9卷4期

• Link 綜論 Review Article
• 台灣企業界職業衛生管理的未來方向－美日五家公司考察後之建議Enterprise-Based Occupational Health Management in the Future of Taiwan-Recommandations Based on a Field Trip to Five American and Japanese Companies
• 陳保中、王榮德、張蓓貞、彭台珠
  Pau-Chung Chen, Jung-Der Wang, Pei-Jen Chang, Tai-Chu Peng
• 無
  Management ; Occupational health ; Employee assistance programs
• 職業衛生管理的目的在於增進勞工生理的、心理的與社會的健康，企業基於維護勞工健康、減少職業災害、增進生產效率、提高經營利潤及建立勞資和諧和企業形象，必須將職業衛生管理列為整體企業管理的重心之一。本文收集美國New England Telephone、Bethlehem Steel Corporation、Shell Oil Company、Chevron Corporation，及日本Kashima Steel Work、等企業的職業衛生管理制度。就各企業的概況、職業衛生政策、管理組織、各項職業衛生計劃內容及職業衛生管理人員，嘗試比較分析其異同，同時將本國某鋼鐵公司的職業衛生管理制度與之對照，以對本國企業職業衛生管理的未來提出建議。我們歸納出下列數點未來特別值得本國職業衛生之優先發展與學習： 1.每個企業應當有明確的職業安全衛生政策，並在公司內確實教導全體員工執行。 2.企業內之安全衛生組織應具有能直通最高決策階層之權力，而能使其做成之決議在生產線上具有相當程度之優先。 3.企業應發展減毒減廢觀念於生產線，以妥善預防公害發生。尤其是在化學相關企業更應考慮將醫療、毒理、環境保護與職安全業衛生等單位，結合成一管理部門，以提昇毒物防治效率。 4.企業應發展有效之員工健檢與環境偵測計劃，並實施電腦化管理，以期早日偵知及預防危害。 5.本國未來應在企業中發展並推廣員工輔助計劃(Employee assistance program)，以便維護人力及捉進員工之心理、社會的全面健康。 6.本國宜及早培植職業衛生相關科系之人才，可採與學術單位合作之工作獎學金或在職進修方式，也可為企業界作一些實際之安衛工作。
  The objective of occupational health programs is to promote the physiological, psychological and social well-being of all workers. Corporate policy should implement an effective program to prevent occupational accidents and diseases, improve production efficiency and enhance labor relations. After on-site visits to 4 American Companies (New England Telephone, Bethlehem Steel, Shell Oil, Chevron Corporation), 1 Japanese company (Kashima Steel Works), and 1 Chinese company (a certain steel corporation), we have the following recommendations for the future development of corporate management of occupational health: (1) Every company should have a clear corporate policy for occupational health. After educating each employee about this policy, it should also be enforced. (2) Occupational safety and health (OSH) organization within a company should have a direct access to top management and production management so that the policy will get a high priority on the production line. (3) Concept of waste and toxics minmization should be integrated into OSH and implemented throughout the production line to prevent pollution. Chemical industry should also combine works involing medical and toxicology departments, OSH and environmental pollution control, perhaps into a single management department, to have a more effective control of hazards from toxic substances. (4) Industry should develop effective environmental and health monitoring programs and computerize these data in order to recognize early and analyze any suspicious health hazard for fast implementation of effective preventive measures. (5) Employee assistance programs should be considered as the first priority for our industry to develop and promote psychological and social well-beings in the future. (6) We should develop occupational health professionals, including doctors, nurses, and industrial hygienists as soon as possible in Taiwan. Such development can be done by a continued education of the people who are on the job, or through work-study scholarship for students in the academic institution.
• 171 - 183
• 10.6288/JNPHARC1989-09-04-01

• Link 原著 Original Article
• 國人對全民健康保險部分負擔之意見調查A Kap Study on Cost Sharing
• 楊志良、蘇春蘭、傅千芬
  Chih-Liang Yaung, Cheng-Lan Su, Chien-Fen Fu
• 無
  Health Insurance ; Cost Sharing Insurance
• 本調查之目的在瞭解民眾對全民健康保險實施部分負擔之態度、對保險費及部分負擔之負擔能力以及「若實施部分負擔，參與健康保險之意願」，並探討其影響因素，以為規畫全民健康保險之參考。 本調查除以分層三段等機率抽樣法抽取2500名設籍在台灣地區（不含離島及山地）之成人樣本外，另由公保處及勞保局抽取822名及500名公、農保被保險人，以獲得足夠之公、農保樣本。本調查採郵寄結構式問卷收集資料，有效問卷回收率為36.2%(1383/3822)，各險別回收樣本與其該險別母?體在性別及年齡別之分佈無顯著差異。 其結果摘要如下： 1.公、勞保樣本自認交保險費金額較實際繳納額高出甚多，而農保樣本則較相近。可能的原因是公勞保被保險人自己負擔的保險費係由政府或雇主自薪資中扣除，而非自行籌款繳交，故造成認知上的差距。 2.為使家戶內尚未投保者都能加入健康保險而同意每戶每月再繳1100元保險費者佔83.5%。 3.每次門診可負擔20%（60元）者佔89.7%；每次住院可部分負擔5%（1,100元）醫療費者佔86.1%；家戶每月部分負擔上限可為3000元者佔76.5%。 4.依所定之部分負擔條件，有78.8%的人贊成實施部分負擔方式為定率制。而若實施部分負擔，仍然願意參加全民保健者達84.1%，由此可見，全民健康保險採行部分負擔制度是為大多數民眾所接受。 5.年紀較輕者，教育程度較高者，在政府機關工作或為雇主者，家庭收入較高者、參加公保和有參加民間壽險者比非具上述特性者，其繳納保險費及部分負擔之能力亦較強。 6.教育程度較高者、在政府機關工作或為雇主者、家庭收入較高者、參加公保、有參加民間壽險者、繳納保險費及部分負擔能力較高者比非具上述特性者，其較贊成實施部分負擔，且參與健康保險之意願亦較強。
  In order to understand the attitude of adults in Taiwan toward cost sharing, the affordability of premium and the intention to join national insurance even with cost sharing, a sample of 3822 adults were randomly selected among residents of Taiwan area those insured by Government Employees' Insurance (GEI) and Farmers Insurance (FI), who received a questionnaire survey by mail. After sending three mailings, the response rate is 36.2% (1383 among 3822). There were no significant differences in sex and age distribution between the respondents of GEI, FI and Labor Insurance (LI) and their populations. Main results are as followings: 1. The reported insurance premium paid by GET and LI insured is much higher than what they acturally pay, but this is not so for farmers. The reason is the insured of GEI and LI pay their premium by a deduction on salary payment. On the other hand, farmers must pay their prmium out of pocket directly. 2. 83.5% of respondents agree to pay an additional monthly premium of NT$ 1,100 in order to allow their still uninsured family members to be covered by health insurance. 3. Regarding cost sharing, 89.7% of respondents reply that they are able to pay NT$60 per OPD (equal to 20% of the average cost of OPD's), 86.1% are able to pay NT$ 1,100 per hospitalization (equal to 5% of the average cost of hospitalizations) and 76.5% agree to set the ceiling of cost sharing at NT$ 3,000 per household per month. 4. 78.8% of respondents agree cost sharing of national health insurance, 68.6% of them regard coinsurance as the best method of cost sharing. Even with cost sharing, 84.1% of respondents still intend to join NHI. 5. Respondents of younger age, higher education, government employment, being an employer, having higher income and subscribing to life insurance axe reporting to be able to pay higher premium than their counterparts. 6. Those who are younger, more educated, and subscribe to life insurance are reporting to be able to pay larger shares of medical costs and more willing to join NHI even with cost sharing than their counterparts
• 184 - 197
• 10.6288/JNPHARC1989-09-04-02

• Link 原著 Original Article
• 臺北縣雙溪鄉國小學童血壓、血脂及肥胖之流行病學調查研究Epidemiological Survey on Blood Pressure, Serum Lipids Andobesity in Primary School Children in a Rural Village-Shuan Shi Village of Taipei County
• 盧豐華、宋元宏、張智仁、曾文雄
  Feng-Hwa Lu, Yuan-Hung Sung, Chin-Jen Chang, Wen-Hsiung Robert Tseng
• 無
  Hypertension ; Hypercholesterolemia ; Hypertriglyceridemia ; Obesity ; Child
• 為了解鄉村地區國小學童的身高、體重、血壓、血清膽固醇、三酸甘油脂及皮下脂肪厚度之分布，並探討肥胖、血壓及血脂值間的關係，於民國76年10月間，以臺北縣雙溪鄉四所國民小學全體學童為對象，樣本數佔全鄉國小學齡學童98.6%，共l,159名。測量其身高、體重、血壓、肱三頭肌皮下脂肪厚度，並抽血檢驗血清膽固醇及三酸甘油脂值。 結果顯示臺北縣雙溪鄉國小學童的身高、體重、收縮壓、舒張懲、皮下脂肪厚度及血清膽固醇值，均隨年齡之增加而增加；血清三酸甘油脂值則自九歲以後亦隨年齡增加而增加。學童的身高、體重和三酸甘油脂值較民國71年臺北市學童調查結果為低；收縮壓較後者為高；舒張壓和膽固醇值二者則相近。 學童肥胖的盛行率為10.2%，其中輕度肥胖者3.5%，中度肥胖者3.9%，高度肥胖者2.8%。肥胖學童比非肥胖學童有顯著較高之收縮壓、舒張壓、身高、血清膽固醇值、三酸甘油脂值、皮下脂肪厚度及上臂臂圍。高血壓的盛行率為2.1%，較臺北市研究0.5%為高，其中僅收縮壓高者有17名(1.5%)，僅舒張壓高者有6名(0.5%)，二者皆高者有1名(0.1%)。高血壓學童的身高、體重、皮下脂肪厚度及上臂臂圍均顯著高於正常血壓學童，但血清膽固醇及三酸甘油脂值則無顯著差別。 高膽固醇血症學童的盛行率為10.9%，較臺北市民國71年的調查研究6.6%為高，其體重及血清三酸甘油脂值，均顯著高於正常膽固醇學童。高三酸甘油脂血症學童的盛行率為2.2%，和臺北市研究2.4%相近，其身高、體重、血清膽固醇值、皮下脂肪厚度及上臂臂圍均顯著高於正常三酸甘油脂學童。
  The aims of the study were to determine the distribution of height, weight, blood pressure, serum cholesterol and triglyceride levels and to investigate the interrelationship among obesity, blood pressure and serum lipids. We surveyed all the children in 4 primary schools in Shuan Shi Village, Taipei County in 1987. The sample size was 1159 which represent 98.6% of all the primary school children in the area. We measured their height, body weight, blood pressure, thickness of the triceps skin-fold. Fasting serum cholesterol and triglyceride levels were also analyzed. The results showed that height, body weight, blood pressure, thickness of the triceps skinfold as well as serum cholesterol increased with the age of the subjects. The level of triglycerides was also found to increase with age after 9 years old. Children in this study had lower mean levels of body height, body weight and serum triglyceride and higher mean levels of systolic blood pressure than Taipei city children surveyed in 1982. The overall pervalence of obesity was 10.2%. Slighty obese cases were 3.5%, 3.9% moderately obese and 2.8% were very obese. The children who were obese did have significantly higher blood pressure, height, serum cholesterol or triglyceride levels, thickness of the triceps skinfold or forearm circumference. The prevalence of hypertension was 2.1%, even incluluding 17 people (1.5%) who only had an elevated systolic blood pressure, 6 people (0.5%) who only had an elevated diastolic blood pressure and one subject (0.1%) had both a high systolic and diastolic pressure, which was heigher than result of Taipei city study (0.5%). The data for height, body weight, thickness of triceps skinfold and forearm circumference of the hypertensive children were higher than corresponding figures in normotensive subjects. However, serum cholesterol and triglycerides were not significantly different. The overall prevalence of hypercholesterolemia of the children was 10.9% which was higher than result of Taipei city study (6.6%). The values for body weight and serum triglycerides were all higher than in the normal subjects. The overall prevalence of hypeririglyceridemia in the children was 2.2% which was closed to result in Taipei (2.4%). Their height, body weight, serum cholesterol, thickness of triceps skinfold and forearm circumference were all significantly higher than normal subjects.
• 198 - 209
• 10.6288/JNPHARC1989-09-04-03

• Link 原著 Original Article
• 台北市國中一年級學生視力現況及相關之知識，態度與行爲分析An Investigation on Visual Status and Analyses of Knowledge, Attitude and Behavior Related to Vision among the Seventh Graders in Taipei City
• 李蘭、黃琪璘、王幼金、紀雪雲、楊志良
  Lee-Lan Yen, Chi-Lin Hueng, Yow-Chin Wang, Shang-Yun Jii, Chih-Liang Yaung
• 無
  Vision ; Knowledge ; Attitudes ; Practice
• 一項以全台北市國中一年級新生為對象的視力調查計畫，自民國七十五年十一月開始實施，迄次年三月底完成。共收得39所學校計1620人之資料。此等樣本的選取係採用系統集束抽樣方法，自台北市全部國中一年級學生抽出40個班級。透過教育行政單位的協助，各校均能按排定日程密切配合，使得完成率達到99.14%。 本研究利用研究小組自行設計並經專家效度處理修正後之問卷為調查工具，另以史奈崙氏E字箱形視力表為檢查視力之工具。由受過訓練的調查員分組前往各校，按統一標準和步驟收集相關資料。 在受試學生中，視力不良所佔的比率達62.78%。其分佈以女性、家庭社經層次高、家庭子女數少、智力百分等級高之學生，罹患視力不良的比率較高。平均而言，每100位視力不良的學生中，有10人自覺視力是正常的；有45人沒有接受矯治；而曾接受矯治且達到正常視力標準的僅有18人。 發現視力不良?未能接受矯治的原因，以父母沒有時間和學生自己功課忙不能抽出時間為主要因素。視力不良的學生雖比視力正常學生在知識測驗上得分高，然而行為得分方面，兩組學生雖有差異但均呈偏低的現象。由於知識和態度二變項均未與行為變項達顯著相關水?，欲幫助視力不良學生接受矯治或鼓勵一般學生力行視力保健行為，宜從著重「促成行為」的各項措施著手，即(1)學校視力檢查標準化；(2)視力矯治服務方便化；(3)教育介入活動行為化和(4)學習環境改善全面化。
  A study of the visual status of students in the 7th grade in Taipei City began in November 1986. Data on 1,620 students from 39 schools were collected in March 1987. 40 classes were selected as samples through the procedures of systematic cluster sampling. With the assistance of the Education Department, the investigation went on schedule to all schools with a completion rate of 96.14%. A self-developed questionnarie verified by professionals and Snellen's Vision Chart installed in a lighted box were applied as the research instruments. Related data were then collected by trained investigators following the same criteria and steps. The rate of visual defects in the subjects is 62.78%. Students who are female, classified as high in SES, born in families with fewer siblings, and ranked high in IQ percentile show higher rates of visual defects than other students. Among students with defective vision, 10.05% of them perceived themselves as haying normal vision; 45.14% never have their defects corrected; only 18.49% have their defects corrected to normal. Being busy is the main reason given by parents and children for not having corrected the visual defects. Students with defective vision receive higher scores in knowledge test than students with normal vision. However, both groups receive low scores in behavioral evaluation though the difference is small. As ”knowledge” and ”attitude” variables are not significantly related to the variable ”behavior”, it is suggested that future efforts be focussed on the following activities which are behavior promotion oriented to improve the visual health of school children in general and to encourage the correction of any defects: (1) conducting standardized visual tests; (2) providing convenient visual correction services; (3) implementing behavior intervention; and (4) improving the overall environment of study.
• 210 - 221
• 10.6288/JNPHARC1989-09-04-04

• Link 研究紀要 Research Brief
• 葡萄球菌食物中毒事件－流行病學調查報告Outbreak of Staphylococcal Food Poisoning-Epidemiologic Investigation Report
• 陳國東、林瑞雄、李智隆、 許國雄
  Kow-Tong Chen, Ruey-Shiung Lin, Chu-Lun Lee, Kao-Siung Tsu, Cheng-Hwa Chuang
• 無
  Staphylococcus ; Food Poisoning
• 無
  An outbreak of gastroenteritis occurred in a 95 Pingtung farmers tour group visiting Hwalien and Ban counties in northern Taiwan on July 22, 1986. Eighty-five (89%) of the 95 farmers were available for interview. Among them, 26 (31%) did not eat lunch boxes and none became ill. By Contrast, 27 (46%) of 59 persons who ate the lunch boxes became ill (P<0.001). Clinical Symptoms of these Patients included vomiting (78%), abdominal pain (67%), and diarrhea (56%) with 3 hours median incubation period. Although the duration of illness was short (<24 hours), symptoms were severe with hospitalization. Vomitus was collected from 22 persons and demonstrateded Staphylococcus aureus positive. A comparison of illness rates among persons who ate and who did not eat specific food item showed a significant association with 5 out of 9 foods by univariate analysis. However, a multiple logistic analysis showed fish cakes were the only food item significantly associated with illness. Three leftover lunch boxes were available for laboratory examination. Fish cakes were located in the center of each lunch box and the other food items were placed either around or directly on top of the fish cakes. S. aureus (>10^5 organisms Per gm) was isolated from all 9 food items in the lunch boxes. Staphy lococcus aureus with same antibiotic sensitivity pattern and enterotoxin ”A” was also isolated from the hands of fish cake maker, vomitus and left over food. This Lesson illustrates that more efforts in health education is needed to prevent future food-borne outbreaks in Taiwan.
• 222 - 229
• 10.6288/JNPHARC1989-09-04-05