本研究之目的為對輪班型態造成女性月經影響之研究。
隨著經濟的發展輪班工作者有著明顯增加的趨勢，現今美國約有730萬輪班工作者，而目前國內也有35.4%的公司實施輪班制度。過去研究指出輪班型態，短期會直接影響睡眠時間、睡眠品質、心理壓力；長期而言易併發心臟血管性疾病（心律不整、呼吸短促）、腸胃道疾病（消化性潰瘍）、三酸甘油酯偏高、sleep-wake現象、生理週期不規則、心理壓力增加、飲食習慣改變及內分泌失調；對於女性輪班工作者更會造成生殖系統的危害，特別是月經異常對婦女的身心健康造成最直接影響。本研究分成二部份進行研究，第一部份針對學生、老師、半導體員工、護士、空服員進行橫斷性問卷調查研究，再依不同輪班型態進行多變項logistic迴歸分析，同時控制年齡、身體質量指數、抽煙、喝酒及壓力等干擾因素。第二部份、以基礎體溫測量及每日日記記錄方式，對自願者學生和空服員進行為期三個月之追蹤性研究。記錄之基礎體溫表由二位生殖內分泌專科醫師進行排卵日之辨讀。依辨讀結果之濾泡期、黃體期、月經、月經週期與壓力、睡眠品質進行線性迴歸分析。
橫斷性研究結果顯示，月經來的天數大於7天者，輪三班者之調整勝算比為不輪班者之2.22倍（95%信賴區間：1.06 ~ 4.46）；月經週期天數小於24天者，不固定班者之調整勝算比為不輪班者之2.53倍（95%信賴區間：1.09 ~ 5.88）；輪班型態中睡眠品質的好壞對月經的影響是一項重要的危險因子。在追蹤性研究中，睡眠品質分數的標準差和濾泡期長短呈負相關；整體壓力分數的平均和月經、濾泡期長短呈正相關；以睡眠品質與整體壓力進行多變相線性迴歸分析結果，濾泡期長度部份，睡眠品質分數標準差的係數為-0.61、標準差2.65、Ｐ值0.02；整體壓力分數的平均數，係數為2.49、標準差1.27、Ｐ值0.05，調整後R2為0.075。輪班型態確實會造成月經的影響，這和睡眠品質的好壞有著重要性的關係；而對於不同輪班型態對月經的影響，輪班型態中換班週期的快慢可能是一項危險因子。

The objective of this study is to investigate the effect of different patterns of shift work on menstrual function. Due to rapid industrialization, there were approximately 7.3 million shift workers in United States and 35.4% workers have carried out shifting work system in Taiwan. Short-term difficulties are associated with sleep disorder, poor sleeping quality, and psychological distress. Long-term effects include the complication of cardiovascular diseases (arrhythmia, and shortness of breath), gastrointestinal diseases (gastrointestinal ulceration), the increase of triglyceride, sleep-wake disorder, irregular menstrual cycles, the increase of psychological disorder, change of eating behavior, and endocrine disorder. There is a potentially reproductive hazard to female shift workers, especially menstrual dysfunction. It will lead to the decrease of fecundability, infertility, osteoporosis, breast cancer, emotional unsteadiness, and the increase of cardiovascular diseases. This study focused on four different patterns of shift work involving flight attendants (oscillating shifts), hospital nurses (three rotating shifts), wafer workers (two fixed shifts), and primary school teachers (permanent day work) and college nursing students. We randomly selected 200 subjects with 20-30 years of age form each group and excluded those with their working years less than 1 year, the history of chronic diseases or gynecological diseases, or the current use of oral contraceptives or intrauterine devices, and dietary restraints and sportswomen. Firstly, we used a questionnaire interview to conduct a cross-sectional study. Secondly, we will conducted a follow-up study for 3 consecutive menstrual cycles using the basal body temperature and diary recording.Multiple logistic regression and linear regression analyses were performed on menstrual function. Women whose work were three rotating shifts had twice of the risk for long menses (more 7 days) compared with women who were permanent day workers (adjusted odds ratio =2.22, 95% confidence intervals 1.06-4.64). Those who were oscillating shift workers had 2.53 of the risk for short cycle length (<24 days)(adjusted odds ratio =2.53, 95% confidence intervals 1.09-5.88). The association was evident that sleep quality was a important factor. In following study, we found that there was negative linear relation between the standard deviations of sleep quality and follicular phase, positive linear relation between the means of total stress ,menses and follicular phase. Shift work was related to an increased risk for menstrual dysfunction. And sleep quality was a important risk factor.

中文摘要1
Abstract2
目錄3
表列6
誌謝8
第一部份：不同輪班型態對月經影響之橫斷性研究9
壹、緒論10
一、前言10
二、研究目的11
三、研究假說11
貳、文獻探討12
一、輪班型態定義12
二、生理規律性12
三、輪班對健康的影響13
1、睡眠障礙13
2、腸胃道不適14
3、心臟血管性疾病14
4、生殖危害15
參、材料與方法21
一、研究設計21
二、研究對象21
三、研究步驟21
四、問卷設計22
五、輪班型態分組22
六、研究對象限制22
七、統計分析23
肆、名詞定義及操作型定義24
伍、結果25
一、各研究組群基本資料比較25
二、各研究組群月經比較26
三、不同輪班方式基本資料描述26
四、各輪班型態人員月經比較27
五、輪班型態相關性比較28
六、月經迴歸性分析比較28
陸、討論34
一、研究限制34
二、健康工人效應34
三、樣本的可比性34
四、職業因素之影響探討35
五、測量問題36
六、輪班型態36
柒、結論與建議38
第二部份：以基礎體溫追蹤測量進行月經異常之危險因子探討60
壹、前言61
貳、材料與方法62
一、研究對象62
二、研究步驟62
三、研究方法62
1、基礎體溫追蹤測量62
2、日記記錄63
四、統計分析63
參、結果64
肆、討論66
伍、結論與建議67
參考文獻74
附錄80

行政院主計處。八十四年臺灣地區人力資源調查統計年報。台北：行政院主計處，1996。
謝光進、刑姍姍。輪班制度與工作績效：員工適應之關係─某工廠之實證研究。1994年人因工程與安全衛生國際研討會，1994;73-78。
陳保中。環境職業性生殖與發展危害。內科學誌 1996;7:69-77。
Harlow SD, Ephross SA. Epidemiology of menstruation and its relevance to women’s health. Epidemiol Rev 1995;17:265-286.
張天鈞。荷爾蒙與疾病（三）。健康世界叢書，台北，1991。
Rutger A. The circadian system of man-Result of experiments under temporal isolation. Springer-Verlag, New York, 1979.
Hastings M.The brain, circadian rhythms and clock genes. Br Med J 1998;317:1704-1707.
Reinberg A, Vieux N, Andlauer P. Night and shift work biological and social aspects. Pergamon Press, New York, 1980.
張家禎、王興耀、劉宏文。輪班制度對工作人員睡眠品質、睡眠時間、心理及家庭之影響。高雄醫誌 1993;9:410-417。
曾珍麗。輪班之護理人員睡覺型紊亂之探討。榮總護理 1995;12:288-304。
Escriba V,Perez S, Bolumar F. Shift work: its impact on the length and quality of sleep among nurses of the valencian region in Spain. Int Arch Occup Environ Health 1992;64:125-29.
黃如瑋。輪班作業人員營養及生理狀況評估研究報告（二）─換班式輪班。台北：行政院勞工委員會勞工安全衛生研究所，1997。
Porkoski J, Iskra-Golec I, Czekaj M, Noworol C. Menstrual rhythm and shiftwork interference: a subjective retrospective study. In: Costa G, Cesana G, Kogi K, Wedderburn A, eds. Shiftwork: Health, Sleep and Performance. Frankfurt, Germany: Verlag PeterLang, 1990;125-130.
黃如瑋。輪班作業人員營養及生理狀況評估研究報告。台北：行政院勞工委員會勞工安全衛生研究所，1996。
Fiedor G, Key M. The assessment factors most nurse forget. RN 1987;52:32-34.
Koller M. Health risks Related to shift work: an example of time-contingent effects of long-term stress. Int Arch Occup Environ Health 1983;53:59-75.
Scott AJ, LaDou J. Shiftwork: effects on sleep and health with recommendations for medical surveillance and screening. Occup Med 1990;5:273-299.
Rosa R, Colligant M. Plain Language About Shift-work. NIOSH, 1997.
Aanonsen A. Medical problems of shift-work. Ind Med Surg 1959;28:422-427.
Lnnernnas M, Akersedt T, Hambraus L. Noctural eating and serum chloesterol of three-shift workers. Scand J Work Environ Health 1994;20:401-406.
Tepas DI:Shiftwork eating and drinking behavior: Myth theory, and reality. Presentation at 1st Ann Conf Shiftwork Management, Chicago, Auguest 3, 1989.
Carandente F, Halberg F. Chronobiology view of shift work and ulcers. Shift work and health. Department of Health, Education, and Welfare, Publication no (NIOSH) 1976;76-203:273-283.
Steenland K. Epidemiology of occupation and coronary heart disease: research agenda. Am J Ind Med 1996;30:495-499.
Tenkanen L, Sjoblom T, Kalimo R, Alikoski T, Harma M. Shift work, occupation and coronary heart disease over 6 years of folow-up in the helsinki Heart study. Scand J Work Environ Health 1997;23:257-65.
Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JE, Speizer FE, Hennekens CH. Prospective study of shift work and risk of coronary heart disease in women. Circulation 1995;92:3178-82.
Knutsson A, Akerstedt T, Jonsson BG, Gomer K. Increased risk fo ischaemic heart disease in shift workers. Lancet 1986;2:89-91.
Knutsson A, Akerstedt T, Jonsson BG. Prevalence of risk factors for coronary artery disease among day and shift workers. Scand J Work Environ Health. 1988;14:317-321.
Romon M, Nuttens MC, Fievet C, Pot P, Bard JM, Furon D, Fruchart JC. Increased triglyceride levels in shift workers. Am J Med 1992;93:259-262.
Knutson, A, Andersson H, Bergund U. Serum lipoproteins in day and shift workers: aprospective study. Br J Ind Med 1994;47:132-134.
Law M, Wald Nj. An ecological study of serum cholesterol and ischaemic heart disease between 1950 and 1990. Eur J Clin Nutr 1994;48:305-325.
黃如瑋。輪班作業人員營養及生理狀況評估研究報告。台北：行政院勞工委員會勞工安全衛生研究所，1996。
陳淑月。某五專學生經期不適之探討。公共衛生 1983;4:451-462。
Hemminki K, Vainio H. Occupational epidemiology and reproduction. In: Harrington jm, ed. Recent advances in occupational health. London: Churchill Livingstone, 1984:117-30.
Lindbohm M-L, Taskinen H, Hemminki k. Reproductive health and working women: spontaneous abortions and congenital malformations. Public Health Rev 1985;13:55-87.
McDonald AD, McDonald JC, Robert D. Prematurity and work in pregnancy. Br J Ind Med 1988;45:56-62.
Mamelle N, Laumon B, Lazar P. Prematurity and occupational activity pregnancy. Am J Epidemiol 1984;119:309-22.
Xu X, Ding M, Li B, Christiani DC. Association of rotating shiftwork with preterm births and low birth weight among never smoking women textile workers in China. Occup Environ Med 1994;51:470-474.
Goulet L, Theriault G. association between spontaneous abortion and ergonomic factors. Scand J work Environ Health 1987;13:399-403.
Infante-Rivard C, David M, Gauthier R, Rivard GE. Pregnancy loss and work schedule during pregnancy. Epidemiology 1993;4:73-75.
Armstrong BG, Nolin AD, McDonald AD. Work in pregnancy and birth for gestation age. Br J Ind Med 1989;46:196-199.
Bisanti L, Olsen J, Basso O, Thonneau P, Karmaus W. Shift work and subfecundity: a European multicenter study. European Study Group on Infertility and Subfecundity. J Occup Environ Med 1996;38:352-358.
Tuntiseranee P, Olsen J, Geater A, Kor-anantakul O. Are long working hours and shiftwork risk factors for subfecundity? A study among couples from southern Thailand. Occup Environ Med 1998;55:99-105.
Joffe M. Biases in research on reproduction and women’s work. Int J Epidemiol 1985;14:118-23.
Messing K, Saurel-Cubizolles MJ, Bourgine M, Kaminski M. Menstrual-cycle characteristics and work conditions of workers in poultry slaughterhouses and canneries. Scand J Work Environ Health 1992;18:302-309.
Harlow S, Matanoski GM. The association between weight, physical activity, and stress and variation in the length of the menstrual cycle. Am J Epidemiol 1999;133:38-49.
Messing K. Occupational health and safety of Canadian women. Ottawa, Canada: Ministry of Labour, 1991. (Catalogue no L016-1748/91E.)
Totterdell P, Spelten E, Pokorski J. The effects of nightwork on psychological changes during the menstrual cycle. J Adv Nurs 1995;21:996-1005.
Tasto D.L., Colligan M.J., Skjei E.W., Polly S.J. Health Consequences of Shiftwork. Cincinnati: US Department of health Education and Welfare, 1978.
Uehata T, Sasakawa N. thefatigue and maternity disturbances of night workwomen. J Human Ergol 1982;11:465-74.
Nurminen T. Shift work, fetal development and course of pregnancy. Scand J Work Environ Health 1989;15:395-403.
Miyauchi F, Nanjo K, Otsuka K. Effects of night shift on plasma concentrations of melatonin, LH, FSH and prolactin, and menstrual irregularity. Sangyo Igaku — Japanese Journal of Industrial Health 1992;34:545-550. [In Japanese; English abstract]
何弘能、陳信孚。月經與內分泌。大眾醫學叢書，台北，1993。
中華民國不孕症暨生殖內分泌醫學會。不孕症及生殖內分泌學。合計圖書出版社，台北，1999。
Kobayashi F, Furui H, Akamatsu Y, Watanabe T, Horibe H. Change in Psychophysiological functions during night shift in nurses inflence of changing from a full-day to a half-day work shift before night duty. Int Arh Occup Environ Health 1997;65:83-89.
林俊宏、李昭男。台灣南部青春期少女月經問題的探討。高雄醫誌 1987;3:150-154。
陳淑月。中部地區五專女生經期不適及其相關因素之探討。公共衛生 1984;3:361-375。
Whelan EA, Sandler DP, McConnaughey DR, et al. Menstrual and reproductive characteristics and age at natural menopause. Am J Epidemiol 1990;131:625-32.
Parazzini F, Bidoli E, Franceschi S, et al.Menopause, menstrual and reproductive history, and bone density in northern Italy. J Epidemiol Community Health 1996;50:519-23.
Henderson BE, Ross Rk, Judd EM. Reproductive factors and breast cancer. Epidemiol Rev 1993;15:36-47.
Whelan EA, Sandler DP, Root JL, et al. Menstrual cycle patterns and risk of breast cancer. Am J Epidemiol 1994;140:1081-90.
Sowers MR, Shapiro B, Gilbraith MA, et al. Health and hormonal chatacteristics of premenopausal women with lower bone mass. Calcif Tissue Int 1990;47:130-5.
Chan DW, Chan TSC. Reliability, validity and the structure of the General Health Questionnaire in a Chinese context. Psychol Med 1983;13:363-371.
Cheng TA, Williams P. The design and development of a screening questionnaire (CHQ) for use in community studies of mental disorders in Taiwan. Psychol Med 1986;16:415-422.
Chong MY, Wilkinson G. Validation of 30- and 12-item versions of the Chinese Health Questionnaire (CHQ) in patients admitted for general health screening. Psychol Med 1989;19:495-505.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for Psychiatric practtice and research. Psychiatry Res 1989;28:193-213.
Norušis MJ/SPSS Inc. SPSSR for Windows: Base system user’s guide, Release 6.0. Chicago, IL: SPSS, Inc., 1993. 828 pp.
Norušis MJ/SPSS Inc. SPSSR for Windows: Advanced Statistics, Release 6.0. Chicago, IL: SPSS, Inc., 1993. 580 pp.
Fenster L, Quale C, Waller K, Windham GC, Elkin E, Benowitz N, Swan S. Caffeine consumption and menstrual function. Am J Epidemiol 1999;149:550-7.
Friedberg W, Faulkner N, Snyder L, Obrien K. Galactic cosmic Radiation exposure and associated health risks for air carrier crewmembers Aviat Space Environ Med 1989;25:1104-08.
Shortridge LA, Lemasters GK, Valanis B, et al. Mwnstrual cycles in nurses handling antineoplastic drugs. Cancer Nurs 1995;18:439-44.
Gold Eb, Eskenazi B, Hammond SK, et al. Prospectively assessed menstrual cycle characteristics in female wafer-fabrication and nonfabrication semiconductor employees. Am J Ind Med 1995;28:799-815.
謝功毅。晶圓製造廠女性員工生殖健康之研究〔碩士論文〕。台北：國立台灣大學公共衛生學院職業醫學與工業衛生研究所，1998。
Bamford CR. Menstual- associated sleep disorder: an unusual hypersomniac variant associated with both menstruation and amenorrhea with a possible link to prolactin and metoclopramide. Sleep 1993;16:484-6.
Schenker MB, Gold EB, Beaumont JJ, et al. Association of spontaneous abortaneous and other reproductive effects with in the semiconductor industry. Am J Ind Med 1995;28:639-59.
陳相志。晶圓製造廠離子植入機台維修保養工作之砷暴露研究[碩士論文]。台北：國立台灣大學公共衛生學院職業醫學與工業衛生研究所，1997。
健康世界編輯部。婦女醫學。健康世界叢書，台北，1993。
陳淑月。中部地區五專女生經期不適及其相關因素之探討。公共衛生 1984;3:361-375。
薛永興。新竹縣某五專女生月經不適與人格型態之調查研究。公共衛生 1986;2:174-185。
周勵志。大專女生月經週期身心症狀調查研究。公共衛生 1994;20:343-351。
Waller K, Swan SH, Windham GC, Fenster L, Elkin EP, Lasley BL. Use of urine biomarkers to evaluate menstrual function in healthy premenopausal women. Am J Epidemiol 1998;147:1071-1080.
Cole RJ, Loving RT, Kripke DF. Psychiatric aspects of shiftwork. Occup Med 1990;5:301-314.