臺灣博碩士論文加值系統

目的：本研究旨於調查台灣地區長期住院慢性精神病患之高血壓盛行率及BMI≧24kg/m2體重過重盛行率，並進一步分析長期住院慢性精神病患的生活型態 (包含飲食、吸菸、運動)、BMI值及其血壓值三者間之相關性。方法：採橫斷性研究法，以東台灣某精神專科醫院住院慢性精神病患為研究對象，有效樣本數計1,086人。資料經由病歷檔案分析、問卷訪查、血壓、身高及體重測量等方法蒐集個案的社會人口學變項、疾病史與服用藥物、飲食、吸菸、運動、BMI值及血壓值。結果： 壹、研究對象高血壓盛行率為35.1%；血壓偏高盛行率為20%。 貮、研究對象 BMI≧24kg/m2之盛行率為66%。 參、以t-test及ANOVA分析研究對象血壓值在不同性別、年齡別、族群別、病房類別、社會功能、發病年數、是否服用降血壓藥物、正餐飲食別、非正餐飲料種類、吸菸經驗、吸菸年數、吸菸量等變項達顯著差異，但在不同的運動行為變項的表現上，則皆未達顯著差異。 肆、以pearson相關分析研究對象的收縮壓值與非正餐飲食量及非正餐飲料量呈負相關，與吸菸年數及BMI值呈正相關；而舒張壓值與非正餐飲食量呈負相關，與BMI值呈正相關。 伍、卡方分析研究對象之BMI是否≧24kg/m2在族群別、正餐飲食別、運動時間及運動強度等變項達顯著相關。 陸、邏輯迴歸分析發現正餐飲食別、正餐飲食量、運動頻率、運動時間及運動強度為BMI≧24kg/m2體重過重之顯著預測因子。 柒、多元迴歸分析控制住院慢性精神病患社會人口學變項、疾病史及用藥情形下，吸菸量、BMI值等變項為收縮壓之顯著預測因子；BMI值亦為舒張壓之顯著預測因子。結論：本研究結果顯示長期住院慢性精神病患的高血壓盛行率、血壓偏高盛行率及BMI≧24kg/m2體重過重盛行率皆較台灣一般民眾為高。研究對象的生活型態及其BMI值與血壓值顯著相關，此研究發現得以建議未來研究可進一步驗證影響住院慢性精神病患BMI值及血壓值之健康生活型態。

Objective: This study investigated the prevalence of hypertension and overweight, defined as BMI≧24kg/m2, and their associated life styles in chronic mentally ill inpatients. Methods: This cross-sectional study included 1,086 inpatients in a psychiatric hospital in eastern Taiwan. Data were collected from medical records, questionnaire, and measurement of participants’ blood pressure, height and weight. Social demographic data, disease history, use of atypical anti-psychotics, diet, smoking, regular exercise, BMI and BP were analyzed. Results: 1. The hypertension and high normal blood pressure prevalence rates were 35.1% and 20% respectively. 2. The prevalence rate of overweight was 66%. 3. The variables of sex, age, race, ward category, social function, disease history, use of medication to reduce blood pressure, diet category, beverage category, smoking behavior, length of smoking history, and smoking frequency were significantly different among patients with hypertension, high normal blood pressure, and optimal blood pressure. 4. The intake of food quantity and the beverage category beyond regular food and drinks supplied by the hospital were negatively associated with Systolic Blood Pressure (SBP). The length of smoking history and BMI were positively associated with SBP. The intake of food quantity beyond the regular food supplied by the hospital was negatively associated with Diastolic Blood Pressure (DBP). The variable of BMI was positive associated with DBP. 5. The variables of races, diet category, exercise duration, and exercise intensity were significantly associated with Patients’ BMI. 6. The significant predictors of the BMI≧24kg/m2 by logistic regression were diet category, diet quantity, exercise frequency, exercise duration, and exercise intensity. 7. The smoking quantity and BMI were significant predictors of SBP when the variables of social demographic variables, disease history, and the use of medication were under control. In the same statistic analysis model, this study showed that BMI was a significant predictor of DBP. Conclusion: This study showed that the prevalence of hypertension, high normal blood pressure and overweight in chronic mentally ill inpatients were much higher than in the general population in Taiwan. The life styles of study participants were significantly associated with their BMI and blood pressure. The findings of this study suggest the necessity of further researches to identify the impacts of healthy life style on the BMI and blood pressure in chronic mentally ill inpatients.

誌謝﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ Ⅰ
中文摘要﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ Ⅱ
英文摘要﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ Ⅲ
目錄﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ Ⅴ
表目錄﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ Ⅷ

第一章　緒論
第一節　研究動機與重要性﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 1
第二節　研究目的﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 4
第三節 研究假設﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 5
第四節 名詞釋義﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 6
第五節 研究範圍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 8

第二章　文獻探討
第一節　精神病患者心血管疾病死亡率探討﹍﹍﹍﹍﹍﹍ 9
第二節 心血管危險因子探討﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 13
第三節　精神病患生活型態、服用藥物、與體重及血壓相
關性探討﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 15
第四節　高血壓之定義與預防﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 23
第五節　高血壓盛行率之探討﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 26


第三章　研究材料及方法
第一節　研究設計﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 30
第二節　研究對象﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 31
第三節　研究架構及研究流程﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 33
第四節　研究變項之操作型定義﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 35
第五節　研究工具﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 41
第六節 資料收集與品質控制﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 44
第七節 資料處理與分析方法﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 49

第四章　研究結果
第一節　問卷回收情形﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 52
第二節　研究對象背景資料分佈情形﹍﹍﹍﹍﹍﹍﹍﹍﹍ 54
第三節　研究對象生活型態、BMI值及血壓值之分佈情形.. 55
第四節　研究對象血壓偏高及高血壓盛行率﹍﹍﹍﹍﹍﹍ 57
第五節 研究對象血壓值分別在不同背景資料間之差異性
分析﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 58
第六節 研究對象血壓值分別在不同生活型態間之差異性
分析﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 60
第七節 研究對象背景資料及其血壓值之相關分析﹍﹍﹍ 62
第八節 研究對象生活型態及BMI值與其血壓值之相關分
析﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 63
第九節 研究對象社會人口學、疾病史、服藥情形、飲食、
運動行為與BMI值之關聯 ﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 64

第十節 控制研究對象社會人口學及服藥情形下，飲食、
運動行為對BMI值之邏輯迴歸分析﹍﹍﹍﹍﹍﹍﹍﹍﹍ 67
第十一節 控制研究對象人口學、疾病史、服藥情形下，飲食
、吸菸行為、運動行為與血壓值之多元迴歸分析﹍ 68

第五章　討論
第一節　樣本代表性及資料可信度﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 71
第二節　高血壓及血壓偏高盛行率之討論﹍﹍﹍﹍﹍﹍﹍ 72
第三節　研究對象背景資料、生活型態及BMI值各變項分
佈情形之討論﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 73
第四節　研究假設之驗證﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 75

第六章　結論、限制與建議
第一節　結論﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 83
第二節　研究限制與建議﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 86
第三節　臨床意涵﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 87

參考文獻
中文部份﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 121
英文部份﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍ 123

附錄
附錄一　參與研究工具效度審查學者專家芳名錄﹍﹍﹍﹍ 135

中文文獻
丁予安、韓志陸（民79）。吸菸與高血壓。國防醫學院，10，103-107。
行政院衛生署國民健康局（民93），國際衛生統計，摘自2004年7月26日行政院衛生署：http：//www.doh.gov.tw/statistic/data/衛生統計重要指標/9.xls。
行政院衛生署（民89）。中老年慢性病防治計劃：國民營養健康狀況變遷調查。台北市：行政院衛生署。
行政院衛生署（民91）。台灣地區居民體位及肥胖狀況：成人過重及肥胖盛行率 (以身體質量指數為標準)依性別、年齡別之比較。台北市：行政院衛生署。
行政院衛生署（民91）。台灣地區15歲以上國人高血壓盛行率調查。行政院衛生署：http://www.doh.gov.tw/cht/index.aspx。
行政院衛生署（民94）。台灣地區2010年衛生指標白皮書。台北市：行政院衛生署，49-51。
吳統雄（民74）。態度與行為研究的信度與效度：理論、應用、反省。民意學術專刊，29-53。
邱千芳（民77）。社區性高血壓流行病學的探討－埔里研究。國立陽明大學公共衛生研究所碩士論文，未出版，台北市。
邱怡玟、黃璉華（民84）。台北市安康社區低收入戶中老年人生活型態與罹患高血壓關係之探討。護理研究，3(4)，343-350。
邱春旺（民89）。認識高血壓。高雄醫師會誌 27(1)，21-22.
洪建德（民83）。台北市士林北投區兒童及青少年飲食習慣、高膽固醇血症及膳食營養狀況。中華民國營養學會雜誌，19(2)，201-220。
孫文榮（民83）。高雄縣湖內鄉社區性高血壓流行病學研究。國立陽明大學公共衛生學研究所碩士論文，未出版，台北市。
徐毓秀（民84）。台灣地區45-64歲民眾飲食行為與心血管疾病生理指標之相關研究，國立臺灣大學公共衛生學系碩士論文，未出版，台北市。
張薰文、宋鴻樟（民87）。活動量與血脂、血壓的相關探－金山居民的研究。國立台灣大學公共衛生學院環境衛生研究所碩士論文，未出版，台北市。

陳宗林、賴世偉、林文元、劉秋松、陳維恭（民92）。健檢民眾體位之描述性分析:以某醫學中心為例。 中台灣醫誌，8(2)，114-119。
陳艷菁（民78）。竹東及朴子地區居民血壓相關因子之流行病學研究。國立台灣大學公共衛生研究所碩士論文，未出版，台北市。
曾春典、曾淵如、江福田、許寬立、廖朝崧、李悌愷（民84）。台灣地區65歲以上老年人高血壓的研究。慈濟醫學，7(3)，179-184。
曾淵如、謝博生、許寬立、陳永銘（民82）台灣的高血壓，臺灣醫誌，92(附冊1)，13-18。
黃金安（民88）。健保門診篩檢高血壓之成本效果分析─以預防腦中風為例。中國醫藥學院醫務管理研究所碩士論文，未出版，台中市
楊若梅（民92）。精神分裂症住院病患吸菸行為之相關因素探討。高雄醫學大學行為科學研究所碩士論文，未出版。
葛應欽（民72）。台灣地區中國人之高血壓流行病究。高雄醫學大學醫學研究所
博士論文，未出版，高雄市
葛應欽（民83）。台灣地區原住民的健康問題。高雄醫師會誌，10(7)，337-351。
董道興（民84）。埔里地區糖尿病與高血壓流行病學研究：世代研究與橫斷研究之比較。國立陽明大學公共衛生學研究所碩士論文，未出版，台北市。
潘怜燕（民80），與血壓偏高相關之健康行為研究，國立台灣大學醫學院公共衛生研究所碩士論文。未出版，台北市。
潘碧珍（民72）。台灣六個地區居民之心臟血管疾病與糖尿病調查及高血壓相關因子之分析。國立台灣大學公共衛生研究所碩士論文，未出版，台北市。
羅俊欽（民87）。運動對高血壓的影響。中華體育，12(2)，61-68。


英文文獻
Anderson, J., & Kessenich, C. (2002). Women and coronary heart disease. The Nurse Practitioner, 26(8), 12-30.
Allison, D.B, Mentore, J,L, Heo, M.(1999). Antipsychotic-induced weigh gain: a comprehensive research synthesis. Am J Psychiatry, 156, 1686-1696.
Anderson, J., & Kessenich, C. (2002). Women and coronary heart disease. The Nurse Practitioner, 26(8), 12-30.
Armstorng, B., Martin, C., Ward, W., Norman, N., & Masarei, J. (1979).Urinary sodium and blood pressure in vegetarians. Am J Clin. Nutr, 32, 2472-2476.
Aromaa, A ., Raitasalo, R., Reunanen, A., Impieaara, O ., Heliövaara, M., Knekt, P., Lehtinen, V. , J oukamaa, M., & Maatela, J ., (1994). Depression and cardiovascular diseases. Acta Psychiatr Scand, 89 (suppl 377), 77-82.
Beebe, L.H. (2006). Discribing the health parameters of outpatients with schizophrenia. Applied Nursing Research,19, 43-47.
Bentante, R., Reed, D.& Frank, J.(1992). Do coronary heart disease risk factor measure in the elderly have the same predictive role as in the middle aged: Comparison of relative and attributable risk. Annual Journal of Epidemiology, 2(3), 273-282.
Beratis, S., Katrivanou, A., & Gourzis, P. (2001). Factors affecting smoking in schizophrenia. Compr Psych, 42(5), 393-402.
Berkey ,C,S., Rockett, H.R.H., Gillman, M.W., and Colditz , G .A (2003) One-Year changes in activity and in inactivity among 10 to 15-Year-Old boys and girls：relationship to change in body mass index. Pediatrics, 111(4), 836-843.
Bernstein, M.A., Tucker, K.L., Ryan, N.D., O'Neill, E.F., Clements, K.M., Nelson, M.E., Evans, W.J., & Fiatarone Singh, M.A.(2002). Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc, 102, 1096-1104.
Blair, S. N., Ellsworth, N. M., Haskell, W. L., Stern , M. P., Farquhar, J.W., Wood, P. D., (1981). Comparison of nutrient intake in middle –aged men and women runners and controls. Med Sci Sports Exerc, 113, 310-315.

Boaz, D. R., Mohammed, F.S., Steven, S., Khurram, N., Thor, E., Gregory, B., Michael, J.H., Donna, K.A., Shenghan, L.,David, A.B., & João, A.C.L(2006). Hypertension and Smoking Are Associated With Reduced Regional Left Ventricular Function in Asymptomatic Individuals,The Multi-Ethnic Study of Atherosclerosis. Journal of the American College of Cardiology, 47(6):1150-1158.
Bonnet, F., Irving. K., Terra, J.L., Nony, P., Berthezene, F., & Moulin, P.(2005). Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis, 178, 339-344.
Braunwald, E. (1997). Heart Disease: A textbook of cardiovascular medicine (5 th ed). USA: Saunders company.
Bridler,R.,& Umbricht, D.(2003).Atypical antipsychotics in the treatment of schizophrenia. Swiss med wkly,133,63-76.
Brown, S., Birtwistle, J., Roe, L., & Thompson, C.,(1999) The unhealthy lifestyle of people with schizophrenia. Psychol Med. 29(3), 697–701.
Bryman, A., & Cramer, D.(1995). Quantitative data analysis for social scientists (2nd ed.). London: Routledge.
Burt, V. L., Whelton, P., Roccella, E. J., Brown, C., Culter, J.A., Higgins, M., Horan, M. J., & Labarthe, D. (1995). Prevalence of hypertension in the US adult population: Results from the third national health and nutrition survey, 1988-1991. Hypertension, 25, 305-313.
Carney, R.M., Freedland, K.E., Miller, G.E., Jaffe, A.S.(2002). Depression is a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J. Psychosom Res, 53, 897-902.
Carson, J.L., Ruddy, M.E., & Duff,A.E.(1994) .The effect of gastric surgery on ypertension in morbidly obese patients. Archives of Internal Medicine, 154(2), 193-200.
Centorrino, F., Baldessarini, R.J., Kando, J.C., Frankenburg, F.R., Volpicelli, S.A., Flood, J.G.(1994). Concentrations in serum and clinical findings during treatment of chronically psychotic patients. J Clin Psychopharmacology, 14(2), 119-125.


Chaine, G., Cormier, L., Moutillet, M., Norean, L., Norean, L., & Landry, F.(1989). Body mass index as a discriminate function among heal health related variables and risk factors. Journal of Sports Medicine and Physical Fitness, 29(3). 253-261。
Chamacho, T.C., Robert, R.E., Lazarus, N.B., Kaplan, G .A., Cohen, R.D.(1991). Physical activity and depression: evidence from the Alameda County Study. Am J Epidemiol, 134, 220-231.
Chamove, A. S. (1986). Positive short-term effect of activity on behavior in chronic schizophrenic patients. British Journal of Clinical Psychology, 25, 125-133.
Chang,F.T., Chang, S.J., Wu, Y.Y., Wang, T.N., & Ko, Y.C.(1995). Body mass index and hyperuricemia differences between aboriginal and non-aboriginal children in Taiwan. Kaohsiung J Med Sci , 11, 315-321.
Chen,W.J., Huang, Y.J., Yeh,L.L, Rin.H., & Hwu,H.G..(1996). Excess mortality of psychiatric inpatient in Taiwan. Rsychiatry Reserch, 62, 239-250.
Chobanian ,A.V., Bakris, G .L., Black, H.R. et al., (2003). The seventh report of the joint National Commottee on prevention, detection, evaluation and treatment of high blood pressure. JAMA, 289, 2560-2572.
Cohn, T., Prud’homme, D., Streiner, D., Kameh, H., Remington, G..( 2004). Characterizing coronary heart disease risk in chronic schizophrenia: high prevalence of the metabolic syndrome. Can. J. Psychiatry, 49, 753 – 760.
Collazo-Clavell, M. L.(1999).Safe and effective management of the obese patient. Mayo Clinic Proceedings, 74(12), 1255-1259.
Coodin, S.(2001). Body Mass Index in Persons with Schizophrenia. Can J Psychiatry, 46, 549-555.
Cook, N.R. (1995). Implications of small reductions in diastolic blood pressure for primary prevention. Archives of Internal Medicine, 155, 701-709.
Cormac,I.,Martin, D., & Ferriter, M.(2004).Improving the physical health of long-stay psychiatric in-patients. Advance in Psychiatric Treatment, 10, 107-115.
Davidson, K., Jonas, B.S., Dixon, K.E., & Markowitz, J.H.( 2000). Do depression symptoms predict early hypertension incidence in young adults in the CARDIA Study? Coronary artery risk development in young adults. Arch Intern Med, 160, 1495-1500.
Dawber, T. R., Knnel, W.B., & Kagan, A.(1967). Environment factors in hypertension. In Stamler, J., Stamler, R. ＆ T.N. Pullman, (Eds). The Epidemiology of Hypertension. Grune & Stratton, 255-587.
DeLeon, J., Dadvand, M., Canuso, C., White, A.O., Stanilla, J. K., & Simpson, G.. M. (1995). Schizophrenia and Smoking: An Epidemiological survey in a state Hospital. Am J Psychiatry, 152(3), 453-455.
DeLeon, J., Diaz, F.J., Rogers, T., Browne, D., & Dinsmore, L.,(2002a) Initiation of daily smoking and nicotine dependence in schizophrenia and mood disorders. Schizophr Res, 56, 47–54.
DeLeon, J., Tracy, J., McCAnn, E., McGrory, A., & Diaz,F.J.(2002b) Schizophrenia and tobacco smoking: a replication study in another US psychiatric hospital. Schizophr Res, 56, 55–65.
Dennison, B. A., Rockwell, H. L., & Baker, S. L. (1997). Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity. Pediatrics, 99(1), 15-22.
Diwan,A., Castine, M., Pomerleau,C.S., Meador-Woodruff, J.H., & Dalack, G..W.(1998). Differential prevalence of cigarette smoking in patients with schizophrenic vs mood disorders. Schizophr Res, 33, 113–118.
Dixon, L., Postrado,L., Delahanty, J.,Fischer, P., Lehman, A.(1999). The association of medical comorbidity in schizophrenia with poor physical and mental health. J Nerv Ment Dis, 187, 496-502.
Drewnowski, A., Henderson, S.A., Shore, A.B., Fischler, C., Preziosi, P. & Hercberg, S.(1996). Diet quality and dietary diversity in France: implications for the French paradox. J Am Diet Assoc, 96, 663-669.
Dubbert, P.M., Martin, J.E., Cushman, W.C., Meydrech, E.F., & Carroll, R.G..(1994) Endurance exercise in mild hypertension: Effects on blood pressure and associated metabolic and quality of life variables. Joronal of Human Hypertension, 8, 265-272.
Dyer,A.R. & Elliott,P.(1989). The INTERSALT study:relations of body mass index to blood pressure. Journal Human Hypertension, 3, 299-380.

Faulkner, G.,& Biddle, S.(1999). Exercise as an adjunct treatment for schizophrenia: Areview of the literature. Journal of Mental Health, 8(5), 441-457.
Fish, A.F., Smith, B.A., Frid, D.J., Christman, S.K., Post, D., & Montalto, N.J. (1997). Step treadmill exercise training and blood pressure reduction in women with mild hypertension. Progress in Cardiovascular Nursing, 12(1), 4-12.
Freestone, S., & Ramsay, L.E.(1985). Effect of coffee and cigare-tee smoking on the blood pressure of untreated and diuretic-treated hypertensive patients. Am J Med, 73, 348-353.
Garaulet, M ., Martinez A ., Victoria F ., Perez-Llamas F ., Ortega , R.M ., & Zamora, S. (2000). Differences in dietary intake and activity level between normal-weight and overweight or obese adolescents. JPGN, 30(3), 253-258.
Giammattei, J., Blix, G ., Marshak, H.H., Wollitzer, A.O., & Pettitt, D.J.(2003). Television watching and soft drink consumption. Arch Pediatr Adolesc Med, 157(9), 882-886.
Glassman, A. H.(1993). Cigarette smoking: Implications for psychiatric illness. Am J Psychiatry, 250(4), 546-553.
Goff, D.C.,Henderson, D.C., & Amico, E.(1992). Cigarette smoking in schizophrenia: Relationship to psychopathology and medication side effects. Am J Psychiatry, 49, 1189-1194.
Goff, D.C., Sullivan, L.M., McEvoy, J.P., Meyer, J.M., Nasvallah, H.A., Daumit, G.L., Lamberti, S.L., D’Agostino, R.B., Stroup, T.S., Davis, S., & Lieberman, J.A.,.( 2005). A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophrenia Research , 80, 45-53.
Hagberg, J.M.(1990). Exercise fitness and hypertension. Exercise fitness and health. Bouchard C. shepherd RJ.Shephard T. Stephens J.R. cham-paign, IL：Human Kinetics, 455-466.
Hagan, R.D., Upton, S.J., Wong, L., & Whittam, J. (1986). The effects of aerobic conditioning and/or caloric restriction in overweight men and women. Medicine and Science in Sports and Exercise, 18(1), 87-94.
Han, T.S., Tijhuis, M.A., Jean, M.E., & Seidell, J.C.(1998). Quality of life in relation to overweight and body fat distribution. Am J Public Health, 88, 1814-1820.
Harts, D.,Ben-Naim, M., Dabach, Y., Hollander, G ., Stein, O., & Stein, Y.(1898). Cigarette smoking renders LDL susceptible to peroxidative modification and enhanced metabolism by macrophages. Atherosclerosis, 79, 245-252.
Hatloy, A., Torheim, L.E., & Oshaug, A.(1998). Food variety--a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa.Eur J Clin Nutr, 52, 891-898.
He J, Ogden L, Bazzano L, Vupputuri S, Loria C, Whelton P.(2001). Coronary heart disease, smoking and hypertension are the greatest risk factors for congestive heart failure Arch Intern Med , 161, 996-1002.
Henderson, D.C., Cagliero, E., Copeland, P.M., Borba, C.P., Evins, E., Hayden, D., Weber, M.T., Anderson, E.J., Allison, D.B., Daley, T.B., Schoenfeld, D., & Goff, D.C.(2005). Glucose meta- bolism in patients with schizophrenia treated with atypical anti- psychotic agents: a frequently sampled intravenous glucose tolerance test and minimal model analysis. Arch. Gen Psychiatry, 62(1), 19 – 28.
Henderson, D.C., Daley,T.B., Kunkel, L., Rodrigues-Scott, M., Koul, P., Hayden, D.(2004). Clozapine and hypertension: a chart review of 82 patients. J Clin Psychiatry, 65 (5), 686-689.
Herran, A., de Santiago, A., Sandoya, M., Fernandez, M. J., Diez-Manrique, J. F., & Vazquez-Barquero, J. L.(2000). Determinants of smoking behavior in outpatients with schizophrenias. Schizophr Res, 41, 373-381.
Hewer, W., Rossler, W., Fatkenheuer, B.,& Loffler, W. (1995). Mortality among patients in psychiatric hospitals in Germany. Acta Psychiatrica Scandinavica, 91(3), 174-179.
Higgins, B.(2000). Puerto Rican Cultural beliefs：Influence on Infant Feeding Practices in Western New York. Journal of Transcultural Nursingm, 11(1), 19-30.
Hopins, P.N., & Williams, R.R.(1981). A survey of 246 suggested coronary risk factors. Atherosclerosis. 40, 1-52.
Hsiao, C.C., Ree, S.C.,Chiang, Y.L.,Yeh, S.S.,& Chen, C.K.(2004).Obesity in schizophrenic outpatients receiving antipsychotics in Taiwan. Psychiatry Clin Neurosci, 58, 403-409.
Hsu-Hage, B.H., & Wahlqvist, M.L.(1996). Food variety of adult Melbourne Chinese: acase study of a population in transition. World Rev Nutr Diet, 79, 53-69.
Hubert, H.B. ,Feinleib, M., McNamara,P.M., & Castelli, W.P.(1983).Obesity as an independent risk factor for cardiovascular disease：a 26-year follow-up participants in the Framingham Heart Study. Circulation, 67(5), 968-77.
Hughes, J.R., Hatsukami, D. K., Mitchell, J. E., & Dahlgren, B. A.(1986). Prevalence of smoking among psychiatric outpatients. Am J Psychiatry, 143(8), 993- 997.
Johannessen, L., Strudsholm, U., Foldager, L., & Munk-Jørgensen, P.(2006). Increased risk of hypertension in patients with bipolar disorder and patients with anxiety compared to background population and patients with schizophrenia. Journal of Affective Disorders, In Press, Corrected Proof, 1-5.
Jones-Webb, R., Jacobs Jr., D.R., Flack, J.M., Liu, K.(1996). Relationships between depressive symptoms, anxiety, alcohol consumption, and blood pressure: results from the CARDIA Study. Coronary artery risk development in young adults study. Alcohol Clin Exp Res, 20, 420-427.
Jousilahti, P., Patja, K., ＆ Salomaa, V. (2002). Envionmental tobacco smoke and the risk of cardiovascular disease. Scand Journal Work Environ Health, 28(S2),41-51.
Kamara, S.G., Peterson, P.D., & Dennis, J.L. (1998). Prevalence of physical illness among psychiatric inpatients who die of natural causes. Psychiatric Services, 49(6), 788-793.
Kannel, W.B.,＆ Higgins, M.(1990). Smoking and hypertension as predictors of cardiovascular risk in population studies. Hypertension, 8(1) (Suppl Ⅴ), 3-8.
Kannel,W.B.(1976).Some lessons in cardiovascular epidemiology. Epidemiology, 37(1), 269-282.
Keil, U., Chambless, L., Remmers, A.(1989). Alcohol and blood pressure: results from the Luebeck Blood Pressure Study. Prev Med, 18(1), 1-10.
Kelly, C., & McCreadie, R.G..(2000). Cigarette smoking and schizophrenia. Advances in Psychiatric Treatment, 6, 327-331.
Kenney James J.(2005). Effect of low-fat high-fiber diet and exercise program on hypertension and Metabolic Syndrome. American Journal of Hypertension, 18( 5), 198.
Kokkinos,P.F.,Narayan,P.,& Papademetriou,V.(2001). Exercise as hypertension therapy . Cardjology Clinics, 19(3), 507-516.

Lahti-Koski, M., Pietinen, P., Heliovaara, M., & Vartianen, E.(2002). Associations of body mass index and obesity with physical activity, food choice, alcohol intake and smoking in the 1982-1997. Funrisk Studies, 75(5), 809-817.
Liao, D.L., Yang, J.Y., Lee, S.M., Chen, H.,& Tsai, S.J.(2002). Smoking in Chronic Schizophrenic Inpatients in Taiwan. Neuropsychobiology , 45(4), 172-175.
Lindsted, K. Tonstad, S.,& Kuzma, J.W. (1991). Body mass index and patterns of mortality among Seventh-day Adventist men. Int. J. Obes, 15(6), 397-406.
Lu, F.H., Tang, S.J., Wu, J.S., Yang, Y.C., & Chang, C.J.(2000). Hypertension in elderly persons: Its prevalence and associate cardiovascular risk factors in Tainan City, southern Taiwan. Journals of Gerontology Series A, Biological Sciences & Medical Sciences, 55(8), 463-468.
Ludwig, D.S., Peterson, K. E., & Gortmaker, S.L. (2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet, 357(9225), 505-508.
Manson, J. E., Rimm, E. B., Stampfer, M. J., Colditz, C. A., Willett, W. C., Krolewski, A. S., et al., (1991). Physical activity and incidence of non-insulin- dependent- diabetes mellitus in women. Lancet, 38, 774-778.
Marshall, T.A., Stumbo, P.J., Warren, J.J., & Xie, X. J.(2001). Inadequate nutrient intakes are common and are associated with low diet variety in rural, community-dwelling elderly. J Nutr, 131, 2192-2196.
McCreadie, R., Macdonald, E., Blacklock, C., Tilak-Singh, D., Wiles, D., Halliday, J., Paterson, J.(1998). Dietary intake of schizophrenic patients in Nithsdale. Scotland: case-control study, 317, 784-785.
McCreadie, R.G..(2003). Diet, smoking and cardiovascular risk in people with schizophrenia. British Journal of Psychiatry, 183, 534-539.
McCrory, M.A., Fuss, P.J., McCallum, J. E., Yao, M.., Vinken, A.G., Hays, N.P., & Roberts,S.B.(1999). Dietary variety within food groups: association with energy intake andbody fatness in men and women. Am J Clin Nutr, 69, 440-447.
Meyer,J.M.(2002). Awareness of Obesity and Weight Issues Among Chronically Mentally Ill Inpatients: A Pilot Study. Ann Clin Psychiatry, 14, 39-45.
Miller, W.L., Crabtree, B.F. & Evans, D.K.(1992). Exploratory study of the relationship between hypertension and diet diversity among Saba Islanders. Public Health Rep, 107, 426-432.
Morris, J. N., Clayton, D. G .,Everitt, M. G., Semmence, A. M., Burgess, E. H.(1990). Exercise in leisure time: coronary attack and death rates. Br Heart J, 63, 324-325.
Morris, J.M., Everitt, M.G., & Pollard, R.(1980). Vigorous exercise in leisure-time: Protection against coronary heart disease. Lancet, 1207-1210.
Norman, R.J.,Noakes, M.,Wu, R.,Davies, M.J.,Moran, L.,& Wang, J.X.(2004) .
Ohio AAP(2003.11.23). Ohio AAP Statement on Softdrink Contract in Schools. http://www.ohioaap.org/softdrinks.htm.
Okamoto, K., Horisawa, R., Ohno, Y. (2005). The Relationships of Gender, Cigarette Smoking, and Hypertension With the Risk of Aneurysmal Subarachnoid Hemorrhage: A Case-control Study in Nagoya Japan. Annals of Epidemiology. 15(10): 744-748.
Olincy, A.,Young, D.A.,& Freedman, R.(1997). Increased levels of the nicotine metabolite cotinine in schizophrenic smokers compared to other smokers. Biological Psychiatry , 42, 1–5.
Osby,U., Correia,N.,Brandt,L.,Ekbom, A., & Sparen, P.(2000). Mortality and causes of death in schizophrenia in Stockholm County, Sweden. Schizophrenia Reaserch, 45(1-2), 21-28.
Paffenbarger, R.S., & Wing, A.L.(1983).Physical activity and incidence of hypertension in college alum-ni. American. Journal of Epidemiology, 117(3), 245-257.
Pardaens,K.,Reybrouck,T.,Thijs,L.,&Fagard, R.(1996). Prognostic significance of peak oxygen uptake in hypertension. Medicine and Science in Sports and Exercise, 28(7), 794-800.
Parker, A., Freeman, L.B., Cantor, K., Lynch, C.(2000). Self-report of smoking, obesity and hypertension history and survival among a cohort of iowa renal cell carcinoma cases. Ann Epidemiol, 10(7), 467-468.
Petrella, R. J.,(1998).How effective is execise training for the treatment of hypertension? Clinical Journal of Sport Medicine, 8(3), 224-231.


Quinn,T.G.,Alderman,E.L.,& McMillan,A.(1994). Development of newcoronaryatherosclerotic lesions during a 4-year multifactor risk reduction program: The Stanford coronary risk intervention project(SCRIP), 24(4), 900-908.
Rasanen , S.(2003). Excess Mortality among long-stay psychiatric patients in Northern Finland. Soc Psychiatry Psychiatr Epidemiol, 38(6), 297-304.
Reuther, M.A., & Hansen, C.B.(1985). Cardialvascular nursing. New York: Medical Examination Publishing Co., Inc. 232-252。
Rosa M., Santos, J. P., Freitas, M. E., Macedo, E. M., Castro, R. I., Agostinho, A. M., Maria, J,. Lima, & Antonio, F. F.(2002). Obesity in adults. Effect of diet and physical exercise on weight, hypertension and biochemical profile. American Journal of Hypertension, 15, 185.
Sacks F.M., Castelli, W.P., Donner, A. & Kass, E.H.(1975). Plasma lipids and lipoproteins in vegetarians and controls. N Engl J Med, 292, 1148-1151.
Saugstad,L.,& Odegard,O. (1985). Recent rise in supposedly stress dependent causes of death in psychiatric hospitals in Norway indicating increased “stress” in hospitals? Acta Psychiatrica Scandinavica, 71(4), 402-409.
Saugstad,L.,& Odegard,O.(1979). Mortality in psychiatric hospitals in Norway 1950-74. Gaustad Hospital, 59, 431-447.
Sharkey, B.J.(1990). Physiology of fitness. Champaign, Illinois: Human Kinetics.
Crow, R.S., Rautaharju, P.M., & Prineas, R.J.(1986), Risk factor, exercise fitness and electrocardiograpic response to exercise in 12,866 men at high risk of symptomatic coronary heart disease. American Journal of Cardiology, 57,1075-1082.
Silverberg, D.S.(1990). Non-pharmacological treatment of hypertension. Journal of hypertension, 8(4), 21-26.
Simonsick, E.M., Wallance, R.B., Blaxer, D.G., Berkman, L.F.(1995). Depressive symptomatology and hypertension-associated morbidity and mortality in older adults. Psychosom Med, 57, 427-435.
Sokal, J., Messias, E., Dickerson, F.B., Kreyenbuhl, J., Brown, C.H., Goldberg, R.W.,& Dixon, L.B.(2004). Comorbidity of medical Illnesses Among Adults With Serious Mental Illness Who Are Receiving Community Psychiatric Services. The Journal of Nervous and Mental Disease, 192(6), 421-427.
Stark,C., MacLeod,M.,Hall, D., O'Brien,F., & Pelosi,A.(2003). Mortality after discharge from long-term psychiatric care in Scotland, 1977-1994: a retrospective cohort study. BMC Public Health, 30(3).
Strassnig, M., Brar, J.S., & Ganguli, R . (2003a). Body mass index and quality of life in community-dwelling patients with schizophrenia. Schizophr Res, 62,73-76.
Strassnig, M., Brar, J.S., & Ganguli, R.,(2003b). Self-reported body weight perception and dieting practices in community-dwelling patients with schizophrenia. Schizophr Res, 75, 425-432.
Theisen, F.M., Linden, A., Geller, F., Schafer, H., Martin, M., Remschmidt, H., & Hebebrand, J. (2001). Prevalence of obesity in adolescent and young adult patients with and without schizophrenia and relationship to antipsychotic medication. J Psychiatr Res, 35, 339-345.
U.S Department of Health & Human Services.(1983). The health consequences of smoking：cardiovascular disease. A report of the Surgeon General’s office on smoking & health. Rockville,Maryland: DHHS(PHS), 84-50204.
Valenti, M, Necozione, S, Busellu, G, Borrelli, G, Lepore, A.R., Madonna, R., Altobelli, E., Mattei, A., Torchio, P., Corrao, G., & Di, O. F.(1997). Mortality in psychiatric hospital patients: a cohort analysis of prognostic factors. International Epidemiollogical, 26, 1227-1235.
Veterans Administration Cooperative Study Group on Antihypertensive Agents.(1972). Effects of Treatment on Morbidity In Hypertension Part 2. JAMA, (213): 1143-1152.
Vieweg,W.V.,Thomas,M.,Janisko,M.,Booth,M.,Fernandez,A., Pandurangi ,A., & Silverman, J.J.(2004). Patient and direct-care staff body mass index in a state mental hospital: implications for management. Acta Psychiatr Scand, 110, 69-72.
Walther,R.J.,& Tifft C.P.(1985). High blood pressure in the competitive athlete: Guidelines and recommendations. The Physician and Sports Medicine, 13(5), 93-114.
Wetterling,T.(2001). Bodyweight gain with atypical antipsychotics. A comparative review, 24, 59-73.

Whelton, P.K.(1994). Epidemiology of hypertension. Lancet, 344(8915), 101-106.
Willett, W. C., Stampfer, M., Manson, J., & VanItallie, T. (1991). New weight guidelines for Americans: justified or injudicious? Am J Clin Nutr, 53(5),1102-1103.
Yang,P.C., Jou, J.F., Wang, C.W., & Chong, M.Y.(1997). Body weight changes in chronic psychotic female in-patients. Nutr Sci J, 22, 457-464.
Young, T.K.(1991). Prevalence and correlates of hypertension in a subarctic Indian population. Preventive Medicine, 20(4), 474-485.
Zanettini, R., Bettega, D., Agostoni, O., Ballestra, B., Rosso, G.., Michele, R.D., & Mannucci, P.M.(1997). Exercise training in mild hypertension: effects on blood pressure, left ventricular mass and Coagulation Factor Ⅶ and fibrinogen. Cardiology, 88, 468-473.
Ziedonis, D., Willians, J. M., Smelson, D.(2003). Serious Mental Illness and Tobacco Addiction: A model Program to Address This Common but Neglected Issue. Am J Med Sci, 326(4), 223-230.