在台灣人口逐漸老化的情況下，如何延緩勞動者退出就業市場，攸關台灣的社會保險、年金體系及照顧體系之存續，但要勞工能夠延後退休，先決條件是身體健康與否，因此勞工的健康狀況，就不僅僅是個人問題，而是台灣社會面臨的整體危機。主管職業健康的各部門，未能意識到每個政策對於整體勞動生產力，之於經濟發展和社會福利、保險的深遠影響，以致於過度聚焦於對於勞工個人影響的層面，而缺乏思考這些行動背後，對於國家整體的宏觀意義 而在執行工作時中造成肌肉骨骼系統的任何不適、困難或疼痛，更是困擾的許多歐洲的勞工，因此歐盟無不以積極的政策來干預MSD，希望能延長停留在勞動市場的期間，並說明對於雇主、勞工、政府、財政所帶來的幫助。另外透過訪談發現，台灣的物流業從業人員，所處在的工作環境，恰如文獻所提，反覆、負重、工時過長…等，時常有受傷而繼續從事工作的情形，也導致物流業流動率高、從業人員較年輕及容易成為MSD的高風險群。 因此必須從增進MSD的概念、提升勞動條件及減少因病缺勤著手。政府方面則必須建構更完整的MSD數據，並制訂讓MSD勞工留在職場的積極性勞動力市場政策以及廣辦宣導會說明MSD對我國的重要性；雇主的重要性更是不可言喻，不僅扮演第一線的觀察者，快速做出因應措施，並著手改善從業人員勞動條件，並將干預措施予以制度化；勞工則必須透過積極參與有關MSD政策或方案的討論，更重要的是養成並維持良好的生活方式的習慣。 / Taiwan population is rapidly aging. How to persuade workers to delay withdrawing from employment market becomes an urgent challenge because this concern has significant implications to our social insurance, the annuity system and healthcare system. Therefore, the health of workers is not just a personal issue, but a public concern that everyone in this society needs to face. Government officials in charge of healthcare policy are not yet aware of its profound impact on labor productivity, economic development, social welfare and social insurance. Policy wise, we put too much attention on individual health promotion while lose sight of its macro impact. MSD, either caused by work or gene, inflicted many European workers, so that the EU actively deal with this issue with the hope that workers are able to stay longer around the labor market as long as possible. This study finds through the interview that workers of the logistics industry in Taipei endure heavy work-load, long working time, and often time have high rate of presenteeism (the tendency of workers to go to work when they are ill enough to stay at home), causing the logistics industry to have not only high exit rate but also high risk of MSD. Therefore, we have to promote the MSD concept, improve labor conditions and reduce presenteeism. For example employers have to include MSD into their pre-employment training courses for those new entrants, to reduce the hours of working time and to decrease presenteeism through providing subsidy to those who suffer from MSD. The government then has to build up a more complete MSD database, and introduces the concept of MSD and its preventive practice through seminars or workshops. Employers have key roles and duty in this issue. Specifically, they have to adopt as well as carry out preventive measures, and take quick actions whenever incidence of MSD occurs in the frontline of workplace. In addition, they have to improve working conditions and institutionalize those intervention measures. Workers then need to actively participate in MSD policy discussion other than maintaining a healthy life style. Workers, employers, health care system and social welfare system have a cause to this joint effort in keeping workers in Taiwan as healthy as possible so that every nationals can Fit For Work.

本研究探討心理衛生社會工作者與精神病患照顧者工作之中相互期待的角色內涵、影響角色期待之因素或歷程，以及相互期待之認知、行動如何修正與調整。本研究採質性研究深度訪談法，採立意抽樣選取研究對象，對三十九位受訪者（二十六位心理衛生社會工作者、十三位精神病患照顧者）進行半結構式訪談，主要研究發現如下： 1. 精神病患照顧者的照顧內容和與角色立場： （1）照顧內容：症狀因應、社區生活 （2）照顧態度：積極主動、合理期待、自我照顧 （3）與其他家屬互動：聚會交流、自助助人、權益倡導 2. 照顧者樣態與社會工作者對照顧者之角色期待： （1）所見樣態：積極參與、消極參與、不當期待、家庭動力不穩 （2）對照顧者之角色期待：配合服務、適度支持、個別化期待、如個案需要協助 （3）影響因素：社經認知條件、家庭文化因素、疾病照顧經驗、社區環境、社工接觸經驗 3. 社會工作者與照顧者之工作方法，與照顧者對社會工作者的角色期待： （1）工作方法：傾聽陪伴支持、協作釐清期待、衛教家屬團體、家庭動力工作、社區資源連結、權益倡導協調 （2）指導原則：聚焦正向改變、以個案為中心、重視家庭經驗、尊重照顧知識、抱持覺察開放的態度 （3）照顧者對社會工作者之角色期待：教育引導、家庭陪伴、權益倡導 （4）影響社會工作者角色因素：個人因素、專業教育、組織因素、結構因素 4. 照顧者與社會工作者關係：夥伴關係、工作關係、彈性關係 5. 照顧者與社會工作者相互角色期待調整方式： （1）照顧者對社會工作者期待調整：接受現況、調整期待、自立自強 （2）社會工作者對照顧者期待調整：接納現況、調整期待、擇善固執 （3）社會工作者挫折因應方法：經驗回饋、自我照顧、團隊支持 最後，研究者結合上述研究結果，嘗試繪製出心理衛生社會工作者與照顧者相互角色期待內涵與影響因素之概念架構圖，並提出本研究限制與建議，提供照顧者、心理衛生社會工作者和政策制定者、未來研究者參考，期冀本研究有助於減少照顧者可能產生的失望，甚至進而奠定一個基於夥伴關係的服務方式。 / The purpose of the study was to explore the content of mutual role expectation for mental health social workers and caregivers, the factors influencing role expectation, and the adjustment process of role expectation. This study used purposive sampling to select thirty-nine participants (twenty-six mental health social workers and thirteen caregivers), conducting in-depth interviews by using a semi-structured interview outline. The major results of the study include: 1. Care content and role of caregivers: (1) Care content: symptom management, community life promotion. (2) Care attitude: proactive, reasonably expected, self-care. (3) Interaction with other caregivers: family support group and gathering, help others and self-help, advocacy. 2. Caregiver pattern and role expectation of caregivers: (1) Caregiver pattern: actively participated, passively participated, improperly expected, unstable family dynamics. (2) Role expectation of caregivers： service adherence, moderate support, individual expectation, potential client. (3) Factors influencing role expectation: socioeconomic and cognitive conditions, family and cultural factors, caring experience, community environment, the experience of contacting social worker. 3. Working methods and role expectation of social workers: (1) Working methods: listening and accompanying, cooperating to clarify expectation, group psychoeducation, family systems therapy, mobilizing community resources, advocacy and negotiation. (2) Guiding principles: focus on positive changes, case-centered, attention to family experience, respect for caring knowledge, open-mindedness and self-awareness. (3) Role expectation of social workers: educator and guide, family supporter, advocate. (4) Factors influencing role expectation: personal factors, professional education, organizational factors, structural factors. 4. Professional relationship: partnership, working relationship, elastic relationship. 5. Adjustment process of role expectation for caregivers and social workers： (1) Role expectation of caregivers adjusted by social workers: accepting the status quo, adjusting expectation, self-reliance. (2) Role expectation of social workers adjusted by caregivers: accepting the status quo, adjusting expectation, persisting. (3) Frustration coping methods: experience feedback, self-care, team support. Based on above findings, researcher drew out the depiction of mutual role expectation for mental health social workers and caregivers, as well as the factors influencing role expectation, proposing the study restrictions and suggestions on policy making, partnership-based approach for mental health social workers and caregivers, and further research.

研究目的：本研究使用共通信念模式，以瞭解第二型糖尿病患者持有的疾病表徵對自我照護行為的預測關係。過去的研究顯示，糖尿病患者的「控制」表徵能夠有效預測患者的自我照護行為和糖化血色素值；也就是，患者相信疾病能被控制的程度愈高，在自我照護行為的表現愈好，糖化血色素值愈低。但是，「結果」表徵與「情緒」表徵無法顯著一致的預測患者的自我照護行為。透過回顧與健康行為相關的理論發展與文獻，考量慢性疾病的自我調節歷程中，除了疾病表徵以外，還需要納入與自我意識有關的人格特質。為此，本研究目的有四:(1)先檢驗在台灣糖尿病患者的疾病表徵建構，是否與國外使用疾病共通信念模式的研究結果一致，有相同的因素結構。(2)檢定台灣第二型糖尿病患者，其持有的疾病表徵對自我照護行為與血糖控制的預測，是否與Harvey和Lawson(2009)的研究結果一致。(3)評估糖尿病患者的人格特質對自我照護行為與糖化血色素值的影響。(4)探索第二型糖尿病患者反芻反思特質，在疾病表徵影響自我照護行為上的調節效果。 研究方法：本研究以立意取樣的方式，邀請新竹某教學醫院門診的第二型糖尿病患者為受試。排除漏答與亂填者，共有142位符合資格的受試者；每位受試者皆需完成受試者同意書、背景資料、糖尿病自我照護量表、疾病表徵問卷與中文版反芻反思量表。根據研究目的，以階層回歸和羅吉斯回歸分析等統計方法進行假設考驗。 研究結果：(1)臺灣第二型糖尿病患者的疾病表徵結構與國外患者相似，共包含：「認同」、「病因」、「時間感急慢性」、「時間感循環性」、「結果」、「情緒」和「控制」表徵。(2)研究結果與Harvey和Lawson(2009)的研究結果一致，「控制」表徵可以顯著預測整體自我照護行為和糖化血色素值。(3)第二型糖尿病患者的反芻反思特質，無法單獨預測自我照護行為與糖化血色素值。(4) 第二型糖尿病患者的反芻反思特質會與病表徵產生交互作用，共同調節各種自我照護行為的表現。 結論：本研究資料與其他使用共通信念模式的研究資料一致，亦即控制表徵能預測自我照護行為和糖化血色素值。此外，本研究發現，不同自我照護行為會受到疾病表徵與反芻或反思特質的交互作用而影響。由於，增加自我照護行為的執行度，是目前糖尿病治療與衛教的首要目標。建議未來從事糖尿病照護的實務工作者，能提供疾病表徵與反芻反思特質的專業心理評估；以協助建立個別評估與個別介入的個別化治療方案，進而提高患者在自我照護行為的執行度、增加臨床治療的效果。 / Background and Aims. It is increasingly being used to understand and predict individuals' coping with and subsequent self-care of chronic illness is Leventhal and colleagues' the common sense model. This model postulates that it is the individual's illness representation is the proximal determinant of coping behavior. The role of personality in determining self-care behavior has been relatively ignored, possibly because of the lack of convergence in concepts and measures. Due to the lack of research in the area of interest, the present study attempt to resolve this issue. We investigated, (a) using subjects of Type-II diabetes in Taiwan, are the results of present study similar as others studies directed by common sense model to identify the factors of illness representation, (b) discussing the influences of illness representation to self-care behavior and glycemic control (HbA1c); like as Harvey and Lawson(2009)’s study, (c) assessing whether traits of normal personality are associated with variations in self-care behavior and glycemic control in patients with type 2 diabetes, (d) examining whether personality moderate the relationships between illness representations and self-care behavior. Methods. Patients were eligible if they had Type 2 diabetes, were aged 20 years or more at diagnosis. Before we collect data, a physician will invite patient to enter the study. Patient want to join this study, they be giving an informed consent and be asked to complete four questionnaires. A total 142 patients completed the demographic survey ( age, educational level, diabetes duration et al.), Diabetes Self-Care Scale, the Revised Illness Perception Questionnaire(IPQ-R), the Chinese version of Rumination- Reflection Questionnaire. Analysis were concluded using multiple regression analysis, logistic regression and so on. Results. The results revealed that: (1) as our hypothesis, the structures of the IPQ-R in type 2 diabetes in Taiwan were similar as other foreign studies directed by common sense model. (2) Control representation can induce main effect on self care behavior. Higher control representation was significantly positive associated with self care behavior, and it was significantly negative associated with HbA1c. (3) Self reflection and self rumination were inconsistently associated with self care behavior and HbA1c. (4) Personality moderated the relationships between illness representations and self-care behavior. Conclusions. This study supports the Common Sense Model (CSM) of illness representation when considering type 2 diabetes in Taiwan. Based on our results, we found personality traits may offer new insights in to variations in self-care in patients with type 2 diabetes undergoing standard management. Personality refers as self-reflection and self-rumination which moderated the relationships between illness representations and self-care behavior. Therefore, CSM could become the theoretical framework for psychological interventions in type 2 diabetes. Furthermore, according to the study result, we suggested the practitioners paying attention to the different interaction when representation and personality are together in diabetes’ each self-care behavior.

University of Macau / Institute of Chinese Medical Sciences

University of Macau / Institute of Chinese Medical Sciences

癌症至今已連續蟬聯並高居國人十大死因之首，由於癌症初期病患接受適時治療的存活率較高，因此若能「早期發現，早期診斷，早期治療」則可降低死亡率。本文所引用的資料庫，是經由「表面強化雷射解吸電離飛行質譜技術」（SELDI-TOF-MS）所擷取建置的蛋白質質譜儀資料，包括兩筆高維度資料：一筆為攝護腺癌症，另一筆則為頭頸癌症。然而蛋白質質譜儀資料常因維度變數繁雜眾多，對於資料的存取容量及運算時間而言，往往造成相當沉重的負擔與不便；有鑑於此，本文之目的即在探討將高維度資料經由維度縮減後，找出分錯率最小化之分析方法，希冀提高癌症病例資料分類的準確性。 本研究分為實驗組及對照組兩部分，實驗組是以主成份分析（Principal Component Analysis，PCA）進行維度縮減，再利用支持向量機（Support Vector Machine，SVM）予以分類，最後藉由重疊法（Overlap）以期改善分類效果；對照組則是以支持向量機直接進行分類。分析結果顯示，重疊法對於攝護腺癌症具有顯著的改善效果，但對於頭頸癌症的改善效果卻不明顯。此外，本研究也探討關於蛋白質質譜儀資料之質量範圍，藉以確認專家學者所建議的質量範圍是否與分析結果相互一致。在攝護腺癌症中的原始資料，專家學者所建議的質量範圍以外，似乎仍隱藏著重要的相關資訊；在頭頸癌症中的原始資料，專家學者所建議的質量範圍以外，對於研究分析而言則並沒有實質上的幫助。 / Cancer has been the number one leading cause of death in Taiwan for the past 24 years. Early detection of this disease would significantly reduce the mortality rate. The database adopted in this study is from the Protein Mass Spectrometry Data Sets acquired and established by “Surface-Enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry” (SELDI-TOF-MS) technique, including the Prostate Cancer and Head/Neck Cancer Data Sets. However, because of its high dimensionality, dealing the analysis of the raw data is not easy. Therefore, the purpose of this thesis is to search a feasible method, putting the dimension reduction and minimizing classification errors in the same time. The data sets are separated into the experimental and controlled groups. The first step of the experimental group is to use dimension reduction by Principal Component Analysis (PCA), following by Support Vector Machine (SVM) for classification, and finally Overlap Method is used to reduce classification errors. For comparison, the controlled group uses SVM for classification. The empirical results indicate that the improvement of Overlap Method is significant in the Prostate Cancer case, but not in that of the Head/Neck case. We also study data range suggested according to the expert opinions. We find that there is information hidden outside the data range suggested by the experts in the Prostate Cancer case, but not in the Head/Neck case.

本篇論文的目的在介紹階層貝氏之時間與空間統計模式(spatio-temporal model)，將此模式應用在疾病地圖的分析，以了解疾病在空間上的分佈狀態與時間趨勢。模型中除了納入時間、空間和年齡的效應外，也包括時間與空間、時間與年齡的交互作用，並考慮到空間相關性(spatial correlation)，然後以DIC值(Deviance information criterion)作為模式選取的準則。 本文並以民國88-90年全身紅斑性狼瘡的女性患病人數做為實證分析的資料。配適時間與空間統計模式後，以馬可夫鏈蒙地卡羅法(MCMC)來模擬參數值，估計出各時間、地區、年齡層的對數疾病發生率。由疾病地圖可看出，台灣地區全身紅斑性狼瘡的女性疾病發生率，以20-59歲的年齡層發生率較高，0-19歲的發生率較低。不管在哪一個年齡層，北部和中部地區的發生率都是最高的。時間趨勢方面，88-90年整體疾病發生率有遞減的趨勢，60歲以上的發生率也是遞減的趨勢。但在部分地區，則有發生率遞增的趨勢。 / In this study, we introduce the spatio-temporal model in a hierarchical Bayesian framework and use disease maps to display the spatial patterns and the temporal trends of disease. A special feature of the model is the inclusion of spatial correlations used to examine spatial effects relative to both regional and regional changes over time by group. Then, we use deviance information criterion (DIC) to compare complex hierarchical models. The methodology is illustrated by an analysis of female Systemic Lupls Erythematosus (SLE) morbidity data in Taiwan during the period 1999-2001.The model inference is implemented using Markov chain Monte Carlo method. The outcomes of the practical analysis appear that the higher morbidity rate occurs in 20-year and 40-year period. No matter what age group, the morbidity rate is highest in the north and the middle of Taiwan. Furthermore, the morbidity rate decreases with respect to year as well as over the 60-year period but it increases in some places.

No description available.

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(教育学) / 甲第20842号 / 教博第215号 / 新制||教||173(附属図書館) / 京都大学大学院教育学研究科臨床教育学専攻 / (主査)准教授 髙橋 靖恵, 教授 皆藤 章, 准教授 松下 姫歌 / 学位規則第4条第1項該当 / Doctor of Philosophy (Education) / Kyoto University / DGAM