居家照顧服務疑似受暴長者的樣態、服務需求、求助行為和因應方式

[[abstract]]人口老化使得失能和失智人數增加，受暴個案人數成長，老人保護成為重要議題，只是相關研究並不多，因為保護個案潛藏社區，受訪意願不高，如何透過研究，探討長者受暴的樣態和因應行為，作為實務的參考實為當務之急。本研究目的是瞭解居家服務失能長者疑似遭受家庭暴力的樣態、服務需求、求助行為、和因應方式的情形，並針對研究結果提出實務因應原則。研究對象來自北、中、南、東四個區域內的居家服機構，由督導員轉介疑似或曾經受暴個案，取得個案同意，由訪員進行面對面的結構式問卷訪談，最後每區各取得30 位，總樣本數為120，取得的量化資料以SPSS 21.0 進行分析。研究結果顯示老人受暴類型比率依序為精神虐待、疏忽、身體虐待、遺棄，相對人主要是兒子，個人因素為情緒失控、失業、酒癮、精神疾患，家庭互動關係以溝通不佳和照顧壓力大為主，受暴者因素以失能為主。受害者使用最多的服務是長期照顧、關懷訪視、和經濟補助。不過，受暴長者不求助的居多，主因是體諒子女壓力、怕失去扶養依靠、家醜不可外揚。使用服務的障礙包括不知道有該項服務、不知道如何申請、怕別人笑、或不好意思

Factors Associated With Leisure Participation Among the Elderly Living in Long-term Care Facilities

[[abstract]]Background A lack of participation in leisure activities often leads to depression in the elderly. This study investigated the factors impacting leisure participation among the elderly living in long-term care facilities. Methods This cross-sectional study recruited 309 individuals older than 65 years from six long-term care facilities located in the Taipei area. Structured in-person questionnaires were administered to assess their demographic characteristics, general self-rated health status, leisure constraints, and leisure participation. Results The average frequency of leisure participation was 27.20 ± 12.48 points. The top five most popular leisure activities were watching television, walking, chatting, reading, and participating in religious activities. Elderly subjects who tended to be female, have religious beliefs, have a high school education level, be married, perceive themselves in better health, demonstrate better cognitive function and have higher scores on activities of daily living and instrumental activities of daily living scales were more likely to participate in leisure activities (p < 0.05). In contrast, those who were older, had stayed in the facility for a longer time period and had more leisure constraints were less likely to participate in leisure activities (p < 0.05). Overall, the predictive factors for leisure participation included religious beliefs, educational level, cognitive skill, instrumental activities of daily living score, depression, personal inner constraints, and structural constraints. The entire model was significant (F = 11.03, p < 0.001). Conclusion Based on the self-reported interests, health status and level of cognitive skill of elderly residents, long-term care facilities should arrange appropriate leisure activities to prevent depression and to improve quality of life. Key Words depression; elderly; leisure activities; long-term care; physically handicappe

[[alternative]]The Resilience and Social Support systems for Hemodialysis Patients

[[abstract]]血液透析治療對病患生理、心理、社會、日常生活品質影響為永久性。慢性腎臟病其腎功能衰退的速率則受病患對疾病的認知、服藥的遵從性、飲食的控制、壓力調適、治療模式及其他特殊情況等影響，病程進展到末期腎臟病時，病患就必須接受透析的治療。實務經驗中發現，患者在接受血液透析治療時，會形成病患的另一種壓力源，例如：生活形態改變和工作能力等多方面的內在或外在影響與衝擊，且伴隨透析治療過程而來的併發症也常使患者倍感生命受威脅，而引發焦慮、憂鬱，甚至亦有病患以自殺來結束生命。 因為復原力與社會支持均有助於病患面對壓力的適應和處理，因此若能夠了解患者本身的復原力，將有助於患者接受血液透析治療；而提供適當的社會支持資源，也能幫助患者回歸生活，降低其憂鬱。希望藉此篇文章提供給家屬、醫療護理同仁及未來研究者之參考學習依據。[[abstract]]Hemodialysis therapy has a significantly adverse influence on patients physically, mentally and socially. More often than not, patients are inadequately prepared to cope with their chronic disability and often fail to adhere to instructions regarding therapy, medications and dietary control. As a consequence, progressive deterioration to end-stage renal disease (ESRD) is frequently inevitable and decisions regarding appropriate renal replacement therapy have to be made. Patients with ESRD are usually under a lot of stress, such as: the significant disruptions to their way of life and job performance. Depression is known to be prevalent in these patients and some are even known to have suicidal thoughts or tendencies. Patients who are unable to overcome their difficulties have poor outcomes and quality of life, while those who show resilience of spirit adapt better and have more favorable outcomes. Health care workers can get involved by helping patients cope with their personal as well as medical problems by encouraging them to build up resilience and by facilitating access to social support systems in order to minimize disruptions to their work and lifestyle. Hopefully, this paper may lay a good foundation for patients and their families, dialysis nurses and for future researchers interested in this issue

The Analysis of the health checkup data of freshmen from Taiwanese university

[[abstract]]背景：由於一般大眾大都認為年輕人較為健康，屬患有慢性疾病機率較低的族群，因此有關台灣年輕人健康狀態評估的資料頗為缺乏。目前社區中，心血管及腦血管病例已有逐年增多的趨勢；此現況可能與早期生活型態有關。因此醫學界的專業人員甚為憂心，因為不適當的健康篩檢，應有很多的年輕族群未及時發現患有慢性疾病並執行早期衛教及疾病防治的工作。有鑑於此，今特研究分析台灣北部某綜合大學大學部新生入學健康檢查資料，藉以瞭解此族群健康狀態並將結果應用於年輕族群衛生保健、疾病防治策略及政策等之訂定，以增強台灣年輕人的健康狀態。方法：我們利用描述性橫斷式分析法收集北區某大學八十九及九十年度大學部新生入學體檢資料，共有7,706人（包括3,316男性），平均年齡為19.88±1.51歲。體檢資料以SAS 8.01版程式進行統計分析並以卡方檢定及t-檢定來比較變項間之差異。B型肝炎帶原盛行率及心血管病有關危險因子的探討包含在此研究。結果：研究結果顯示，平均身體質量指數(BMI)為21.36±3.37kg/m2（男生為22.42±3.54kg/m2，女生為20.55±2.99kg/m2，P<0.001）。若依世界衛生組織亞太體位判斷標準分析，肥胖者佔12.4%，體重過重者佔12.7%。血壓偏高者佔13%。高總膽固醇血症者佔5.6%，邊緣性高總膽固醇血症者佔24.9%。貧血者約佔6.33%。肝功能指數異常者約為6.4%。在B型肝炎檢查部份，B肝帶原率約為7.5%。糖尿者佔0.6%。蛋白尿者佔4.4%。尿潛血者佔5.7%。高尿酸血症者佔41.71%。男性比女性更易有血壓偏高、B型表面抗原呈陽性、肝功能指數異常、高尿酸血症；在高總膽固醇血症及尿潛血方面，女性則比男性為多，且兩性間比較均具有統計意義(P<0.001)。然而在貧血、糖尿及蛋白尿等檢查結果，其兩性之間比較則無顯著差異。結論：許多台灣年輕學生，尤其是男性較易有心血管及腦血管疾病危險因子的傾向。如欲減低心血管及腦血管疾病的長期危險性，應適當引導如健康的教育知識及生活型態的改變。另外，從研究結果顯示，雖B型肝炎帶原率已逐漸下降，但B型肝炎病毒傳播的預防及帶原者追蹤檢查仍是台灣公共衛生的重要議題之一。[[abstract]]Background: There appears to be a relative paucity of data pertaining to the health status of young Taiwanese adults. Therefore, the purpose of this study was to analyze the health checkup of freshmen at a university in Taiwan and to draw an implication from the results for developing a disease-preventive strategy in order to promote their health status. Methods: A total of 7,706 subjects (3,316 men), featuring a mean age of 19.88±1.51 years were included in this study. Chi-square test and Student's t-test were applied for data analysis. Results: The average BMI (Body Mass Index) of the freshmen studied was 21.36±3.37kg/m2, with 22.42±3.54kg/m2 for males and 20.55±2.99kg/m2 for females. Of study subjects, 12.4% were classified as being obese and 12.7% as being overweight, and 13% were classified as exhibiting high blood pressure, with 5.6% and 24.9% of the freshmen, respectively, being classified as revealing hypercholesterolemia and borderline hypercholesterolemia. The prevalence of hypercholesterolemia and borderline hypercholesterolemia amongst female students (6.0% and 26.4% respectively) was greater than it was for their male counterparts (5.0% and 22.9% respectively). Of the study subjects, 6.33% were anemic, and 13.4 % and 1.5% of male and female students, respectively, revealed high serum creatinine levels. An abnormal serum alanine aminotransferase level was also observed for 6.4% of the subjects (11.2% of males and 2.8% of females). From a hepatitis-B survey, 7.5% of the subjects were shown to be hepatitis-B carriers. Male students exhibited a higher hepatitis-B carrier rate than did female students. Of the study subjects, 0.6% and 4.4% exhibited positive results for sugar and protein in the urine upon routine examination, and further, 5.7% of subjects revealed a positive urine occult test which included 9.4% of women and 0.8% of men. A total of 41.71% (56.83% of males and 30.3%of females) of the freshmen revealed hyperuricemia. Conclusion: Our university freshmen, particularly male subjects, are prone to the risk factors for cardiovascular diseases, and cerebral vascular accident. Appropriate intervention as regards health education and life-style modification appears to be warranted in this population

[[alternative]]A Survey of Depression and Its Related Factors of the Institutionalized and Non-institutionalized Elderly in Hsin-Tien City

[[abstract]]由於人口快速老化，老人相關的議題漸漸受到重視。本研究的目的是探討老人憂鬱症狀與盛行率，及影響老人憂鬱的因素，並從研究的結果提出醫療團隊可能的因應措施與建議。本研究採量化調查方法，以問卷訪談方式蒐集資料，樣本的取得是採取隨機取樣的方式，從到耕莘醫院看門診的社區老人及與醫院有合作關係的安養中心，抽取年齡大於65歲的老人各200名，總共樣本400名。憂鬱判定採用老人憂鬱量表（Geriatric Depression Scale），其餘變項的測量參考過去文獻選取適當的量表。所蒐集的資料以對數迴歸方法分析，檢視和老人憂鬱相關的因素。 結果發現在機構老人憂鬱的盛行率是39.2％而社區老人的盛行率是29.5％，比例都不低。而影響憂鬱之相關因素，不論在機構或社區老人包括了﹕有無生活重要事件變故，自評健康，以及日常生活功能量表。另外分別來看，在機構的老人，社會支持幫助的滿意度影響憂鬱；而社區老人則是經濟狀態的滿意度影響憂鬱。 因此在預防老人憂鬱的方向，除了盡力照顧老人身體健康並恢復獨立性，注意是否有生活重大變故的出現。並且是要提供適當的社會福利，或老年年金來改善經濟問題造成社區老人的憂鬱。而對機構老人則是應加強社會支持，像是促進老人的親朋好友多交流，或導入社工關懷來減少機構老人憂鬱。[[abstract]]The purposes of this study are (1) to explore the prevalence and symptomatology of depression among the elderly, and (2) to examine factors related to depression among the elderly. A Structured questionnaire was used to interview 400 individuals (age 65 and above). The sample was randomly selected from two groups: the Community Group (who live in the community and visit the clinics for medical care provided by the Department of Family Medicine, n=200), and the Institutional Group (who live in the institution affiliated with Cardinal Tien Hospital, n=200). The criteria for diagnosing depression were based on the Geriatric Depression Scale. All collected data were analyzed with logistic regression method to assess the variables related to depression among the elderly. The findings of this study indicated that the prevalence of depression among the elderly in the Institutional Group is higher than that in the Community Group, 39.2% and 29.5% respectively. The related factors of depression included: stressful life events, health, self-assessed health status, and level of functioning. Satisfaction of Social Support affected the depression in Institutional Group but not in the Community Group. Satisfaction of economic status is related to depression among the elderly in Community Group. In conclusion, the strategies to prevent depression among the elderly should include maintaining the health status and independence of the elderly, and being aware of the occurrence of stressful life events. Furthermore, access to resources of social welfare, and/or senior retirement fund is also needed to prevent depression among the elderly who have economic problems. On the other hand, strengthening social support such as encouraging communication among family members and friends, and engaging social services are helpful to prevent the depression among the elderly living in an institution. (Taiwan J Fam Med 2004; 14: 81-93

Analysis of the Health Status of Foreign Brides in A Community Hospital in Taipei County.

[[abstract]]BACKGROUND: Very few studies regarding the health status of foreign brides in Taiwan are so far available. The purpose of this study was to analyze the health status of foreign brides in a community hospital setting in Taipei County. METHODS: We retrieved and analyzed 493 foreign brides' medical records recorded between November 1, 2002 and October 31, 2003. The records included a medical history, physical examination parameters, serological test data for infectious diseases, urinalysis for drug use, stool sample data for intestinal parasites, and chest radiography mainly to rule out tuberculosis. RESULTS: Of the 493 foreign brides included in this study, 247 were from China (50.1%); 122 from Burma (24.7%), 55 from Indonesia (11.2%), and 32 from Vietnam (6.5%). A small proportion of women, 69 (14%), were infected with intestinal parasites. Seven subjects (1.4 %) had tuberculosis, of which 4 (0.8%) were diagnosed as having old tuberculosis. None of the foreign brides was positive for the HIV antibody or on the syphilis screening. The seronegative rate of anti-rubella IgG among the foreign brides was 14.4%. Three percent of the brides had an elevated morphine level (> or = 300 ng/mL), but none of them was positive (> or = 500 ng/mL) for amphetamine. CONCLUSIONS: Future national statistics should include brides from China. The main concerns about foreign brides are the low vaccination rate against rubella virus, the high infection rate with intestinal parasites, and the high prevalence of tuberculosis. A nationwide survey should be carried out in order to assess the health status of all foreign brides in Taiwan

[[alternative]]Case Study Outlining Medical Profession Initiatives to Resolve Cases of Foreign Workers' Sexual and Physical Abuse

[[abstract]]一位28歲印尼女傭，前來醫院進行外勞例行性體檢，在初步身體檢查，個案雙手臂有多處新舊燙傷疤痕，嘴巴周圍有多處瘀青，脖子雙側也有新舊擦傷，經詢問個案才發現是暴力虐待事件。因台灣目前並無保護外勞的法源及作業程序可茲依循，體檢的醫護人員基於人道精神隨即啟動該院的家庭暴力暨性侵害防治流程，並委請勞工局會同警察單位至急診處受理此外勞家暴事件，使女傭與雇主隔離以保護受虐者。此個案在勞工局及社會福利機構與雇主協調下達成協議，讓外勞提前解約回國。 由此案例得知，醫護人員應有高度的警覺心和面談技巧來篩檢出受虐的外籍勞工。尤其是女性的外籍勞工受虐或性侵害事件的處理，有賴於團隊的合作，需要醫師與護士、社會工作人員、和牧靈人員的密切配合。並且，每個醫院都需要建立醫院內對受虐或性侵害外勞處理的流程和原則。政府相關機構也應本著維護基本人權的精神，積極訂定或修訂立法，將外勞的權益也納入法律保護的條文之內，交由執法機關執行，以達到公平、正義的原則。[[abstract]]A 28 years old female foreign worker from Indonesia came to the hospital for a routine medical check-up. She appeared quite scared. During the initial physical screening, several bruises around her mouth, burn marks on her arms, and abrasions on both sides of her neck were noted. After ascertaining more detailed information from the worker, a case of physical abuse was suspected. Unfortunately, due to no government provisions or laws to protect foreign workers in Taiwan, the medical staff had a dilemma on how to report the abuse. However, based on humanitarian principles, the involved personnel activated the hospital’s protocol of preventing family violence and sexual abuse for citizens. County police and the labor departments were contacted to help remove the patient from the employer to avoid further abuse. After negotiations with the employer, the county labor department and a non profit organization were successful in nullifying the patient's work contract and helped her return to Indonesia. As observed from this case, the medical professionals should be on high alert to screen abused foreign workers. In particular, female foreign workers who have been physically or sexually abused require the well-coordinated efforts from medical staff, social workers and pastoral care workers. Additionally, every hospital should establish protocols and regulations in dealing with physically and/or sexually abused foreign workers. The responsible government agencies should, in the interest of protecting and maintaining fundamental human rights, either establish new or modify existing legislations to help protect the interests and rights of foreign workers. This approach will help to ensure future incidents are treated in a fair and just manner

the unmet ADL needs of dependent elders and their related factors: an approach from both an individual-and area-level perspective

[[abstract]]Background The unmet activities of daily living (ADL) needs often lead to negative consequences in dependent elders. This study examines disabled elders' unmet ADL needs and the factors associated to those unmet needs. Methods Data from a representative sample from Taiwan of 6820 elders and family caregiver dyads were analyzed, using hierarchical linear modeling to identify the individual- and area-level factors. Standardized measures were administered through face-to-face interview. Results The highest percent of unmet ADL needs was for climbing stairs (21.0%), and the lowest pertained to eating (5.9%). The mean age of the respondents in this study was 79.25 years. The majority of respondents were female (59.3%). The mean ADL score was 55.39, showing a medium level of dependency. The mean instrumental activities of daily living (IADL) limitation number was 7.49. The results revealed the following factors as important: education level; living arrangements; number of illnesses; number of IADL limitations; caregiver's age; the caregiver–patient relationship; care burden; household size; interaction between welfare expense and service uptake; and between welfare expense and the number of IADL limitations. Conclusion Our results show that social welfare expenditure moderates unmet needs by provision of services, which means that the positive effect of social welfare services cannot be ignored; therefore, the government should play a supervisory role. In addition, the definition and measurement of unmet needs must be further clarified to assess accurately the prevalence of such needs, and further research should be undertaken on the adverse consequences of unmet needs. Keywords ADL; disabled elders; hierarchical linear modeling; interaction; unmet need