台灣公共衛生雜誌/Taiwan Journal of Public Health
臺灣公共衛生學會,正常發行
選擇卷期
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人類乳突病毒（Human papillomavirus, HPV）是子宮頸癌的主要致病因子。目前已有兩種HPV疫苗，分別為四價（HPV-6, 11, 16及18）及二價（HPV-16, 18），核准於26歲以下的青少女使用。由於定價昂貴，且長期保護力及疫苗安全性有待觀察，對HPV 疫苗接種政策出現若干不同意見。本文回顧相關文獻，並從美國Centers for Diseases Control and Prevention與Public Health Leadership Society共同制定的歷史性文獻Principles of the Ethical Practice of Public Health所揭櫫的公共衛生倫理（Public health ethics）原則來剖析「是否應強制全面接種HPV疫苗」及「是否應公費補助接種HPV疫苗」兩個議題。我們認為，在目前有限之資料下，是否強制施打，仍有商榷餘地，將來更需要進行公開透明之政策討論，取得公眾之信任，以決定HPV疫苗之強制施打是否能夠通過比例原則之考量。是否公費補助則必須考量成本效益，在最佳條件之假設下，成本效益分析顯示HPV疫苗在台灣具成本效益，因此，以公費補助低收入戶少女接種HPV疫苗，應是目前適當的做法。
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目標：應用標準位置理論及環境選擇模式分析台灣各鄉鎮市區血液透析床資源與基層腎臟科醫師產出表現的關係。方法：利用國家衛生研究院全民健康保險資料庫，以回溯性世代研究探討2007年鄉鎮市區透析資源對已執業及新執業基層腎臟科醫師於2009年產出表現之影響，採piecewise迴歸及逐步複迴歸分析。結果：血液透析床資源飽和程度對已執業醫師與新執業醫師產出未達統計上顯著差異，基層腎臟科醫師之總申報金額隨血液透析床資源飽和程度僅有小幅下降。醫師產出隨都市化程度往鄉鎮市區降低而增加，2007年每萬人口醫院血液透析床越多，已執業醫師2009年總申報金額會減少0.5%，而新執業醫師總申報金額降低0.38%。結論：血液透析床資源飽和程度可能影響醫師間的競爭情形，使基層腎臟科醫師之產出增加趨勢有減緩現象，且每萬人口醫院血液透析床越多則基層腎臟科醫師之產出下降。
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Objectives: To investigate the association of household income and healthcare utilization as well as survival status of patients with catastrophic illnesses under the NHI system in Taiwan. Methods: Data from the ”Survey of Family Income and Expenditure” (2003 to 2006) and the ”Registry of patients with catastrophic illness” were first linked to identify subjects. Patients with cancer or end stage renal disease (ESRD) holding only one NHI catastrophic illness card were included in this study. Information related to healthcare utilization was obtained from NHI claims data (2002 to 2007) and survival data was obtained from the ”National Registry of Deaths” (2003 to 2009). Negative binominal regression, multiple regression, and the Cox proportional hazard model were used to analyze the relationships among healthcare utilization, survival, and socioeconomic variables. Results: Regarding the healthcare utilization, the average length of stay (ALOS) of ESRD patients in the highest income bracket was 8.987 days longer than that of patients in the lowest bracket (p＜0.05). Hemodialysis usage, the number of outpatient visits and hospitalizations presented no correlation with household income. Among cancer patients in the highest income bracket, the IRRs of outpatient visits and hospitalization were 1.18 (p＜0.05) and 2.11 (p＜0.001), respectively. The ALOS of those in the highest income bracket was 11.36 days longer than that of patients in the lowest income bracket (p＜0.001). With respect to survival status, male ESRD patients had a higher mortality than females (HR=1.82, p＜0.05). Among cancer patients, being males (HR=1.66, p＜0.05) and in the highest income bracket had higher mortality (HR=1.6, p＜0.05), those with the highest education level had lower mortality (HR=0.52, p＜0.05). Conclusions: The relationship between household income and healthcare utilization varied according to type of diseases. Income level was positively associated with healthcare utilization among cancer patients while patients in the highest income bracket had higher mortality. But the association was not significant among ESRD patients. Future researchers can conduct further analyses on other catastrophic illnesses.
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Objectives: The purpose of this study is to examine the consumption of sugar-sweetened beverages, snacks and desserts among pre-school children and estimate the intake of refined sugar among children aged 2 to 5 by a prospective cohort. Methods: Total 301 infants were followed up annually to the age of 5 (n=132). The intake of refined sugar is calculated by using 24-hour recalls. Estimated percentages of refined sugar in various food products are used in order to obtain the average daily intakes. Results: The consumption of sugar-sweetened beverages increased with age. ”Flavored and fermented milk” contributed to the highest percentage among children aged 2-5, while the ”whole grains drinks” and ”tea drinks” showed an increasing trend over the years and the ”tea drinks” increased its consumption sharply. For snacks and desserts, ”biscuits” contributed the highest percentage among children aged 2 to 4, while ”Chinese sweet soup” showed an upward trend over the years with the highest percentage among children aged 5. The estimated refined sugar consumption was 13 ± 12g, 19 ± 16g, 32 ± 18g, 29 ± 20g (p for trend＜0.01), energy intake from refined sugar was 5%, 6%, 9% and 8% among children aged 2, 3, 4 and 5, respectively. Conclusions: Over one-third of 5-year old children had over 10% of their caloric intakes from refined sugar. The caffeine in tea may not be suitable for young children. Proper eating habits and a balanced diet could facilitate the normal growth and development of healthy children.
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目標：口腔黏膜檢查為偵測口腔癌之有效措施，口腔癌為台灣男性第四位之惡性腫瘤，本研究旨在探討具有酒精、檳榔及吸菸等習慣造成罹患口腔癌之不同健康風險族群接受口腔黏膜檢查的社會心理差異。方法：本研究運用修正型健康信念模式探討參與無檳社區活動計劃居民接受口腔黏膜檢查之信念，共有866位完成問卷測量，我們依據參與者是否有喝酒、嚼食檳榔、吸菸等習慣區分為罹患口腔癌之高、中與低風險組，並採用結構方程模式建立及比較三組不同健康風險族群接受口腔黏膜檢查的可能性與影響路徑之差異。結果：證明修正後的健康信念模式對高、中與低風險組模型配適度良好並可解釋三組接受口腔黏膜檢查之可能性分別為50%、37%、30%，且三組在健康信念影響接受口腔黏膜檢查可能性之直接與間接路徑上有顯著差異。結論：不同健康風險族群接受口腔黏膜檢查可能性之健康信念與影響路徑有顯著差異，建議未來教育介入針對不同健康風險族群宜採取不同介入模式以提高無檳社區計畫之有效性。
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目標：霸凌事件是值得研究的公共衛生議題。本文目的乃描述台灣地區公立國中學生之霸凌角色的分佈，並探討與其相關之個人及家庭因素。方法：為獲得台灣地區具代表性之公立國中生樣本，因此先自台灣北、中、南、東各區，以系統抽樣的方式抽出五間學校，每校每年級選兩班作為研究樣本。最後共20間學校，120個班級參加調查，於2010年9至12月完訪3,441人。為考量設計效果，以抽取率的倒數作為權值，並以SAS 9.1.3之Proc Survey模組進行描述統計及多項式邏輯斯迴歸分析。結果：台灣地區國中生有8.71%為霸凌者、7.01%為被霸凌者，2.91%為雙重身份者，共18.63%為霸凌事件的涉入者。性別、衝動人格、自覺受歡迎程度、父母最高教育程度、家庭衝突頻率、口語責罵頻率及體罰頻率分別與霸凌角色有不同的關連性。結論：霸凌事件在國中盛行，建議在國中之前即可發展預防介入計畫。不同霸凌角色之相關因素不同，應針對不同角色設計介入方案。整體而言，建議家庭增加良性互動和減少衝突及過度責罰。
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目標：中風是造成老人身心障礙的主因之一。本研究旨在探討台灣中老年中風患者之身心健康退化狀況。方法：擷取「台灣中老年人身心社會生活狀況長期追蹤調查」1999及2003二個年度資料，依二年度中風病史紀錄將個體分為「無中風病史組」（3,207人）、「新發中風個案組」（170人）及「慢性期中風個案組」（109人），分析三組中老年人身心健康狀態。身心健康指標，包括健康自評、基本／工具性日常生活功能、認知困難、憂鬱傾向及生活滿意度等測量。以成對樣本t檢定、Wilcoxon符號化等級檢定及廣義線性方程式分析三組中老年人在二年度間身心健康的退化及其差異。結果：三組中老年人自1999年其後4年的身體健康狀態均明顯退化，「新發中風個案組」身體功能退化尤其明顯；但「慢性期中風個案組」在身心健康六項指標中，有五項的退化幅度與「無中風病史組」無顯著差異。結論：中風是造成患者身心健康狀態改變的重要因素。而慢性期中風患者在多數的身心健康指標之退化並未比無中風者明顯，顯示中風患者在慢性期後身體功能的退化，雖有部分是中風後遺症導致，但老化可能是更大的影響因素。建議慢性期中風患者可透過各種健康促進活動，延遲老化所帶來的衝擊。本研究將中風對患者的影響初步量化，其結果可作為社會政策擬定及照護資源分配的部分參考。