Hospital Competition and Patient-Perceived Quality of Care Evidence from a Single-Payer System in Taiwan

Objectives To examine the effects of market competition on patient- perceived quality of can under a single-payer system in Taiwan Methods Data came from two nationwide surveys conducted on discharged patients and National Health Insurance (NHI) hospital claim datasets in 2002 and 2004 Competition was measured by the Herfindahl-Hirschman Index ( HHI) Quality of care was measured by patient-rated hospital performance including interpersonal skills and clinical competence domains We used the instrumental variable approach to address the endogeneity between competition and patient-perceived quality of care Results The results showed that HHI was significantly associated with a decrease in the perceived interpersonal skills (coefficient of -0 460 p< 0 001) indicating that the interpersonal skill level increases in competition A similar association was found for the perceived clinical competence (coefficient of -0 457 p= 0 001) Conclusion Quality of care from the patients perspective is sensitive to the degree of competition By using patient- reported data this study provides new evidence concerning competition and quality of car

Measuring competition and quality of care in healthcare market

過去已有許多研究探討市場競爭與廠商行為的議題，但多半著重於市場競爭和醫院成本的關係，甚少探討市場競爭的測量以及市場競爭對於醫療品質的影響。本研究分為下列三個主題：(1)主題一：競爭程度的測量：以台灣的醫療照護市場為例；(2)主題二：檢驗醫院市場競爭程度分別與病患主觀感受品質及傳統客觀品質指標之相關性；(3)主題三：檢驗醫院市場競爭與病患主觀感受品質的相關，是否透過醫院投入之中介機制所影響。資料來源方面，主題一：使用衛生署統計室1994年至2007年「醫院服務量檔」；主題二、三：使用2002年及2004年「出院病人調查」資料串連當次住院的健保申報資料。針對不同主題採用不同的分析方式：主題一：描述各學派市場競爭程度，並檢驗歷年間各學派市場競爭程度之變化趨勢的相關性；主題二：採用工具性變項及隨機截距模型，檢驗市場競爭分別與病患主觀感受品質以及傳統客觀品質的相關性；主題三：採用階層式模型和隨機截距模型，檢驗醫院投入是否為市場競爭和病患主觀感受品質之中介因素。研究結果方面；主題一：發現不論是採用「結構學派」或「行為學派」之市場競爭程度，皆隨著年代呈現逐年下降的趨勢，且歷年不同學派間市場競爭指標具有中高度的相關性。主題二：發現醫院位於市場競爭程度愈高的地區，醫院病患不論在人際面或技術面所感受到的主觀醫療品質皆較高。然而，醫院面對的市場競爭程度與傳統客觀品質指標(病患出院後30日內的再住院情形)並無顯著相關。主題三：發現市場競爭對於人際面和技術面病患主觀感受品質有不同的影響機制：市場競爭對於病患人際面感受品質具有直接的影響力，換言之市場上存在品質競爭的情形；然而，控制護理人力素質後，醫院面對的市場競爭和病患技術面感受品質的關係減弱。研究之結論為：一、若醫院位於愈競爭的區域，出院病患感受品質愈高。二、醫院投入（護理人力素質）為市場競爭和病患技術面感受品質之中介機制。建議政府在制定醫療產業相關政策上，應該要引入市場競爭機制，且醫院評鑑制度應要規範醫院人力之素質。The majority of previous studies on the relationship between market competition and hospital behaviors have focused on the impact of competition on costs. However, the measures of market competition and it effects on health care quality have been rarely discussed. This study comprised three research topics: (1) Measuring market competition using data from Taiwan’s health care market; (2) Examining the relationship between hospital market competition and patient quality of care; and (3) Investigating the mediating effect of hospital input on the relationship between market competition and patient perceived quality of care.ata for the first research topic came from the “Health care institution survey” and “Hospital services volume survey” from 1994 to 2007. We compared the trend of market competition defined by the Structuralism with that by the Behaviorism. For the second and third research topics, we used the 2002 and 2004 “Discharge patient survey” and national health insurance claim datasets. Instrumental variable and random intercept model were applied to examining the impact of market competition on subjective and traditional objective quality of care measures. Furthermore, hierarchical models and random intercept model were performed to test the mediating effect of hospital input on the association between market competition and patient perceived quality of care. he level of market competition, measured either by Structuralism or Behaviorism, both showed to be decreasing. There was a significant and moderate correlation between the two measures. When hospitals were in a more competitive market, their patients reported better perceived quality of care in terms of interpersonal skills and clinical competence. However, competition level was not significantly associated with traditional quality indicator, the readmission rate after 30 days of discharge. The mechanism linking market competition and quality of interpersonal skills tended to be different from that linking competition and clinical competence. There was a direct effect of market competition on quality of interpersonal skills, while hospital input in nursing professional (skill mix) mediated the association between competition and quality of clinical competence. more competitive market is associated with better patient perceived quality. Hospital input (e.g. nursing professionalism) mediates the relationship between market competition and patient perceived quality of clinical competence. According to our findings, we suggest that the government should employ competition approach to promote the quality of hospital care and incorporate the quality of hospital staff in the hospital accreditation system.誌謝 I要 I文摘要 II一章 緒論 1一節 研究背景與動機 1二節 研究目的 4三節 研究重要性 5二章 文獻探討 7一節 市場競爭概念的理論 7二節 市場競爭和醫療品質的理論 12三節 市場競爭和醫療品質實證研究的回顧 21四節 市場競爭和醫療品質實證研究中方法學之討論 33五節 市場競爭和醫療品質之中介機制 47三章 研究方法 54一節 市場競爭程度的測量：以台灣醫療市場的競爭為例 55二節 市場競爭對病患主觀感受品質和傳統客觀品質的影響 63三節 市場競爭、醫院投入與病患主觀感受品質 73四章 研究結果 80一節 市場競爭程度的測量：以台灣醫療市場的競爭為例 80二節 市場競爭對病患主觀感受品質和傳統客觀品質的影響 95三節 市場競爭、醫院投入與病患主觀感受品質 120五章 討論 131一節 市場競爭程度的測量：以台灣醫療市場的競爭為例 131二節 市場競爭對病患主觀感受品質和傳統客觀品質的影響 135三節 市場競爭、醫院投入與病患主觀感受品質 141六章 結論與建議 145一節 研究結論 145二節 政策意涵 146三節 未來研究方向 147考文獻 148文文獻 148文文獻 14

Better Continuity of Care Reduces Costs for Diabetic Patients

Objective: To examine the effects of continuity of care on healthcare utilization and expenses for patients with diabetes mellitus. Study Design : Longitudinal study based on claims data. Methods: Data on healthcare utilization and expenses from a 7-year period (2000-2006) were gathered from claims data of the Taiwanese universal health insurance system. The continuity of care index (COCI) was analyzed, and the values were classified into 3 levels. Outcome variables included the likelihood of hospitalization and emergency department visit, pharmaceutical expenses for diabetes-related conditions, and total healthcare expenses for diabetes-related conditions. A generalized estimating equation that considered the effects of repeated measures for the same patients was applied to examine the effects of continuity of care on healthcare utilization and expenses. Results: Compared with patients who had low COCI scores, patients with high or medium COCI scores were less likely to be hospitalized for diabetes-related conditions (odds ratio [OR] 0.26, 95% confidence interval [CI] 0.25, 0.27, and OR 0.58, 95% CI 0.56, 0.59, respectively) or to have diabetes- related emergency department visits (OR 0.34, 95% CI 0.33, 0 .36, and OR 0.64, 95% CI 0.62, 0.66, respectively). Patients with low COCI scores incurred $126 more in pharmaceutical expenses than patients with high COCI scores. Furthermore, patients with high COCI scores had greater savings ($737) in total healthcare expenses for diabetes-related conditions than patients with low COCI scores. Conclusion: Better continuity of care was associated with less healthcare utilization and lower healthcare expenses for diabetic patients. Improving continuity of care might benefit diabetic patients

Evaluation of nutritional quality of the two stage fermented soybean meal and its application in weaned piglet diet

大豆粕(soybean meal，SBM)含有高量蛋白質與胺基酸，是飼料蛋白質來源，然而大豆粕含有部分抗營養因子(anti-nutritional factors，ANF)，限制在幼畜飼料使用量。本研究之目的在利用發酵技術降低抗營養因子，以提高在動物飼料之利用率。本研究分離兩類大豆致過敏蛋白質(soybean allergenic protein)─大豆球蛋白(glycinin)與β-大豆伴球蛋白 (β-conglycinin)與其五個次單位，並製備次單位之多株抗體(polyclonal antibody)，作為監測發酵大豆粕(fermented soybean meal，FSBM)所含致過敏性蛋白質的探針。由刺膚測試(cutaneous test)確認引起仔豬過敏之大豆球蛋白與β-大豆伴球蛋白之最低劑量分別為200μg與400μg。使用麴菌(A. oryzae)配合乳酸菌(L. casei)進行兩階段發酵之發酵大豆粕(FSBMA+L)，可降解胰蛋白酶抑制因子(trypsin inhibitor)、大豆球蛋白、β-大豆伴球蛋白、棉子糖(stachyose)與水蘇糖(raffinose)等抗營養因子。大豆蛋白質被降解為小分子蛋白肽，增加TCA(trichloroacetic acid)可溶性蛋白質的含量。大豆粕經兩階段發酵後的可利用離胺酸含量與in vitro蛋白質消化率顯著高於大豆粕，與大豆濃縮蛋白(soybean protein concentrate，SPC)無顯著差異，且較大豆粕、麴菌發酵大豆粕與大豆濃縮蛋白有更高乳酸含量和低pH值。動物試驗使用120頭離乳仔豬，逢機分成五個不同飼糧組進行動物試驗，五個處理組分別為全大豆粕控制組、大豆粕-魚粉對照組、大豆粕-兩階段發酵大豆粕對照組、全兩階段發酵大豆粕對照組與大豆粕-大豆濃縮蛋白對照組。對照組使用兩階段發酵大豆粕取代大豆粕-魚粉組中的魚粉或大豆粕-大豆濃縮蛋白組中的大豆濃縮蛋白對離乳仔豬之平均日增重(ADG)、平均日採食量(ADI)與飼料轉換率(FCR)均無顯著差異。離乳仔豬餵飼大豆粕-兩階段發酵大豆粕組飼糧的十二指腸絨毛高度高於餵飼全大豆粕組飼糧。餵飼大豆粕-兩階段發酵大豆粕組與全兩階段發酵大豆粕組飼糧之處理組的結腸內大腸桿菌數低於餵飼全大豆粕組飼糧者。餵飼兩階段發酵大豆粕可以降低離乳仔豬下痢的發生率與嚴重性。綜上所述，大豆粕經由兩階段發酵作用增加了小分子蛋白肽含量、提升蛋白質消化率與降低抗營養因子，而提升營養價值。以兩階段發酵大豆粕取代離乳仔豬飼糧中的魚粉或大豆濃縮蛋白可獲得相同之生長性狀，且改善餵飼全大豆粕仔豬之下痢發生率與嚴重性。Soybean meal (SBM) contains high protein and amino acids. It is a protein source in animal diet. However, the amount of SBM used in young animal diet is limited by anti-nutritional factors (ANFs). The purpose in this study was to improve the availability of soybean meal in animal diet by fermentation technique to decrease ANFs and to find adequate methods to evaluate the quality of fermented soybean meal (FSBM). Glycinin and β-conglycinin, two of allergenic proteins, were separated from soybean and isolated of five subunits to prepare seven anti-soybean protein specific polyclonal antibodies which were used in reverse as probes to monitor those allergenic proteins in FSBM. Threshold of allergenic proteins were confirmed by cutaneous test with weaned piglet. Both of glycinin and β-conglycinin are 200 and 400 μg. Soybean meal was fermented by A. oryzae followed L. casei, a two stage fermentation (FSBMA+L) in this study. Trypsin inhibitor, glycinin, β-conglycinin, mannose and stachyose were destroyed by the two stage fermentation. Soybean protein was hydrolyzed into small peptides and consequently TCA soluble protein content was increased. FSBMA+L had higher available lysine and in vitro protein digestibility than did SBM but rather than did soybean protein concentrate (SPC). The FSBMA+L contained higher lactic acid than did other soybean products. The lactic acid produced by the L.casei in the second stage of fermentation resulted in low pH valve in FSBMA+L. One hundred and twenty weaned piglets were randomly allocated into five treatments of different feed for animal feeding trial. There was no adverse effect on average daily gain, average daily feed intake and feed conversion ratio when FSBMA+L replaced SBM, fish meal or SPC as a protein source in weaned piglet diet. Piglet fed SBM-FSBMA+L diet had higher villi height in duodenum than did SBM diet. It also showed piglets fed SBM-FSBMA+L and FSBMA+L diet had higher Lactobacillus and lower Coliform in colon than did SBM diet. FSBMA+L did decrease both incidence and severity of diarrhea daily. In conclusion, the nutritional value of SBM is improved by two stage fermentation resulted in increasing the small peptide amount and protein digestibility and decreasing the ANFs. FSBMA+L may replace SPC or FM in weaned piglet diet without compromising growth performance. Weaned piglet decreases diarrhea incidence and severity when FSBMA+L replace for SBM in diet.中文摘要………………………………………………………………………….. ⅰ 英文摘要……………………………………………………………………………ⅲ 目次…………………………………………………………………………………ⅴ 圖目次………………………………………………………………………………..v 表目次………………………………………………………………………….v 壹、前言……………………………………………………………………………..1 貳、文獻檢討………………………………………………………………………...3 一、大豆………………………………………………………………………………3 (一) 大豆簡介……………………………………………………………………….3 (二) 大豆蛋白質…………………………………………………………………….3 (三) 大豆抗營養因子……………………………………………………………….3 1. 尿素酶…………………………………………………………………………4 2. 抗胰蛋白酶抑制因子…………………………………………………………4 3. 大豆致過敏性蛋白質…………………………………………………………6 4. 寡醣類………………………………………………………………………….9 二、大豆加工製品………………………………………………………………..11 (一) 大豆粕…………………………………………………………………….…11 (二) 全脂豆粉………………………………………………………………….…11 (三) 大豆濃縮蛋白…………………………………………………………….…11 (四) 大豆精離蛋白……………………………………………………………….12 三、 加工方式對大豆粕營養價值之影響……………………………………….13 (一) 熱處理……………………………………………………………………….13 (二) 化學處理…………………………………………………………………….13 (三) 酵素處理…………………………………………………………………….14 (四) 發酵處理………………………………….…………………………………14 四、應用於發酵作用之菌種…………………………………………………………16 (一) Aspergillus oryzae……………………………………………………………16 (二) Lactobacillus casei…………………………………………………………16 五、仔豬離乳時引起的問題………………………………………………..………..17 叁、試驗部分……………………………………………………………………..18 第一章、大豆致過敏性蛋白質的純化與抗體的製備及應用…………………..18 摘要…………………………………………………………………………………18 前言…………………………………………………………………………………18 材料與方法…………………………………………………………………………19 一、試驗材料及其處理……………………………………………………………19 二、方法與分析……………………………………………………………….19 (一) 大豆致過敏性蛋白質分離………………………………………………… 19 (二) 大豆致過敏性蛋白質次單位純化………………………………………….22 (三) 多株抗體製備……………………………………………………………….23 (四) 免疫墨漬法………………………………………………………………….24 (五) 刺膚測試…………………………………………………………………….24 三、統計方法………………………………………………………………………25 結果與討論…………………………………………………………………………25 一、大豆致過敏性蛋白質大豆球蛋白與β-大豆伴球蛋白的分離……..………….25 二、大豆致過敏性蛋白質大豆球蛋白與β-大豆伴球蛋白次單位的純化與多 株抗體製備……………………………………………………………25 三、抗大豆特異性多株抗體之應用……………………………………………….26 四、刺膚測試評估對大豆致過敏性蛋白質之過敏閥值…………………………..26 結論…………………………………………………………………………………..27 第二章、兩階段發酵大豆粕製備條件探討……………………………………….35 摘要………………………………………………………………………………….35 前言…………………………………………………………………………………35 材料與方法………………………………………………………………………….36 一、 試驗材料與處理……………………………………………………………36 (一) 材料與菌株………………………………………………………………….36 (二) 兩階段發酵大豆粕製備…………………………………………………….36 (三) 發酵大豆粕發酵過程條件之監測………………………………………….37 (四) 發酵大豆粕發酵過程品質之監測………………………………………….37 (五) 乾燥條件之探討…………………………………………………………….37 二、分析方法…..………………………………………………………………...37 (一) 水分與乾物質含量………………………………………………………….37 (二) 溫度測定…………………………………………………………………….38 (三) pH值測定……………………………………………………………………...38 (四) 粗酵素液製備與酵素活性測定…………………………………………….38 (五) 膠體電泳…………………………………………………………………….39 (六) In vitro 蛋白質消化率測定………………………………………………...39 (七) KOH鹼解蛋白質溶解率測定………………………………………………39 三、統計方法……………………………………………………………………….39 結果與討論………………………………………………………………………….40 一、 兩階段發酵大豆粕製備時發酵條件的變化………………………………….40 (一) 水分含量…………………………………………………………………….40 (二) 溫度變化…………………………………………………………………….40 (三) pH值變化……………………………………………………………………41 二、兩階段發酵大豆粕製備時酵素活性的變化…………………………………41 (一) α –半乳糖苷酶活性………………………………………………………...41 (二) 酸性蛋白酶活性…………………………………………………………….42 三、兩階段發酵大豆粕製備時in vitro消化率與蛋白質的變化……………….42 (一) 大豆蛋白質分佈…………………………………………………………….42 (二) In vitro蛋白質消化率………………………………………………………43 四、乾燥條件與KOH鹼解蛋白質溶解率………………………………………….43 結論…………………………………………………………………………………44 第三章、兩階段發酵大豆粕品質評估…………………………………………..54 摘要………………………………………………………………………………..54 前言……………………………………………………………………………….54 材料與方法………………………………………………………………………..55 一、 試驗材料及處理……….…….…………………………………………………..55 (一) 材料來源…………………………………………………………………….55 (二) 品質評估…………………………………………………………………….55 (三) 動物飼養與in vivo迴腸末端蛋白質消化率測定………………………56 (一) 粗蛋白質與胺基酸測定…………………………………………………….57 (二) 胰蛋白酶抑制因子活性定…………………………………………………...57 (三) 免疫墨漬法測定大豆致過敏性蛋白質…….………………………………..57 (四) 可溶性蛋白質分佈測定……………………………………………………57 (五) 寡醣測定…………………………………………………………………….58 (六) KOH鹼解蛋白值溶解率測定………………………………………………58 (七) 可溶於TCA之蛋白質測定…………………………………………………58 (八) 有效性離胺酸測定………………………………………………………….59 (九) In vitro蛋白質消化率測定…………………………………………………....59 (十) pH值與乳酸含量測定………………………………………………………59 三、統計方法………………………………………………………………………59 結果與討論…………………………………………………………………………....60 一、組成分…………………………………………………………………….…….60 (一) 粗蛋白含量………………………………………………………………….60 (二) 胺基酸含量………………………………………………………………….60 二、抗營養因子的破壞………………………………………………………………61 (一) 胰蛋白酶抑制因子的破壞……………………………………..…………..61 (二) 大豆致過敏性蛋白質的降解………………………………………..……..62 (三) 寡醣的水解…………………………………………………………..……..62 三、蛋白質品質評估…………………………………………………………….…….63 (一) TCA可溶性蛋白質與in vitro蛋白質消化率………………………………...63 (二) KOH鹼解蛋白質消化率……………………………………………………64 (三) 可利用離胺酸含量………………………………………………………….64 (四) 可溶性蛋白質之分佈……………………………………………………….64 (五) In vivo迴腸末端蛋白質消化率………………………………………….65 四、乳酸含量與pH值……………………………………………………………….65 結論………………………………………………………………………………..66 第四章、兩階段發酵大豆粕作為離乳仔豬飼糧蛋白質來源之評估………….75 摘要……………………………………………………………………………….75 前言……………………………………………………………………………….75 材料與方法………………………………………………………………………76 一、 材料與動物試驗設計……………………..……………………………………..76 二、分析項目及方法………………………………………………………………….77 (一) 生長性狀…………………………………………………………………….77 (二) 腸道組織切片之觀察……………………………………………………….77 (三) 微生物檢測………………………………………………………………….77 (四) 腸內容物總揮發性脂肪酸測定…………………………………………….77 (五) 下痢發生率與下痢嚴重性評分…………………………………………….78 三、統計方法…………………………………………………………………78 結果與討論………………………………………………………………………78 一、 兩階段發酵大豆粕取代飼糧中魚粉與大豆濃縮蛋白對離乳仔豬生長性狀 之影響……………………………….………………………….……………….78 二、 兩階段發酵大豆粕取代飼糧中魚粉與大豆濃縮蛋白對離乳仔豬腸道性狀 之影響……………………………….………………………….……………….80 三、 兩階段發酵大豆粕取代飼糧中魚粉與大豆濃縮蛋白對離乳仔豬腸內微生 物菌數之影響……………………………………………………………………81 四、兩階段發酵大豆粕取代飼糧中魚粉與大豆濃縮蛋白對離乳仔豬腸道內 VFA含量之影響………………………….…………………….……………….81 五、兩階段發酵大豆粕取代飼糧中魚粉與大豆濃縮蛋白對離乳仔豬下痢發生 率與下痢分數之影響…..………………………….…………………………….82 結論………………………………………………………………………………..83 肆、總結………………………………………………………………………...91 伍、參考文獻……………………………………………………………………..92   圖目次 頁 圖1. 胰蛋白酶抑制因子結構……………………………………………………….5 圖2. β-大豆伴球蛋白的分子結構圖……………………………………………6 圖3. 大豆球蛋白的分子結構圖…………………………………………………7 圖4. 標準蛋白質與大豆蛋白質次單位之SDS-PAGE電泳圖…………………..8 圖5. 水蘇糖、棉子糖與蔗糖的結構圖…………………………………………….10 圖6. 大豆致過敏性蛋白質分離流程圖...............................................................21 圖 7. 仔豬刺膚測試前處理……………………………………………………...…..28 圖8. 大豆粕、β-大豆伴球蛋白和大豆球蛋白 的膠體電泳圖…………………….29 圖9. 大豆致過敏性蛋白質SDS-PAGE與大豆特異性多株抗體進行之免疫 墨漬圖………………………………………………………………………30 圖 10. 不同豆科的SDS-PAGE與以特異性抗體分析免疫墨漬圖............31 圖11. 刺膚測試後典型反應照片…………………………………….......32 圖12. 大豆粕經麴菌與乳酸菌二階段發酵期間水分之變化………….45 圖13. 大豆粕經麴菌與乳酸菌二階段發酵期間溫度之變化………………46 圖14. 大豆粕經麴菌與乳酸菌二階段發酵期間pH之變化…………….47 圖15. 大豆粕經麴菌與乳酸菌二階段發酵期間α –半乳糖苷酶活性 之變化……………………………………………………………………..48 圖16. 大豆粕經麴菌與乳酸菌二階段發酵期間酸性蛋白酶活性之變 化…………………………………………………………..…………49 圖17. 大豆粕經麴菌發酵後再經乳酸菌發酵不同時間之SDS-PAGE圖.……50 圖18. 大豆粕經麴菌發酵後再經乳酸菌發酵不同時間之in vitro蛋白質 消化率………………………………………………………….…51 圖19. 兩階段發酵大豆粕在不同乾燥溫度與時間的乾物質含量………52 圖20. 兩階段發酵大豆粕在不同乾燥溫度與時間的鹼解蛋白質溶解率.53 圖21. 不同大豆製品膠體電泳圖與使用免疫墨漬檢測大豆發酵製品……70 圖22. 仔豬餵飼不同大豆製品飼糧的蛋白質消化率…….……………..72 圖23. 不同大豆製品蛋白質之Tricine-SDS-PAGE的分佈圖……………….73 圖 24. 不同大豆粕產品蛋白質之電泳膠體經過藍染後光密度測定的結果…......74 圖25. 離乳小豬餵飼含大豆粕-魚粉、大豆粕、大豆粕-發酵豆粉、發酵豆 粉與大豆粕-濃縮大豆蛋白的飼糧在14天試驗期內的每日下痢發 生率…………………………………………………………….………..89 圖26. 離乳小豬餵飼含大豆粕-魚粉、大豆粕、大豆粕-發酵豆粉、發酵豆粉 與大豆粕-濃縮大豆蛋白的飼糧在14天試驗期的每日下痢小豬的下痢 嚴重性…..………………………………………………………….90   表目次 頁 表1. 皮下注射不同濃度大豆蛋白萃取物，5、15、30後腫脹直徑..33 表2. 皮下注射不同濃度的β-大豆伴球蛋白(β-conglycinin)和大豆 球蛋白(glycinin)，5、15、30後腫脹直徑…….……….……34 表3. In vivo飼養試驗飼糧配方組成……………………………………….67 表4. 大豆粕、發酵豆粉與大豆濃縮蛋白營養品質……………………………….68 表5. 不同大豆製品胺基酸含量……………………………………………………69 表6. 大豆製品寡糖的分布……………………………………………………….71 表7. 仔豬餵飼不同大豆製品飼糧的蛋白質消化率………………………………72 表8. 試驗飼糧組成………………………………………………………………84 表9. 離乳小豬餵飼含大豆粕-魚粉、大豆粕、大豆粕-發酵豆粉、發酵豆粉與 大豆粕-濃縮大豆蛋白的飼糧在14天試驗期的生長性狀………………85 表10. 離乳小豬餵飼含大豆粕-魚粉、大豆粕、大豆粕-發酵豆粉、發酵豆粉與 大豆粕-濃縮大豆蛋白的飼糧在離乳後第14天的小腸腸道性狀…………86 表11. 離乳小豬餵飼含大豆粕-魚粉、大豆粕、大豆粕-發酵豆粉、發酵豆粉與 大豆粕-濃縮大豆蛋白的飼糧在離乳後第14天的迴腸與糞便中微生物 數量………………………………………………………………………..87 表12. 離乳小豬餵飼含大豆粕-魚粉、大豆粕、大豆粕-發酵豆粉、發酵豆粉 與大豆粕-濃縮大豆蛋白的飼糧在離乳後第14天於迴腸與結腸內容物 的揮發性脂肪酸含量……………………………………………………..8