation of the current status of general practice, through assessment of clinics by visiting experts who used a modified primary care accreditation list with a full score of 56. Results are summarized as follows: (1) The mean age of physicians in the actual 129/137 practicing clinics is 57±12 years; (2) The ratio of population/clinic varies from 1,462:1 to 14,138:1; (3) Classiffication of physicians shows non-medical graduates, 28.7%; medical graduates, 48.8% and specialists, 22.5%. Their average total scores were 28.6±5.6, 34.4±6.3 and 38.6±5.1, respectively; (4) Clinics with the following practice pattern and services had higher scores: two or more physicians (group practice), no double registration, good medical record, instrument-assisted diagnosis, using laboratory data in diagnosis, no inappropriate use of drugs and injections, available service more than 6 days a week, providing vaccination service, using sterile equipment and providing observation beds; (5) The study of medical care provided by the three types of physicians described, revealed that the specialists, in addition to obtaining higher scores and attedning more continuing medical education courses, showed more favorably in such criteria as group practice, instrument-assisted diagnosis, using laboratory data in diagnosis and using sterile equipment.
• 83 - 89
• 10.6288/JNPHARC1989-09-02-03

• Link 原著 Original Article
• 病人分類衍生的護理需求人員配置系統－國內值得推廣的實証作業The Empirical Operation for a Nurses Staffing Sys Tem Based on Patient Classification a Practical System in Taiwan
• 蘇喜、周照芳、 楊麗瑟
  Syi Su, Chao-Fang Chaw, Li-Se Young
• 無
  Cases Mix ; Productivity ; Staffing and Scheduling
• 由於傳統的護理人力配置方法無法現場反應病人的護理需要，乃藉由病人分類系統將病人依護理需求不同分為數類。同時配合直接護理作業建立各類病人所需的直接護理服務量，並以工作樣本研究探討護理人員工作時間之分佈。統合前述作業，成功地運用到在台灣地區負起領導地位的一所教學醫院之內、外科病房，其結果提供了一套足以反應病人護理需求的護理人員短程及長程的配置法，應該可以應用到其他醫院，且值得推廣。
  Traditional staffing method based on a fixed patient-to-personnel ratio can not effectively reflect the true needs of patients in a hospital. We constructed a patient classification system in which the expected amounts of nursing care consumed were used to categorized patients into three classes: self-care, partial care and total care A directcare survey was conducted to establish the actual nursing care time provided to each class of patients. Also, a work sampling study was used to determine the time distributions that nurses devoted to each type of nursing activity. A patient classification system integrating the results of both the direct care survey and the work sampling study can be effectively used to make short term and long term staffing plans.
• 90 - 104
• 10.6288/JNPHARC1989-09-02-04

• Link 原著 Original Article
• 台北某學院學生胃痛症狀相關因素之探討A Study on Epigastralgia and Related Factors among Students in a Collage in Taipei
• 季瑋珠、村源卿
  Wei-Chu Chie, Yuan-Ching Ko
• 無
  Psychosomatic medicine ; Students ; health services ; Stress
• 為探討大學學生胃痛症狀的相關因素，作者於民國75學年度在台北市某私立工學院（全體學生共1193人）進行了一項簡短的問卷調查，共有802人完成問卷，完成率67.2%。研究結果顯示：在過去一年中曾有過一次或一次以上胃痛症狀者有177人，占全部受調查學生的22.0%。在各項可能的相關因素中，早餐規則性、吸菸、飲酒、喝咖啡均無顯著相關，家族史呈現微弱相關；而自覺生活壓力（主要為學業壓力）與開夜車的需要性二項，則呈現顯著的正相關。本研究顯示了學業壓力在大學生胃痛症狀出現上的重要性，為學校衛生工作的研究與應用開聞了值得努力的新方向。
  For the purpose of investigating epigastralgia and related factors, a questionnaire survey was conducted in a college of 1193 students in Taipei. Only 802 students (67%) completed the questionnaire Of those, 177 (22%) have had at least one episode of epigastralgia in the previous year. Among the suspeted risk factors we investigated were smoking, alcohol, coffee, family history, subjective stress in daily life, and overnight studying. Only the last two items showed strongly significant positive associations (P<.01). These results demonstrate the importance of stress (especially academic stress) in the health of college students.
• 105 - 110
• 10.6288/JNPHARC1989-09-02-05