臺灣博碩士論文加值系統

Papanicolaou smear screening of women with and without intellectual disabilities study used a nationwide population-based dataset to compare the utilization of Pap smear screening for women aged 35 and over with and without intellectual disabilities in order to define the pattern of Pap screening needs and various factors that are associated with receiving of cervical screening, which if modified could improve the utilization of such test in Taiwan.
Method: A retrospective population-based study. Administrative claims data obtained from the Taiwan National Health Insurance Research Database covering the periods 1996—2007 was used to examine women utilized pap smear screening test between 2000 and 2007 (n = 990,906) to determine whether they had received a Pap test in 2007. Main outcome measures: Independent variables income, intellectual disability status, level of disability, geographical location and urbanization level of residences. Chi-Square test, multivariate logistic regressions were performed in this study.
Result: 79,557 women (8.03%) had received cervical cancer screening during 2007. After adjusting for other factors, the odds of such screening by women in general population were found to be 3.18 times more likely to have a Pap test than women with ID, with the odds decreasing with women’s urbanization level. Women residing in southern National Health Insurance of Taiwan were more likely to use preventive dental health service than those living in Taipei *National Health Insurance and northern* NHI, while women in central* National Health Insurance of Taiwan had higher usage probability of Pap test within ID group. Women with low income had higher odds of usage of Pap test those have medium and high income. Women with moderate ID less likely to have cervical screening than other severity level of women. Overall tendency of the Pap smear screening usage by women with and without ID from 2000 to 2007 in Taiwan has been increasing among two groups.
Conclusion: Women’s income, geographical location, urbanization level, status of intellectual disability, severity of intellectual disability have significant associations with Pap smear screening usage, and this usage rates has been increasing from 2000 to 2007 in both women with and without ID.

Papanicolaou smear screening of women with and without intellectual disabilities study used a nationwide population-based dataset to compare the utilization of Pap smear screening for women aged 35 and over with and without intellectual disabilities in order to define the pattern of Pap screening needs and various factors that are associated with receiving of cervical screening, which if modified could improve the utilization of such test in Taiwan.
Method: A retrospective population-based study. Administrative claims data obtained from the Taiwan National Health Insurance Research Database covering the periods 1996—2007 was used to examine women utilized pap smear screening test between 2000 and 2007 (n = 990,906) to determine whether they had received a Pap test in 2007. Main outcome measures: Independent variables income, intellectual disability status, level of disability, geographical location and urbanization level of residences. Chi-Square test, multivariate logistic regressions were performed in this study.
Result: 79,557 women (8.03%) had received cervical cancer screening during 2007. After adjusting for other factors, the odds of such screening by women in general population were found to be 3.18 times more likely to have a Pap test than women with ID, with the odds decreasing with women’s urbanization level. Women residing in southern National Health Insurance of Taiwan were more likely to use preventive dental health service than those living in Taipei *National Health Insurance and northern* NHI, while women in central* National Health Insurance of Taiwan had higher usage probability of Pap test within ID group. Women with low income had higher odds of usage of Pap test those have medium and high income. Women with moderate ID less likely to have cervical screening than other severity level of women. Overall tendency of the Pap smear screening usage by women with and without ID from 2000 to 2007 in Taiwan has been increasing among two groups.
Conclusion: Women’s income, geographical location, urbanization level, status of intellectual disability, severity of intellectual disability have significant associations with Pap smear screening usage, and this usage rates has been increasing from 2000 to 2007 in both women with and without ID.

Abstract
OUTLINE OF CONTENTS I
LIST OF TABLES III
LIST OF FIGURES IV
CHAPTER 1: INTRODUCTION 1
Research background and motivation 1
Objective of this research 4
Research questions 4
CHAPTER 2: LITERATURE REVIEW 6
Overview of Intellectual disability 6
Reproductive and sexual health care issue of women with disability 9
Basic concept of cervical cancer 12
Cervical cancer screening 20
Factors affect to receive Pap smear test 25
Income 25
Urbanization level 27
Geographic location 28
Intellectual disability (ID) status 28
Level of Intellectual disability 29
Research framework and hypothesis 30
CHAPTER 3: METHODOLOGY 33
Data sources 33
Study sample 33
Study variables 34
Independent variables 34
Dependent variable 34
Operational definition of variables 34
Statistic analysis 36
CHAPTER 4: ANALYSES RESULTS 37
Descriptive analysis 37
Chi-square analysis 39
Utilization rates 42
Logistic regression in different groups 43
Logistic regression in intellectual disabled groups 45
The trend of preventive dental program from 2004 to 2007 47
Rejection of Null Hypotheses 48
CHAPTER 5: DISCUSSION CONCLUSIONS 50
Summary of research findings and interpretation 50
Study limitations and strengths 52
Policy implications and recommendations 53
Conclusion and suggestion for future research 54
REFERRENCES 55

LIST OF TABLES
1 Classification of intellectual disability severity 8
2 A comparison of deaths from cervical cancer and maternal mortality in selected developing countries in 2000 14
3 HPV infection, cervical pre cancer, and invasive cervical cancer 17
4 Cervical cancer screening rates (age 20-69 years) during 2000-2009 in 12 OECD countries 21
5 Pap screening rates for women age 25-64 years by World Health Survey by country, 2002-2003 22
6 Women’s characteristics and use of Pap smear test 37
7 The Comparison of Utilization of Pap smear between different groups in 2007 41
8 The Comparison of the Utilization of Pap Smear between ID and Normal people in 2007 43
9 The Logistical Regression of the Utilization of Pap Smear between difference groups in 2007 44
10 The Logistical Regression of the Utilization of Pap Smear between in ID groups in 2007 46

LIST OF FIGURES
1 Cancer incidence among women 13
2 Cancer mortality rate among women 13
3 Prognoses of infection of HPV 17
4 Research framework 30
5 The percentage of Pap smear test from 2000 to 2007 48

1. Ramirez, A., et al., Disability and preventive cancer screening: results from the 2001 California Health Interview Survey. Am J Public Health, 2005. 95(11): p. 2057-64.
2. Chi, H., et al., Molecular epidemiology and phylodynamics of the human respiratory syncytial virus fusion protein in northern taiwan. PLoS One, 2013. 8(5): p. e64012.
3. Lin, J.D., et al., The general picture of supportive health environments for persons with intellectual disabilities among 121 disability welfare institutions in Taiwan. J Intellect Disabil Res, 2006. 50(Pt 1): p. 25-32.
4. Lin, J.D., et al., Spinal and limb abnormalities in adolescents with intellectual disabilities. Res Dev Disabil, 2010. 31(3): p. 686-91.
5. Lin, L.P., et al., Papanicolaou smear screening of women with intellectual disabilities: a cross-sectional survey in Taiwan. Res Dev Disabil, 2010. 31(2): p. 403-9.
6. Lin, Y.L., et al., Oxaliplatin-based Chemotherapy Might Provide Longer Progression-Free Survival in KRAS Mutant Metastatic Colorectal Cancer. Transl Oncol, 2013. 6(3): p. 363-9.
7. Lin, J.D., et al., A cross-sectional study of the characteristics and determinants of emergency care utilization among people with intellectual disabilities in Taiwan. Res Dev Disabil, 2006. 27(6): p. 657-67.
8. Yu, H., et al., Identification of a novel, small molecule activator of KCNQ1 channels, in Probe Reports from the NIH Molecular Libraries Program2010: Bethesda (MD).
9. Lin, J.D., et al., Quality of life in caregivers of children and adolescents with intellectual disabilities: use of WHOQOL-BREF survey. Res Dev Disabil, 2009. 30(6): p. 1448-58.
10. Chevarley, F.M., et al., Health, preventive health care, and health care access among women with disabilities in the 1994-1995 National Health Interview Survey, Supplement on Disability. Womens Health Issues, 2006. 16(6): p. 297-312.
11. Mele, N., J. Archer, and B.D. Pusch, Access to breast cancer screening services for women with disabilities. J Obstet Gynecol Neonatal Nurs, 2005. 34(4): p. 453-64.
12. Wei, W., P.A. Findley, and U. Sambamoorthi, Disability and receipt of clinical preventive services among women. Womens Health Issues, 2006. 16(6): p. 286-96.
13. Armour, B.S., J.M. Thierry, and L.A. Wolf, State-level differences in breast and cervical cancer screening by disability status: United States, 2008. Womens Health Issues, 2009. 19(6): p. 406-14.
14. Hsu, S.W., et al., Emergency department utilization and determinants of use by 0- to 6-year-old children with disabilities in Taipei. Res Dev Disabil, 2009. 30(4): p. 774-81.
15. Lin, J.D., et al., Physical and mental health status of staff working for people with intellectual disabilities in Taiwan: measurement with the 36-Item Short-Form (SF-36) health survey. Res Dev Disabil, 2009. 30(3): p. 538-46.
16. Lin, J.D., et al., Serum uric acid, hyperuricemia and body mass index in children and adolescents with intellectual disabilities. Res Dev Disabil, 2009. 30(6): p. 1481-9.
17. Lin, J.D., et al., Received, understanding and satisfaction of National Health Insurance premium subsidy scheme by families of children with disabilities: a census study in Taipei City. Res Dev Disabil, 2009. 30(2): p. 275-83.
18. van Schrojenstein Lantman-De Valk, H.M., et al., Health problems in people with intellectual disability in general practice: a comparative study. Fam Pract, 2000. 17(5): p.405-7.
19. Tuffrey-Wijne, I., The palliative care needs of people with intellectual disabilities: a literature review. Palliat Med, 2003. 17(1): p. 55-62.
20. Walsh, J.M., Lipids in women: screening and treatment. J Am Med Womens Assoc, 2003. 58(4): p. 240-7.
21. Tuffrey-Wijne, I., et al., People with learning disabilities who have cancer: an ethnographic study. Br J Gen Pract, 2009. 59(564): p. 503-9.
22. Stein, K. and N. Allen, Cross sectional survey of cervical cancer screening in women with learning disability. BMJ, 1999. 318(7184): p. 641.
23. Sullivan, S.G., L.M. Slack-Smith, and R. Hussain, Understanding the use of breast cancer screening services by women with intellectual disabilities. Soz Praventivmed, 2004. 49(6): p. 398-405.
24. Watts, S., Access to cervical screening for women with learning disabilities. Br J Nurs, 2008. 17(8): p. 518-25.
25. Lin, J.D., J.L. Wu, and C.F. Yen, An exploratory study into health care policy for persons with intellectual disabilities in Taiwan. J Intellect Disabil Res, 2004. 48(Pt 3): p. 252-61.
26. Lin, J.D., Chow, M. J., Yen, C. F., Wu, J. L., & Chu, C., Setting directions in healthcare policy development for people with intellectual disabilities in Taiwan. Journal of Medical Sciences, 24, 191-198. Journal of Medical Sciences, 2004.
27. O'Regan, P. and E. Drummond, Cancer information needs of people with intellectual disability: a review of the literature. Eur J Oncol Nurs, 2008. 12(2): p. 142-7.
28. Sullivan, W.F., et al., Primary care of adults with developmental disabilities: Canadian consensus guidelines. Can Fam Physician, 2011. 57(5): p. 541-53, e154-68.
29. Croser to retire as Executive Director of AAIDD. Intellect Dev Disabil, 2010. 48(4): p. 292-6.
30. http://www.cdc.gov/ncbddd/dd/mr3.htm.
31. Larson, S.A., et al., Prevalence of mental retardation and developmental disabilities: estimates from the 1994/1995 National Health Interview Survey Disability Supplements. Am J Ment Retard, 2001. 106(3): p. 231-52.
32. http://www.cdc.gov/ncbddd/disabilityandhealth/women.html.
33. Iezzoni, L.I., et al., Use of screening and preventive services among women with disabilities. Am J Med Qual, 2001. 16(4): p. 135-44.
34. Veltman, A., et al., Perceptions of primary healthcare services among people with physical disabilities - part 1: access issues. MedGenMed, 2001. 3(2): p. 18.
35. Diane S. Willis., C.M.K., Lynn Kilbride, Breast cancer screening in women with learning disabilities: current knowledge and considerations. British Journal of Learning Disabilities, 13 Aug, 2008.
36. Patja, K., et al., Life expectancy of people with intellectual disability: a 35-year follow-up study. J Intellect Disabil Res, 2000. 44 ( Pt 5): p. 591-9.
37. Oshima, S., et al., Assessing the knowledge of future internists and gynecologists in caring for a woman with tetraplegia. Arch Phys Med Rehabil, 1998. 79(10): p. 1270-6.
38. Hagenlocher, T., et al., Influence of dietary fatty acid, vegetable, and vitamin intake on etheno-DNA adducts in white blood cells of healthy female volunteers: a pilot study. Cancer Epidemiol Biomarkers Prev, 2001. 10(11): p. 1187-91.
39. Greenspan, S., A sex police for adults with "mental retardation"? Comment on Spiecker and Steutel. J Moral Educ, 2002. 31(2): p. 171-9.
40. Steutel, J. and B. Spiecker, Reasonable paternalism and the limits of sexual freedom: a response to Greenspan and Leicester and Cooke. J Moral Educ, 2002. 31(2): p. 189-94.
41. Chamberlain, A., et al., Issues in fertility control for mentally retarded female adolescents: I. Sexual activity, sexual abuse, and contraception. Pediatrics, 1984. 73(4): p. 445-50.
42. Catoira, R., et al., The HCL gene of Medicago truncatula controls Rhizobium-induced root hair curling. Development, 2001. 128(9): p. 1507-18.
43. http://www.who.int/reproductivehealth/topics/cancers/en/.
44. Prevention, A.f.C.C., Planning and Implementing Cervical Cancer Prevention and Control Programs. 2004.
45. Wang, K.L., Human papillomavirus and vaccination in cervical cancer. Taiwan J Obstet Gynecol, 2007. 46(4): p. 352-62.
46. Elfgren, K., et al., A population-based five-year follow-up study of cervical human papillomavirus infection. Am J Obstet Gynecol, 2000. 183(3): p. 561-7.
47. Xi, L.F., et al., Genomic variation of human papillomavirus type 16 and risk for high grade cervical intraepithelial neoplasia. J Natl Cancer Inst, 1997. 89(11): p. 796-802.
48. Tilbrook, D., J. Polsky, and A. Lofters, Are women with psychosis receiving adequate cervical cancer screening? Can Fam Physician, 2010. 56(4): p. 358-63.
49. (Taiwan), D.o.H.R.O.C., Public Health Report of DOH in Taiwan 2010.
50. http://www.health.gov.au/internet/screening/publishing.nsf/content/papsmear.
51. Gasperin, S.I., A.F. Boing, and E. Kupek, [Cervical cancer screening coverage and associated factors in a city in southern Brazil: a population-based study]. Cad Saude Publica, 2011. 27(7): p. 1312-22.
52. Pons-Vigues, M., et al., Preventive control of breast and cervical cancer in immigrant and native women in Spain: the role of country of origin and social class. Int J Health Serv, 2011. 41(3): p. 483-99.
53. Katz, S.J. and T.P. Hofer, Socioeconomic disparities in preventive care persist despite universal coverage. Breast and cervical cancer screening in Ontario and the United States. JAMA, 1994. 272(7): p. 530-4.
54. Finkelstein, M.M., Preventive screening. What factors influence testing? Can Fam Physician, 2002. 48: p. 1494-501.
55. Reyes-Ortiz, C.A. and K.S. Markides, Socioeconomic factors, immigration status, and cancer screening among Mexican American women aged 75 and older. Health Care Women Int, 2010. 31(12): p. 1068-81.
56. Sulkin, N.M. and D.F. Sulkin, Tissue changes induced by marginal vitamin C deficiency. Ann N Y Acad Sci, 1975. 258: p. 317-28.
57. Lai, C.Y. and K. Wada, Phospholipase A2 from human synovial fluid: purification and structural homology to the placental enzyme. Biochem Biophys Res Commun, 1988. 157(2): p. 488-93.
58. Francis, G.S., et al., Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis. Ann Intern Med, 1985. 103(1): p. 1-6.
59. Fish, R.D., et al., Responses of coronary arteries of cardiac transplant patients to acetylcholine. J Clin Invest, 1988. 81(1): p. 21-31.
60. Andresen, O., 5 alpha-androstenone and testosterone in peripheral plasma of the boar during and following copulation. Acta Vet Scand, 1976. 17(4): p. 475-87.
61. Tarnawski, A., et al., Increased expression of epidermal growth factor receptor during gastric ulcer healing in rats. Gastroenterology, 1992. 102(2): p. 695-8.
62. Hall, I.J., et al., Population-based estimates of the prevalence of family history of cancer among women. Community Genet, 2001. 4(3): p. 134-42.
63. Lembke, A. and B. Pause, [Anticaries effectiveness of D(+)-galactose]. Z Stomatol, 1989. 86(4): p. 179-89.
64. Lin, H.C., et al., Urbanization and place of death for the elderly: a 10-year populationbased study. Palliat Med, 2007. 21(8): p. 705-11.
65. Park, S.J. and W.S. Park, Identifying barriers to Papanicolaou smear screening in Korean women: Korean National Health and Nutrition Examination Survey 2005. J Gynecol Oncol, 2010. 21(2): p. 81-6.
66. Fatal Cercopithecine herpesvirus 1 (B virus) infection following a mucocutaneous exposure and interim recommendations for worker protection. MMWR Morb Mortal Wkly Rep, 1998. 47(49): p. 1073-6, 1083.
67. Wu, L.W., et al., Knowledge and attitudes regarding cervical cancer screening among women with physical disabilities living in the community. Res Dev Disabil, 2012. 33(2): p.376-81.
68. Wilkinson, J.E., L. Culpepper, and M. Cerreto, Screening tests for adults with intellectual disabilities. J Am Board Fam Med, 2007. 20(4): p. 399-407.
69. Quint, E.H. and T.E. Elkins, Cervical cytology in women with mental retardation. Obstet Gynecol, 1997. 89(1): p. 123-6.
70. Wilkinson, J.E. and M.C. Cerreto, Primary care for women with intellectual disabilities. J Am Board Fam Med, 2008. 21(3): p. 215-22.
71. Whitlock, E.P., et al., Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med, 2011. 155(10): p. 687-97, W214-5.
72. Nosek, M.A. and C.A. Howland, Breast and cervical cancer screening among women with physical disabilities. Arch Phys Med Rehabil, 1997. 78(12 Suppl 5): p. S39-44.
73. Lin, Y.J., W.H. Tian, and C.C. Chen, Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan. Health Policy, 2011. 103(2-3): p. 236-43.
74. Lin, Y.J., et al., Disease association of the interleukin-18 promoter polymorphisms in Taiwan Chinese systemic lupus erythematosus patients. Genes Immun, 2007. 8(4): p.302-7.
75. Broughton, S. and K. Thomson, Women with learning disabilities: risk behaviours and experiences of the cervical smear test. J Adv Nurs, 2000. 32(4): p. 905-12.
76. Prevatt, B., Gynecological care for women with mental retardation. J Obstet Gynecol Neonatal Nurs, 1998. 27(3): p. 251-6.
77. Messinger-Rapport, B.J. and D.J. Rapport, Primary care for the developmentally disabled adult. J Gen Intern Med, 1997. 12(10): p. 629-36.
78. Jaffe, J.S., Conscious sedation for the performance of gynecologic examination of individuals with intellectual disability. Conn Med, 2005. 69(5): p. 267-9.