26卷1期

• Link 公衛論壇 Public Health Forum
• 由兩則網路“謠言”探討我國藥物食品中致癌物質的管理原則Probing the Management Principle for Food and Drug Carcinogenicity via Two Web Rumors
• 李志恒、 劉宗榮
  Jih-Heng Li, Tsung-Yun Liu
• 無
  none
• 無
  none
• 1-5
• 10.6288/TJPH2007-26-01-01

• Link 原著 Original Article
• 北部某區域醫院的婚前健康檢查滿意度調查Satisfaction Survey of a Premarital Health Examination at a Regional Hospital in Northern Taiwan
• 彭佩儀、藍旻暉、羅翊榕、史麗珠
  Pei-I Peng, Min-Huei Lan, Yi-Jung Lo, Lai-Chu See
• 婚前健康檢查 ； 滿意度
  premarital health examination ; satisfaction
• 目標：探討婚前健康檢查受檢者的檢查時機、受檢及選擇醫院的原因，以幫助婚前健康檢查的推動；詢問其實際及期望滿意度，作為改善的依據。方法：自2005年4至11月，在桃園某區域醫院對婚前健康檢查的受檢者進行問卷調查。結果：前瞻性3份、回溯性3份，集團結婚20份，共4份問卷。平均年齡約29.7歲，女性略多於男性，受檢時機以婚前較多(2.%)，在婚前2.9個月時受檢，婚後佔3.4%，在婚後1.4個月受檢。受檢原因以想知道彼此的健康狀況(45.7%)及優生保健的考量(43.6%)佔最多。50.0%受訪者由傳播媒體得知婚前健康檢查的訊息，選擇醫院原因則是離家或辦公室近(61.7%)、親友推薦(22.3%)、收費合理(21.3%)。比較期望與實際滿意度，顯示競爭優勢為檢查流程的規劃良好，競爭劣勢則是報告解說及遺傳諮詢不足。23.3%受訪者不建議親友接受婚前健康檢查，認為沒有必要、檢查結果沒有用或沒有特別之處。結論：建議應加強報告解說及遺傳諮詢，應增加與遺傳疾病有關的檢查，讓婚前健康檢查與一般的健康檢查有所區隔。
  Objectives: We aimed to investigate when, why, and at which hospitals couples sought to undergo premarital health examinations (PHE). The perceived and expected satisfaction ratings on varied items of the PHE were asked in order to improve such services. Methods: A questionnaire survey was performed in a regional hospital in Taoyuan. Results: From April to November 2005, 38 subjects were recruited prospectively, 36 subjects were recruited retrospectively, and 20 subjects were recruited from a group wedding. The mean age of the study subjects was 29.7 years. Females were slightly older than males. Two-thirds of the subjects underwent a PHE 2.9 months prior to marriage and one-third had a PHE 16.4 months following marriage. The two major reasons given for having a PHE were to determine one’s health status (45.7%) and to identify reproductive or inheritable diseases (43.6%). One-half of the subjects heard about PHE through the multimedia. The three most common reasons given for choosing the study hospital for a PHE were proximity (61.7%), recommendation by relatives or friends (22.3%), and the cost (21.3%). Comparing the perceived and expected satisfaction ratings of the service, most subjects were satisfied with the exam itself (competitive strength), but were not happy with the interpretation of the report and the lack of genetic consulting (competitive vulnerability). 23.3% subjects would not recommend the PHE to their friends because they questioned its necessity, felt the PHE results were not useful, or felt the PHE services did not differ from a routine physical examination. Conclusions: Genetic consulting and improved interpretation of the PHE report should be instituted. More screening for genetic diseases should be added to the PHE in order to distinguish the PHE from a routine physical examination.
• 6-16
• 10.6288/TJPH2007-26-01-02

• Link 原著 Original Article
• 香菸及檳榔課稅效果之研究Effect of Taxes on Cigarettes and Betel Nut
• 李家銘、葉春淵、洪榮耀
  Jie-Min Lee, Chun-Yuan Yeh, Jung-Yao Hung
• 菸控政策 ； 癮性商品 ； 價格彈性 ； 香菸及檳榔消費
  tobacco control policy ; addictive goods ; price elasticity ; cigarette and betel nut consumption
• 目標：在藉由香菸與檳榔的價格彈性估計來評估香菸及未來檳榔健康捐課徵對香菸及檳榔消費的影響效果，研究結果有助於台灣未來調漲香菸健康捐及課徵檳榔健康捐之重要參考依據。方法：以理性上癮模型(rational addiction model)，使用1972-2003年每年的香菸及檳榔銷售的價量時間數列資料，進行香菸與檳榔的價格彈性估計。結果：估計香菸及檳榔的價格彈性分別為－0.3018及－0.254。國內兩次菸品健康捐的課徵將使國人平均每人香菸消費分別減少8.57%及3.29%；若每顆檳榔課徵0.22元的情況下，其對檳榔消費的減少效果為2.88%，可節省醫療支出0.12%。結論：從公衛及財政的觀點，香菸及檳榔捐的課徵將有助於抑制國人香菸及檳榔的消費，又可以增加額外香菸稅及檳榔稅之財政收益。
  Objectives: The effect of a Health and Welfare Tax on cigarettes and betel nut consumption was evaluated by estimating cigarette and betel nut price elasticities. The results of the current study will hopefully provide a useful reference for health policymakers when instituting taxes on cigarettes and betel nuts. Methods: Using the annual statistics published from 1972-2003, we established a model based on the rational addiction model to estimate the price elasticity coefficients of cigarettes and betel nut. Results: The price elasticities for cigarettes and betel nut were -0.3018 and -0.254, respectively. By raising the tobacco health welfare tax twice, there would be an 8.75% and 3.29% reduction in the average per capita cigarette consumption. If a NT$0.22 per Betel Nut Health Tax is levied in the future, there would be a 2.88% reduction in the average per capita betel nut consumption and a medical savings of 0.12%. Conclusions: From a public health and financial perspective, levying taxes on cigarettes and betel nut would not only have a significant effect on reducing cigarette and betel nut consumption, but would also generate additional revenues.
• 17 - 25
• 10.6288/TJPH2007-26-01-03

• Link 原著 Original Article
• 基層醫師釋出慢性病連續處方箋之意願及相關因素Willingness of Clinic Physicians to Approve Prescription Refills for Chronic Diseases
• 龔佩珍、呂嘉欣、 蔡文正
  Pei-Tseng Kung, Chia-Hsin Lu, Wen-Chen Tsai
• 連續處方箋 ； 處方箋釋出 ； 慢性病 ； 滿意度
  refilled prescriptions ; prescription release ; chronic disease ; satisfaction
• 目標：醫師意願為影響慢箋釋出之首要因素，故本研究希望了解影響基層診所醫師釋出慢性病連續處方箋之意願及相關因素。方法：依健保局特約醫事機構名冊篩選符合研究條件之8,830位西醫基層醫師為研究對象，從中隨機抽取4,000位，以郵寄結構式問卷的方式進行問卷調查，共計回收有效問卷813份。除描述性分析外，並以複迴歸分析探討影響基層醫師釋出慢箋意願之相關因素。結果：50.5%的基層醫師表示願意或非常願意釋出慢箋，但也有32.7%醫師表示不願意或非常不願意；不願意理由前三項主因為「醫療糾紛責任區分不明」、「領藥流程造成民眾不便」、「藥師可能私自更換藥品」。五成以上基層醫師表達對於慢箋釋出制度不滿意。在控制其他變項下，影響基層醫師釋出慢箋意願之因素為「醫師認為無法即時掌握病情」、「增加醫師用藥困擾」、「對社區藥師協助用藥安全之認知」及「是否應制定社區藥局處方箋獨立總額之看法」、「對處方交付費滿意度」、「是否自聘藥師協助調劑」、「執業年資」、「平均每週病患人數」及「醫師主要診治之疾病」。結論：約一半基層醫師願意釋出慢性病連續處方箋，但仍有不少醫師不願釋出，若能針對研究中提出之不願意釋出因素加以改善，將能提升慢性病連續處方箋之釋出。
  Objectives: Physicians willingness is the main factor determining the approval of prescription refills for chronic diseases. The aim of the current study was to investigate the factors influencing the willingness of clinic physicians to approve prescription refills. Methods: Of 8,830 clinic physicians in the National Health Insurance database, 4,000 physicians were randomly surveyed with structured questionnaires. Of the 4,000 questionnaires mailed to the physicians, 813 were returned. Descriptive and multiple regression analyses were performed to identify those factors determining clinic physicians’ willingness to approve prescription refills. Results: Of the physician respondents, 50.5% were willing, or very willing, to approve prescription refills for chronic diseases, whereas 32.7% of clinic physicians were unwilling, or very unwilling, to do so. The three major reasons determining a physician's unwillingness to approve prescription refills were: 1) concerns related to medical malpractice, 2) inconvenience associated with the process, and 3) the possibility of the prescription being changed. One-half of physicians were not satisfied with the policy pertaining to the approval of prescription refills. After controlling for other factors, the factors significantly associated with the physicians' willingness to approve prescription refills included: 1) empathy for the patient's medical condition, 2) increased medication problems, 3) the pharmacist's competence in safely dispensing medications, 4) establishing a separate global budget payment schedule for prescription refills, 5) satisfaction with the reimbursement for prescription refills, 5) hiring the pharmacist, 6) years of practice, 7) weekly patient volume, and 8) a physician's speciality. Conclusions: One-half of the clinic physicians sampled in the current study were willing to approve prescription refills for chronic diseases. By focusing on the factors associated with the physicians' unwillingness to approve prescription refills and working to overcome them, the rate of approving prescription refills may be increased.
• 26 - 37
• 10.6288/TJPH2007-26-01-04

• Link 原著 Original Article
• 台灣愛滋病病毒感染者之需求評估Needs Assessment of People Living with HIV/AIDS in Taiwan
• 古力巴、 顏璧梅、傅麗安、陳宜民
  Sidi Coulibaly, Pi-Mei Nancy Yen, Li-An Fu, Yi-Ming Arthur Chen
• 需求 ； 評估 ； 愛滋病病人 ； 台灣 ； 中途之家
  Needs ; Assessment ; People living with HIV/AIDS ; Taiwan ; Halfway house
• 目標：評估及比較北台灣地區在愛滋病特別門診、監獄及中途之家的愛滋病病人需求的內容及差異。方法：自2005年12月至2006年6月，自台北市立醫院愛滋病特別門診、桃園監獄、及兩處愛滋病中途之家共收取367名愛滋病病患作為研究之樣本。以SPSS 12版統計軟體進行問卷資料的統計分析。結果：結果顯示1/3的受訪者不知道自已的CD4指數(32%)及病毒量(37.8%)。來自健康照顧工作者及一般民眾的支持是受訪者最需要的。中途之家的受訪者最需要經濟上的補助、交通工具、及良好的人際關係，且在生理及精神上特別脆弱。中途之家及監獄內的愛滋病病人傾向於需要更多的精神上的支持及社會服務的協助。受訪者基本存活的重要因素包括有營養、雞尾酒療法、運動、家人的照顧及同儕的支持。工作對中途之家的病人似乎格外重要。結論：本研究結果顯示應提供更多的諮商及相關訊息給這些病患。事實上監獄中的愛滋病病人從未接受CD4計數及病毒含量測試，建議監獄裏應該提供這類檢查。
  Objectives: The objective of this study was to assess and compare the needs of HIV/AIDS patients in outpatient clinics, prisons and residential care facilities in northern of Taiwan. Methods: From December 2005 to April 2006, 367 people living with HIV/AIDS (PLWHAs) from the outpatient special AIDS clinics of the Taipei City Hospital, Taipei Detention Centers and Tao Yuan Prisons and two residential care facilities in Taipei participated in this study. The data was analyzed using the Statistical Package of Social Sciences version 12. Results: The results showed that one-third of the all the participants were unaware of their CD4 count (32%) and their viral load (37.8%). Moreover, support from health care workers and personal support were identified as the most important needs among PLWHAs. The following items were listed among PLWHAs from the residential care facilities: financial assistance, transportation, and personal relations. The perceived physical and psychological health was particularly weak among PLWHAs in residential care facilities. Patients in residential care facilities and prisons tended to have higher levels of psychological and social needs. The survival strategies were mostly based on nutrition, antiretroviral therapy, exercise, family care and peer support, however, work seemed to be very important for patients living in residential care facilities. Conclusions: Results of this research projects shown that more counseling and information should be provided to the patients. The fact that most of the patients in prisons have never received CD4 count and the viral load tests indicates that these tests should be provided in prisons.
• 38 - 48
• 10.6288/TJPH2007-26-01-05

• Link 原著 Original Article
• 食品污染新聞報導內容與品質之研究－以2005年“戴奧辛鴨蛋”與“孔雀石綠石斑魚”為例Exploring the Content and Quality of Food Pollution News Reports-A Case Study Involving the 2005 Reports on "Dioxin Duck's Eggs" and "Malachite Green Groupers"
• 陳思穎、吳宜蓁
  Si-Ying Chen, Yi-Chen Wu
• 食品污染 ； 戴奧辛鴨蛋 ； 孔雀石綠石斑魚 ； 內容分析 ； 資訊品質
  food pollution news ; Dioxin Duck's Eggs ; Malachite Green Groupers ; information quality ; content analysis
• 目標：本研究欲探討新聞報紙如何呈現食品污染新聞事件的樣貌？其採訪與報導的方式為何？主要的議題訴求為何？消息來源為何？這些報導是否具有品質？值得民眾信賴。方法：以內容分析法來進行「戴奧辛鴨蛋」與「孔雀石綠石斑魚」新聞報導的研究，分析的報紙有《蘋果日報》、《中國時報》、《聯合報》、《民生報》總計兩起案例130則報導。結果：兩起事件報導版面以「焦點／頭條」版面最多；報導方式以「深度報導」最多；消息來源皆為「政府機構」；戴奧辛鴨蛋以「事件調查」議題為主；孔雀石綠石斑魚則以「社會議題」為主；新聞報導戴奧辛鴨蛋以「事件調查與研究成果」資訊最多；孔雀石綠石斑魚則以「專業知識與預防行為」資訊為多。結論：報紙報導此兩起事件的議題廣度不夠、消息來源過於偏重政府、資訊涵蓋量不夠豐富多元；不過以可靠性而言，各家報紙的報導都是值得民眾信賴的。
  Objective: The purpose of the current study was to discuss consumer's concerns regarding the safety and health of food by asking the following series of questions. What food pollution issue was the broadcasting or media covering? What were the tools or policies used during interviewing and reporting? Why was the case being discussed? What were the resources? Were these reports effective for the consumers? We sought to examine the content and quality of the ”Food Pollution News Reports” to determine whether or not the reports were reliable. Methods: ”Content Analysis” was used to analyze Taiwan's 2005 news reports on ”Dioxin Duck's Eggs” and ”Malachite Green Groupers.” A total of 130 versions of the two reports were sampled from the Apple Daily, the China Times, the United Daily News, and the Min Sheng Daily. Results: The two reports analyzed were primarily reported on the headline news or hot news. The government served as the source for most reports. Most issues regarding ”Dioxin Duck's Eggs” were inquisitions of the event, while most issues regarding ”Malachite Green Groupers” were social issues. Most information pertaining to ”Dioxin Duck's Eggs” involved research results of the event, while most information pertaining to ”Malachite Green Groupers” was based on professional knowledge and prevention awareness. Conclusions: The issues covered in these two reports were not sufficiently extensive. The resources depended on the government and the information covered lacked diversity. Nevertheless, the reports from each newspaper were still reliable and trusted by consumers.
• 49 - 57
• 10.6288/TJPH2007-26-01-06

• Link 原著 Original Article
• 不同種族婦女懷孕期間物質使用和身體受虐的情況與其嬰兒出生體重之關係The Prevalence of Substance Use and Physical Abuse during Pregnancy and the Effects on Birth Weight in Ethnic Groups
• 陳瓊華、徐南麗、楊燦、鍾蝶起
  Chiung-Hua Chen, Nan-Ly Hsu, Tsan Yang, Tieh-Chi Chung
• 物質使用 ； 受虐 ； 出生體重 ； 原住民
  substance use ; physical abuse ; birth weight ; aborigines
• 無
  Objectives: Substance use and physical abuse during pregnancy are known health problems that detrimentally affect maternal health and birth outcomes; however, many health professionals pay little attention to these problems. The aims of this study were to estimate the prevalence of substance use and physical abuse during pregnancy in different ethnic groups and to explore the effects on birth weight. Methods: A total of 481 pregnant women from the Taitung area, including 112 aboriginal and 369 Fukien-Taiwanese women, were recruited between November 2000 and August 2001. A substance use questionnaire, an abuse assessment screening questionnaire, and socio-demographic data were used in the analysis. Results: The prevalence of substance use in aboriginal women during pregnancy was significantly higher than in Fukien-Taiwanese women. There was also a significantly higher rate of physical abuse in aboriginal women (p<0.001). We determined that the birth weight was significantly lower in newborns of mothers who smoked cigarettes or chewed betel quid during pregnancy (p<0.05), but there was no significant association between birth weight and physical abuse. Conclusions: The findings of this study increases knowledge about substance use and physical abuse in pregnant women and provides an incentive to promote maternal and infant health care in the community, especially in aboriginal women.
• 58 - 65
• 10.6288/TJPH2007-26-01-07

• Link 原著 Original Article
• 台北市1991-2004年間社會經濟因子與自殺死亡率趨勢Socioeconomic Factors and Suicide Mortality Trends in Taipei City between 1991 and 2004
• 游舒涵、陳映燁、邱燕楓、 陳喬琪、邱震寰、郭千哲、張珩、宋晏仁
  Shu-Han Yu, Ying-Yeh Chen, Yen-Feng Chiu, Chiao-Chicy Chen, Chen-Huan Chiu, Chian-Jue Kuo, Hang Chang, Yen-Jen Sung
• 自殺率 ； 社經因子 ； 失業率 ； 遷移率 ； 女性勞動參與率
  suicide rate ; socioeconomic factors ; unemployment rate ; social mobility rate ; female labor force participation
• 無
  Objectives: To examine the relationship between socioeconomic factors and suicide mortality trends in Taipei City between 1991 and 2004. Methods: We used data obtained from the Taipei City Bureau of Health to assess Pearson’s correlation coefficients between a series of socioeconomic factors, such as unemployment rates, social mobility rates, divorce rates, percentage of single person households, and poverty rates, and age-standardized suicide mortality rates. Cochrane-Orcutt regression was used to evaluate the relationship between socioeconomic factors and suicide death rates; the analysis was stratified by age and gender. Results: Pearson's correlation analysis showed that with the exception of the female labor force participation rate, all socioeconomic factors had a significant association with suicide death rates (P<0.05); the associations were stronger among males than females. The results obtained by Cochrane-Orcutt regression analysis were similar to the results derived from Pearson’s correlation analysis. In addition, the relationships between socioeconomic factors and suicide rates were stronger among males than females, especially in the 25-64 year old age groups. Conclusions: Socioeconomic factors were powerful determinants of suicide among males, especially for middle-aged men. These finding suggest that implementation of appropriate social policies should be an integral part of an optimal suicide prevention program.
• 66 - 74
• 10.6288/TJPH2007-26-01-08

• Link 原著 Original Article
• 台灣受僱者疲勞的分布狀況與相關因素Distribution and Correlates of Burnout among Paid Employees in Taiwan
• 張晏蓉、葉婉榆、陳春萬、陳秋蓉、石東生、鄭雅文
  Yen-Jung Chang, Wan-Yu Yeh, Chun-Wan Chen, Chiou-Jong Chen, Tung-Sheng Shih, Ya-Wen Cheng
• 疲勞 ； 工作壓力 ； 哥本哈根疲勞量表 ； 台灣
  burnout ; work stress ; Copenhagen Burnout Inventory CBI ; Taiwan
• 目標：了解國內受僱工作者疲勞狀況的社會分布及相關因素。方法：資料源自2004年全國受僱員工調查共計男性8906人，女性6382人。以「哥本哈根疲勞量表」做為測量疲勞的工具，包括「一般疲勞」與「工作相關疲勞」兩個分量表。問卷中也測量其他因素包括工作時數、工作負荷、工作控制感、教育程度、職業等級、家庭照顧負荷等。結果：12.7%的男性與9.1%的女性在調查前一週中工作49小時或以上。在所有年齡層與職等中，女性受僱者的疲勞指數皆顯著高於男性。當依性別分析，我們發現在女性受僱者中，高職等、高教育程度者的疲勞指數高於低職等、低教育程度者。然而在男性受僱者中，疲勞指數並沒有清楚的社會階層分布。複迴歸分析發現，每週工時49小時或以上者、工作心理負荷量較高者、以及家中有六歲以下幼兒或失能老人者，乃是疲勞的高危險族群。另外，45歲以下受僱者的「工作相關疲勞」指數亦顯著高於45歲以上的受僱者。結論：本研究指出受僱者疲勞的高危險群，提供未來職場健康促進策略之方向。
  Objectives: This study was designed to investigate the distribution and correlates of burnout among paid employees in Taiwan. Methods: A national survey was conducted in 2004, consisting of 8906 male and 6382 female paid employees. The status of personal burnout and work-related burnout was measured by the Chinese version of the Copenhagen Burnout Inventory (C-CBI). We also assessed work hours, psychological job demands, job control, level of education, employment grade, and family care workloads. Results: 12.7% of men and 9.1% of women reported working > 49 hours in the week prior to the survey. Higher burnout scores occurred in females than in males across all age groups and employment grades. When stratified by gender, females who were better educated and had higher employment grades had higher levels of burnout than females with a lower socioeconomic status. In males, however, there was no apparent social pattern of burnout across socioeconomic categories. Employees who worked hours = 49 hours per week, had jobs that were more psychologically demanding, had children < 6 years of age, or cared for disabled elderly at home, had higher levels of burnout. Younger employees also had higher levels of work-related burnout. Conclusions: This study identified high-risk groups of burnout among paid employees in Taiwan and, as a result, provides directions for improved health promotion strategies in the work place.
• 75 - 87
• 10.6288/TJPH2007-26-01-09