(3.231.29.122) 您好!臺灣時間:2021/02/26 00:40
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:王美仁
研究生(外文):Meei-Ren Wang
論文名稱:影響婦女接受子宮頸抹片檢查因素之探討---以高雄縣阿蓮鄉為例---
論文名稱(外文):Characteristics of the Women Without Receiving Pap Smear
指導教授:汪忠川汪忠川引用關係
指導教授(外文):Chong-Shan Wang
學位類別:碩士
校院名稱:國立成功大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:96
中文關鍵詞:子宮頸癌抹片篩檢篩檢
外文關鍵詞:cervical cancerPap smearremindersdepressive moodfamily violence
相關次數:
  • 被引用被引用:10
  • 點閱點閱:1313
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
子宮頸癌在世界上是常見癌症的第三位,且最具篩檢成效的一種癌症,早期發現病變其治癒率可高達百分之百。我國婦女接受子宮頸抹片篩檢比例偏低,因此探討其相關因素有助於提高篩檢比例。本研究目的在於探討影響婦女子宮頸抹片篩檢行為之因素,並根據89年度阿蓮鄉衛生所統計資料,在阿蓮鄉30歲以上婦女7697人當中,在三年以上未參與抹片篩檢之婦女4121人和三年內曾參與抹片篩檢之婦女1879人中,採系統抽樣法1比3比例,分別抽出1400位和600位婦女,共計2000名,進行電話問卷訪問,問卷回收1669份,回收率83.5%。
在單變項分析,發現乳房自我檢查、接受過醫護人員乳房檢查、每週至少運動三次、固定就醫地點、電視宣導、專業醫護人員邀約、家庭暴力、憂鬱等和抹片篩檢有很強的相關性;多變項分析發現三年以上未參與篩檢的個案中三年當中曾遭受家庭暴力約是三年內參與篩檢個案的2倍(OR=2.07, 95%C.I=1.45-2.95),持續2個星期覺得心情憂鬱則是1.4倍(OR=1.45, 95%C.I=1.02-2.05),其他影響因素經過多變項分析後發現,三年以上未做抹片篩檢之婦女和三年內有做抹片篩檢之婦女相比較,未參與子宮頸抹片篩檢之個案的良好健康行為較少,如乳房自我檢查較少(OR=0.47, 95%C.I=0.35-0.63)、每週至少運動三次習慣較少(OR=0.62,95%C.I=0.46-0.83),而在提醒系統中,三年以上未參與篩檢之婦女接收到較少的電視宣導(OR=0.66, 95%C.I=0.48-0.91)較多的雜誌介紹抹片(OR=1.67, 95%C.I=1.20-2.33)和較少家醫科醫師的邀約(OR=0.23, 95%C.I=0.17-0.31)、婦產科醫師邀約(OR= 0.65,95%C.I=0.43-0.98)。
另外從未參與篩檢者與每年篩檢者相比,多變項分析後發現,家庭暴力是每年皆參與篩檢者之4.9倍(OR=4.94, 95%C.I=2.69-9.08),在憂鬱的部分,從未參與篩檢的個案部分,顯示其持續兩個星期憂鬱的狀況更是每年皆參與篩檢的2.3倍(OR=2.38, 95%C.I=1.30-4.37);其他影響因素中,從未參與篩檢之婦女定期乳房自我檢查較少(OR=0.43, 95%C.I=0.24-0.79),亦接收到較少婦產科醫師(OR=0.21, 95%C.I=0.07-0.62)、家醫科醫師的邀約(OR=0.08, 95%C.I=0.03-0.17)。
從本研究結果發現,婦女參與子宮頸抹片篩檢與憂鬱、家庭暴力、良好健康行為、醫護提醒系統等有顯著的相關性;未來在提高婦女抹片的策略上,可以針對拒絕篩檢之婦女做進一步的諮詢,是否遭受家庭暴力或憂鬱等,並做適當的轉介或治療,其是否有效仍待進一步追蹤研究。我們也可以加強醫護提醒系統的功能,包括健保抹片給付辦法的修正、醫護人員的在職教育等,以增加醫護人員的正向刺激;也可以發現,良好的健康行為常群聚在一起,藉此可以同時檢視其他健康行為,雖然是在進行抹片篩檢的服務,但是卻可以同時發現婦女其他相關的問題,以求達到增進婦女健康的最大目標。
Cervical cancer is one of the most important female cancers in Taiwan. Papnicolaou (Pap) smear is a useful screening test to detect cervical cancer. Pap smear rate in Taiwan is still low compared with that in the developed countries. Our purpose is to investigate the factors that affected women, aged more than 30 years old, without receiving Pap smear for more than three years or never in A-Lein Township in southern Taiwan. The study was performed from July to October 2001.

In this township, 1400 of the 4121 women who had not received Pap smear for more than three years and 600 of the 1879 women who had taken the test within the last three years were chosen using the systematic random sampling method. There were totally 1669 questionnaires completed by telephone interview and the response rate was 83.5%.

In univariate analysis, regular breast self-examination, having received breast clinical examination by medical personnel, regular exercise (≧ 3 times per week), having a fixed clinic for regular visits, and having received Pap smear suggestions from doctors or nurses were highly associated with receiving Pap smear within three years, P<0.05. Moreover, family violence and depressive mood were strongly associated with not taking Pap smear for more than three years, P<0.05.

The result of multiple logistic regression analysis showed that family violence [odds ratio (OR)= 2.07, 95% confidence interval (C.I.)=1.45-2.95] and depressive mood (for more than 2 weeks), [OR= 1.4, 95% C.I.=1.02-2.05] were significantly associated with not receiving Pap smear within three years. Other significant factors associated with not receiving Pap smear for more than three years were breast self-examination [ OR=0.47,95%C.I.=0.35-0.63], regular exercise (≧ 3 times per week) [OR=0.62,95% C.I.=0.46-0.83], having watched Pap smear advertisements on TV [OR=0.66,95% C.I.=0.48-0.91], having read articles about Pap smear [OR=1.67,95% C.I.=1.20-2.33], and suggestions from family doctors[OR=0.23,95% C.I=0.17-0.31] and gynecologists [OR= 0.65,95% C.I.=0.43-0.98].

Between woman who had never receiving Pap smear and took it every year, in multiple logistic regression analysis showed that woman who had never received Pap smear that family violence [odds ratio (OR)= 4.94, 95% confidence interval (C.I.)=2.69-9.08] and depressive mood (for more than 2 weeks), [OR= 2.38, 95% C.I.=1.30-4.37] were also significantly associated with receiving Pap smear every year. Other significant factors associated with never receiving Pap smear were breast self-examination [ OR=0.43, 95%C.I.=0.24-0.79], and suggestions from family doctors[OR=0.08,95% C.I=0.03-0.17] and gynecologists [OR= 0.21,95% C.I.=0.07-0.62].

Conclusions: Except increasing reminders from mass media and physicians, appropriate counseling is needed for those suffering from family violence and depressive mood.
目 錄
第一章 緒論1
第一節 研究背景與動機2
第二節 研究目的5
第三節 論文架構5
第二章 文獻探討 7
第一節 子宮頸癌7
第二節 子宮頸抹片篩檢在台灣8
第三節 子宮頸抹片篩檢計畫現行策略 10
第四節 台灣子宮頸抹片篩檢相關研究 12
第三章 材料與方法 16
第一節 研究假設 16
第二節 研究設計 16
第三節 研究場域介紹 16
第四節 研究材料與方法 19
第五節 資料統計與分析 20
第四章 研究結果 21
第一節 基本人口學特性分析 22
第二節 預防篩檢行為和抹片篩檢之分析 25
第三節 影響婦女接受子宮頸抹片檢查相關因素調查之分析 27
第四節 多變項分析 31
第五節 每年篩檢和從未篩檢個案之特性分析 43
第五章 討論及建議 53
第一節 健康行為和子宮頸抹片篩檢的關係 53
第二節 提醒系統(reminder system) 57
第三節 婦女本身身心狀況和子宮頸抹片篩檢行為的關係--憂鬱情緒62
第四節 婦女本身身心狀況和子宮頸抹片篩檢行為的關係--家庭暴力66
第五節 子宮頸抹片篩檢政策 69
第六節 總結 71
第六章 研究限制 73
第七章 參考資料 74
附錄
附錄一 問卷85
附錄二 癌症登記年報87
附錄三 全民健康保險子宮頸癌醫療給付改善方案試辦計畫89
附錄四 總體經濟指標95
附錄五 全民健康保險子宮頸抹片檢查申報案件96
表目錄
表3-1 88年阿蓮鄉人口結構分析表 17
表3-2 阿蓮鄉地區30歲以上婦女篩檢狀況 18
表4-1 基本人口學特徵 22
表4-2 健康行為之單變項分析25
表4-3 影響婦女接受子宮頸抹片篩檢行為因素之單變項分析27
表4-4健康行為和抹片篩檢關係之多變項分析 31
表4-5 健康行為和抹片篩檢關係之多變項分析(age<65) 32
表4-6 健康行為和抹片篩檢關係之多變項分析(age<50)33
表4-7 提醒系統─物和抹片篩檢關係之多變項分析 34
表4-8 提醒系統─物和抹片篩檢關係之多變項分析(age<50) 35
表4-9 提醒系統─人和抹片篩檢關係之多變項分析 36
表4-10提醒系統─人和抹片篩檢關係之多變項分析(age<65) 37
表4-11提醒系統─人和抹片篩檢關係之多變項分析(age<50) 38
表4-12 內在變項和抹片篩檢關係之多變項分析39
表4-13 內在變項和抹片篩檢關係之多變項分析(age<65)40
表4-14 內在變項和抹片篩檢關係之多變項分析(age<50)41
表4-15 綜合分析42
表4-16 從未參與V.S每年參與篩檢婦女之基本人口學特性43
表4-17 從未參與V.S每年參與篩檢婦女之健康行為之單變項分析46
表4-18 影響從未參與V.S每年參與篩檢婦女篩檢行為因素之單變項分析48
表4-19 從未參與V.S每年參與篩檢婦女之多變項分析51
圖目錄
圖 1-1研究設計流程6
圖5-1各分組間之憂鬱情形─長條圖65
圖5-2各分組間憂鬱情形─折線圖65
圖 5-3各分組間之家庭暴力情形─長條圖68
圖5-4 各分組間之家庭暴力比例68
1. 行政院衛生署,2001年健康促見年全國保健會議會議記錄,2001。.2. 行政院衛生署:臺灣地區主要癌症申報發生統計,1991-1996。3. 行政院衛生署:臺灣地區歷年女性主要死亡原因,2000。4. 許維邦:抹片和子宮頸癌。基層醫學1998,13(2):34-36。5. 邱燕坤:子宮頸癌的病因與預防。臺灣醫界1997;40(4):25-28。6. 王鵬惠、趙灌中、顏明賢:子宮頸癌的篩檢。中華民國婦癌醫學雜誌1998;10:11-14。7. Schenck U,von Karsa L. Cervical cancer screening in Germany. European Journal of Cancer 2000;36:2221-2226.8. Marrazzo JM, Koutsky A.Papanicolaou Test Screening and Prevalence of Genital Human Papillomavirus Among Women Who Have Sex With Women. American Journal of Public Health2001;91:947-53.9. http://www.moi.gov.tw/,內政部。10. 行政院衛生署:婦女子宮頸抹片篩檢成果,1999。11. http://www.doh.gov.tw/,行政院衛生署。12. 行政院衛生署:國民保健三年計畫,民88年-90年。13. Haverkos H. The cause of invasive cervical cancer could be multifactoral. Biomed &Pharmacother 2000; 54:54-914. Harvard’s Center for Cancer Prevention,2000。15. Maria E, Lynne.G. Cervical cancer screening in developing countries. Primary Care Update for OB/GYNS2000;7:118-123.16. 阿蓮鄉衛生所:高雄縣阿蓮鄉衛生所統計資料:1995。17.StephenA, Jonathan M. Cancer of the Uterine Cervix. Cancer 1996 ; 334:1030-1037.18.賴明芸、周碧瑟:各國子宮頸癌篩檢計畫之初探。公共衛生1993;19(4):384-393。19. Rengaswamy S, Atul M. Effective screening programs for cervical cancer in low-and middle-income developing countries. Bulletin of the World Health Organization 2001;79:954-962.20. http://www.cdc.gov,美國疾病管制局。21.周碧瑟:影響台灣婦女接受子宮頸抹片檢查之因素。生命科學簡訓2000;14(6):10-15。22.季瑋珠:台北市有偶婦女接受子宮頸抹片檢查影響因素之探討。中華衛誌1995;14(2):111-128。22. 陳建仁:台灣地區性子宮頸癌早期篩檢之研究。台灣醫誌1995;94(2),103-111。24.賴明芸、周碧瑟:子宮頸癌篩檢的成效評估:病例對照研究。中華醫誌1992;49:81-5。25.曾炳憲、劉裕森、蔡韻青:台北市立忠孝醫院婦產科門診子宮頸抹片篩檢三年之研究初步報告。台灣醫界1993;39(5):38-40。26.陳怡如、陳淑卿、林上清:社區設站子宮頸抹片檢查之成本及利用情形分析。中華家醫誌1999;9(3):150-158。27. 陳錫中、周碧瑟:台灣鄉村婦女對「子宮頸防癌抹片檢查」的認知及參與之調查研究。中華衛誌1995;14(6):494-501。28.李翠鳳、郭旭崧、周碧瑟:金門縣婦女子宮頸防癌抹片檢查的影響因素。中華衛誌1997;16(3):198-209。29.周碧瑟:台灣地區一般婦女對於防癌宣傳的反應與態度之研究。公共衛生1982;9(2):147-162。30.周碧瑟:台灣地區農村婦女對子宮頸防癌抹片檢查認知與接受之分析研究。中華醫誌1983;31(4):302-311。31.謝長堯、嚴孟祿:最常見的婦科腫瘤,台北中正書局,1993。32.聶鑫:子宮頸癌變之探討。國防醫學1996;23(2):116-118。33.吳香達:臨床婦科學,茂昌圖書有限公司,1998:305-367。34. Anna B, Jonas H. Prevalence of and risks for cervical human papillomavirus infection and squamous intraepithelial lesions in adolescent girls.Arch Pediatr adolesc Med 2000;154:127-134.35. Schiffman MH, Brinton LA. The epidemiology of cervical carcinogenesis. Cancer1995;76:1888-901.36. ranco EL. Epidemiology of uterine cancers. American Society of Clinical Pathologists1997;40:301-24. 37.Graham S, Priore R, Graham M, et al. Genital cancer in wives of penile cancer patients. Cancer1979;44:1870-4. 38.Li JY, Li FP, Blot WJ,et al. Correlation between cancers of the uterine cervix and penis in China. J Natl Cancer Inst 1982;69:1063-5. 39.Franco EL, Campos-Filho N, Villa LL,et al. Correlation patterns of cancer relative frequencies with some socioeconomic and demographic indicators in Brazil: an ecologic study. Int J Cancer 1988;41:24-9. 40.Xavier C, Xavier F. Nubia M,Male Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer in Female Partners.New England Journal of Medicine2002;346:1105-1112.41. Winkelstein W. Smoking and cervical cancer: current status a review. Am J Epidemiol 1990;131:945-57. 42.Schiffman MH, Haley NJ, Felton JS, et al. Biochemical epidemiology of cervical neoplasia: measuring cigarette smoke constituents in the cervix. Cancer Res 1987;47:3886-8. 43. Herrero R, Potischman N, Brinton LA,et al. A case-control study of nutrient status and invasive cervical cancer. Dietary indicators. Am J Epidemiol 1991;134:1335-46. 44. Verreault R, Chu J, Mandelson M,et al. A case-control study of diet and invasive cervical cancer. Int J Cancer 1989;43:1050-4.45.Brock KE, Berry G, Mock PA,et al. Nutrients in diet and plasma and risk of in situ cervical cancer. J Natl Cancer Inst 1988;80:580-5.46.Beral V. Cancer of the cervix:a sexually transmitted infection.Lancet1974;25:103747 Canavan TP, Doshi NR. Cervical Cancer. American Family Physician2000; 61:1369-377.48. Sadovsky R.Identification of barriers to cervical cancer screening. American Family Physician1997;56:579-581.49. George AV. Dr. George Papanicolaou and the birth of the pap test. Obstetrical and Gynecological1999;54:481-83. 50.王佩芬:重新說故事--子宮頸抹片檢查。國立清華大學社會學研究所碩士論文,2001。51.周碧瑟:台灣地區農村婦女對子宮頸防癌抹片檢查的消息來源之探討。中華醫誌1983;31(6):446-456。 52.葉季森、周碧瑟:以健康信念模式分析桃園縣婦女的抹片檢查行為。衛生教育1987;8:58-77。53. Hewitt M, Devesa SB. Papanicolaou test use among reproductive-age women at high risk for cervical cancer: analyses of the 1995 national survey of family growth.American Journal of Public Health 2002;92:666-7054. Brownson RC, Remington PL, Davis JR. Chronic Disease Epidemiology And Control. American Public Health Association.199855. Smith RA, Cokkinides V, Levin B,et al.American Cancer Society guidelines for the early detection of cancer. Cancer Journal for Clinicians2002.52:8-22.56. Hallen M, Vuylsteek K. Epidemiology. Amsterdam :IOS Press,1994.57. .胡幼慧:社會流行病學,台北,巨流圖書公司,1993。58. Berkman LF, Kawachi I. Social Epiedmiology. Oxford, 2000. 59. .黃月桂,葉明義,林勤豐:全民健康保險子宮頸抹片檢查之利用度研究。中華衛誌1998;17(1):28-35。60. Liberators P, Link B, Kelsey JL. The Measurement of Social Class in Epidemiology. Epidemiologic reviews1988;10:87-121.61. Stronegger W, Freidl W, Rásky É. Health behaviour and risk behaviour: socioeconomic differences in an Austrian rural county. Social Science & Medicine1997;44:423-426. 62. Kogevinas M, Pearce N. Social Inequalities and cancer. International agency for Research on cancer,1997.63. Levine A, Walsh T. Society and Health. Oxford, New York,1995. 64.Denise MO. Pidemiology and the Delivery of Health Care Services. Plenum New York and London,1995. 65. Hall K.L. Meyer G.C., Epidemiology, Behavior Change and Intervention in Chronic Disease. Human kinetics publishers, inc. 1988.66. Hall HI, Uhler RJ, Coughlin SS, et al. Breast and cervical cancer screening among Appalachian. Cancer Epidemiology, Biomarkers & Prevention2002; 11:137-42.67. 王秀紅: 婦女健康促進行為及其相關因素的探討--以高雄市三民區及屏東縣高樹鄉居民為例。公共衛生1992;19(3):251-266。68. Hibbard JH, Pope CR. Women’s role, interest in health behavior. Women & Health1987;12:67-84.69. Hahn. The Delivery of Clinical Preventive Services: Acute Care Intervention. J Fam Pract1999;48:785-789.70. Peter G. Effect of Patient Reminder/Recall Interventions on Immunization Rates: A Review. JAMA 2000;284:1820-27.71. 楊南屏、周碧瑟:國小老師對癌症的知識、態度與行為。中華衛誌1991;47(4):270-79。72. Vicki F. Mass media strategies and channels: A review of the use of media in breast and cervical cancers. Wellness Perspectives1995;11:79-106.73. TimothyJ. Medicine and the Media. The new England journal of medicine1998;339:87-92. 74. Black ME. What did popular women''s magazines from 1929 to 1949 say about breastcancer. Cancer Nursing1995;18:270-277.75. Leask J, Chapman S. ''The cold hard facts'' immunisation and vaccine preventable diseases in Australia''s newsprint media 1993-1998. Social Science & Medicine2002; 54:445-57.76. 民生報,91年5.15 資訊科技版。77. James M, Stephanie A. The Impact of Referral to Primary Physician on Cervical Cancer Screening. American Journal of Public Health2001;91:451-455.78. Joan A. Screening for cervical cancer. BMJ 1994,309;241-8.79. 胡幼慧:性別、社會角色與憂鬱症狀。婦女與兩性學刊1991;2:1-18。80. Berry JM, Storandt M. Age and sex difference in somatic complaints associated with depression. Journal of gerontology1984; 39:465-467.81. Clancy K, Gove W.Sex difference in mental illness:a analysis of response bias in self reports. American journal of sociology1974; 80:395-407.82. 郭志通:憂鬱症之診斷標準與協助治療策略。諮商與輔導2001;181:14-18。83. Chirs S. Social skills deficits associated with depression. Clinical psychology review 2000; 20:379-403.84. Kadam UT, Croft P, Lewis M. Use of a cross-sectional survey to estimate outcome of health care: the example of anxiety and depression. Journal of Clinical Epidemiology2001; 54:1112-9.85. Skrabanek P. Cervical cancer in nuns and prostitutes: a plea for scientific continence. J clin Epidemiol 1988;41:577.86. Garcia MC. Dilemmas and opportunities for an appropriate health-service response to violence against women. Lancet2002;359:1509-1515.87.Jewkes R. Intimate partner violence: causes and prevention. Lancet 2002;359:1423-430.88. Branett OW.Why battered women do not leave,part1. Trauma violence,&abuse2000;1:343-372.89.葉肅科:家庭暴力理論觀點與防治策略。社區發展季刊2001;94:289-305。90.周稚傑:家庭暴力。臺北市醫師公會會刊2000;44:39-42。91.Riggs DS,Caulfield MB, Street AE. Risk for domestic violence: factorsassociated with perpetration and victimization. Journal of Clinical Psychology2000;56:1289-1316.92.胡美齡:婚姻暴力家庭互動狀況之探討。輔導季刊2000;36(3):37-42。93.葉肅科:家庭暴力理論觀點與防治策略。社區發展季刊2000;94:289-305。94. Brokaw J, Fullerton GL, Olson L. Health status and intimate partner violence: a cross-sectional study. Annals of Emergency Medicine2002; 39:31-8.95. Jewkes R, Penn K L, Levin J. Risk factors for domestic violence: findings from a South African cross-sectional study. Soc Sci Med 96..Martin SL, Tsui AO, Maitra K, et al. Domestic violence in Northern India. Am J Epidemiol1999;150:417-26.97. Syrjanen KV, Kataji V, Vyliskoski M, et al. Natural history of cervical human papillomavirus lesions does not substantiate the biologic relevance of the Bethesda system. Obstet Gynecol1992;79:675-82.98. David EN, Shayne B, Eve PGr, et al. State Trends in Health Risk Factors and Receipt of Clinical Preventive Services Among US Adults During the 1990s. JAMA 2002; 287:2659-2667.99. Hirschfeld MA, KellerMB, Panico S. et al. The National Depressive and Manic-Depressive Association Consensus Statement on the Undertreatment of Depression. JAMA1997; 277:333-340.100.John W, Cynthia DW, KurtK. Case-Finding for Depression in Primary Care: A Randomized Trial.The american journal of medicine 1999; 106:36-43 .101. Elliott L, Nerney MJ. Barriers to screening for domestic violence. J Gen Intern Med2002. 17:112-6.102.World Health Organization, The World Health Report 2001.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊
 
系統版面圖檔 系統版面圖檔