(3.236.118.225) 您好!臺灣時間:2021/05/16 15:00
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:許晉誠
研究生(外文):Chin-Cheng
論文名稱:雙親因素與幼兒健康之相關性研究:台灣出生世代研究之先驅調查(十八個月大)結果
論文名稱(外文):Parental Factors and Child Health: Results of the Pilot Study (18 Months Old) of TBCS
指導教授:李孟智李孟智引用關係
指導教授(外文):Meng-Chih Lee
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:95
相關次數:
  • 被引用被引用:2
  • 點閱點閱:159
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
兒童是國家未來的主人翁,嬰幼兒期更是身心發展的關鍵時期。過去的研究顯示,父母親之人文及社經背景、照護模式、養育態度以及社會福利政策與健康資源等因素,都會影響所生育子女的身心健康狀況,乃至於子女的人格特質與學習成就的表現。
本論文擬探討之問題包括:母親的人口學特性和健康行為與幼兒健康指標之關係,父親的人口學特性和健康行為與幼兒健康指標之關係,以及照顧行為與幼兒健康指標之關係。
本論文所探討的台灣出生世代研究先驅研究調查(II)乃以先驅研究調查(I)抽樣所得之幼兒(與其母親或主要照顧者)計1783人為對象,於民國94年5月至7月進行出生後十八個月時之訪視調查,問卷內容包含父母親之人文及社經背景、照護模式與幼兒之健康狀態、發展、健康照護及罹病情形。
總計有1620人(90.9%)完成先驅研究(II)訪視調查,無法完成的主要原因為拒訪。將經過卡方檢定後所得到之具有顯著意義的自變項納入,然後進行多變項邏輯迴歸分析。結果顯示:十八個月大幼兒體重落後(<15 percentile)之預測因子含幼兒性別、是否為早產兒以及是否為低出生體重;幼兒十八個月發展情況的預測因子含幼兒性別、是否為低出生體重以及父親是否期望懷孕;B型肝炎疫苗接種率之預測因子含幼兒是否為母親期望的性別和居住地區;幼兒是否曾住院之預測因子為母親是否吸菸;幼兒是否送過急診之預測因子含幼兒性別、母親生產後有無再懷孕、母親是否吸菸及是否另有6歲以下小孩;幼兒是否曾因意外事故送醫之預測因子為母親是否吸菸。
針對十八個月大幼兒之先驅性調查顯示:幼兒之生長發育存在著男女差異及受出生時是否早產、低出生體重及父親期望懷孕與否影響;至於幼兒疫苗接種率,則與幼兒是否為母親期望的性別及居住地區有關;而關於幼兒罹病及就醫之情形,則主要與母親是否有危害健康行為如吸菸、母親是否再懷孕、幼兒性別以及是否另有6歲以下小孩有關。以上之發現,希望能有助於未來對於幼兒健康狀況相關因素之釐清,以及作為將來更進一步研究之參考。

The purpose of this pilot study of 18-month-old babies of TBCS (Taiwan Birth Cohort Study) is to explore the relationship between parental variables and child health.
Mothers or main caregivers of 1783 babies had previously completed the questionnaire for the pilot study of 6-month-old babies of TBCS. This time, the 1783 babies (with their mothers or main caregives) are the subjects of the pilot study of 18-month-old babies of TBCS. A questionnaire was conducted to obtain parental variables and child health through interviewing the mothers or main caregivers of children during May and July, 2005.
Mothers or main caregivers of total 1620 children completed the questionnaire with a response rate of 90.9%. The major reason for non-response was refusal. The predictive factors for the children whose body weight less than 15 percentile were gender, prematurity, and low birth weight. The predictive factors for the growth and development of children were gender, low birth weight, and the father’s pregnancy intention. The predictive factors for the vaccination rate of hepatitis B were the mother’s gender expectation for this baby and living area. The predictive factor of hospitalization was maternal smoking. The predictive factors of the baby ever been sent to emergency room were gender, whether the mother was pregnant again, maternal smoking, and if any other children under the age of 6. The predictive factor of whether babies ever been sent to hospital due to accidents was maternal smoking.
According to the results of the pilot study of 18-month-old babies of the TBCS, the conclusions are as follows.
Gender difference, prematurity, low birth weight, and the father’s pregnancy intention were related to the growth and development of babies. The mother’s gender expectation for this baby and living area were related to the vaccination rate. Maternal smoking, whether the mother was pregnant again, gender, and if any other children under the age of 6 were related to sickness and hospitalization of babies.


誌謝-------------------------------------------------------------------------------------------- I
中文摘要------------------------------------------------------------------------------------- II
英文摘要------------------------------------------------------------------------------------ IV
第一章 緒論-------------------------------------------------------------------------------- 1
第一節 前言--------------------------------------------------------------------------- 1
第二節 文獻回顧--------------------------------------------------------------------- 3
第三節 研究架構--------------------------------------------------------------------- 8
第二章 研究方法------------------------------------------------------------------------- 10
第一節 研究對象-------------------------------------------------------------------- 10
第二節 研究工具-------------------------------------------------------------------- 11
第三節 統計分析-------------------------------------------------------------------- 12
第三章 結果------------------------------------------------------------------------------- 14
第四章 討論與建議---------------------------------------------------------------------- 17
第一節 先驅調查結果之討論---------------------------------------------------- 17
第二節 田野調查方式及問卷內容修正之建議------------------------------- 19
第三節 研究的限制及未來研究的方向---------------------------------------- 20
第五章 結論------------------------------------------------------------------------------- 21
參考文獻------------------------------------------------------------------------------------- 22
附表------------------------------------------------------------------------------------------- 32
表1、雙親人口學特性---------------------------------------------------------------- 32
表2-1、雙親照護與幼兒受照護之特性------------------------------------------- 33
表2-2、雙親照護與幼兒受照護之特性(續)-------------------------------------- 34
表3、十八個月大幼兒之特性------------------------------------------------------- 35
表4、十八個月大幼兒成長與發展狀況------------------------------------------- 36
表5-1、十八個月大幼兒過去一年內之疫苗接種情形------------------------- 37
表5-2、十八個月大幼兒過去一年內之疫苗接種情形(續)-------------------- 38
表6、十八個月大幼兒之罹病及就醫狀況---------------------------------------- 39
表7、幼兒體重落後(<15 percentile)之逐步邏輯迴歸分析結果--------------- 40
表8、幼兒不能走得很穩之逐步邏輯迴歸分析結果---------------------------- 41
表9、幼兒不會用筆亂塗之逐步邏輯迴歸分析結果---------------------------- 42
表10、幼兒不會有意義叫爸媽之逐步邏輯迴歸分析結果------------------- 43
表11、幼兒不會雙手端杯喝水之逐步邏輯迴歸分析結果-------------------- 44
表12、幼兒未完成B型肝炎疫苗接種之逐步邏輯迴歸分析結果------------ 45
表13、幼兒曾住院之逐步邏輯迴歸分析結果----------------------------------- 46
表14、幼兒送過急診之逐步邏輯迴歸分析結果-------------------------------- 47
表15、幼兒意外事故送醫之逐步邏輯迴歸分析結果-------------------------- 48
附錄一、台灣地區嬰幼兒健康照護需求調查(18個月大幼兒)--------------------- 49
附錄二、嬰兒發展及教養量表----------------------------------------------------------- 79
附錄三、嬰兒母親自覺健康狀態自填問卷-------------------------------------------- 84
附錄四、嬰兒父親自覺健康狀態自填問卷-------------------------------------------- 90

1. Barker DJP. Mothers, Babies and Health in Later Life. Edinburg: Churchill Livingstone, 1998.
2. Kuh D, Power C, Blance D, Bartley. Social pathways between childhood and adult health. In: D Kuh, Y Ben-Shlomo (eds). A Life Course Approach to Chronic Disease Epidemiology. Oxford: Oxford University Press, 1997.
3. Susser E, Terry ME, Matte T. The birth cohorts grow up: new opportunities for epidemiology. Paediatr Perinat Epidemiol 2000;14:98-100.
4. Wadsworth MEJ, Kuh DJL. Childhood influences on adult health: a review of work from the British 1946 national birth cohort study, the MRC national survey of health development. Paediatr Perinat Epidemiol 1997;11:2-20.
5. Batty GD, Morton SM, Campbell D, Clark H, Smith GD, Hall M, Macintyre S, Leon DA. The Aberdeen Children of the 1950s cohort study: background, methods and follow-up information on a new resource for the study of life course and intergenerational influences on health. Paediatr Perinat Epidemiol 2004;18:221-39.
6. The Millennium Cohort Study (whttp://www.cls.ioe.ac.uk/Mcs/mcsmain.htm accessed 7/10/2004).
7. The National Children Study (http://nationalchildrensstudy.gov/about/overview.cfm accessed 7/10/2004).
8. Marmot MG, Wadsworth MEJ (Editors). Fetal and Early Childhood Environment: Long-term Health Implications. London: British Medical Bulletin, 1997; Vol. 53.
9. Rubin DH, Krasilinikoff PA, Leventhal JM, Berget A. Effect of passive smoking on birth-weight. Lancet 1986;2:415-7.
10. Ogawa H, Tominaga S, Hori K, Noguchi K, Kanou I, Matsubara M. Passive smoking by pregnant women and fetal growth. J Epidemiol Commu Med 1991;45:164-8.
11. Martinez FD, Wright LA, Taussig LM. The effect of parental smoking on the birthweight of newborns whose mothers did not smoke. Am J Public Health 1994;84: 1489-91.
12. Nandi C, Nelson MR. Maternal pregnant weight, age and smoking status as risk factors for low birth weight births. Public Health Rep 1992;107:658-62.
13. Ahluwalia IB, Grummer-Strawn L, Scanlon KS. Exposure to environmental tobacco smoke and birth outcome: increased effects on pregnant women aged 30 years or older. Am J Epidemiol 1997;146:42-7.
14. 吳唯雅:雙親因素與六個月大嬰兒健康之相關性研究:台灣出生世代研究之先驅調查結果。台中,中山醫學大學醫學研究所碩士論文,2006。
15. Rosenfield A, Maine D. Maternal mortality--a neglected tragedy Where is the M in MCH? Lancet 1985;2:83-5.
16. AbouZhar C, Wardlaw T. Maternal mortality at the end decade: what signs of progress? Bull WHO 2001;79:561-73.
17. 潘懿真、謝功毅、陳保忠:早產兒危險因子之探討──社區性病例對照研究。中華衛誌 1999;18(2):105-15.
18. Chen PC, Li CY, Lin RS, Sung FC. Maternal smoking, environmental tobacco smoking and low birthweight. Taiwan J Public Health 2002;21:321-8.
19. DiFranza JR, Lew RA. Morbidity and mortality in children associated with the use of tobacco products by other people. Pediatrics 1996;97:560-8.
20. California Environmental Protection Agency. Health effects of exposure to environmental tobacco smoke. California: Office of Environmental Health Hazards Assessment, California Environmental Protection Agency, 1997.
21. SCOTH. Report of the Scientific Committee on Tobacco and Health.London, United Kingdom: Scientific Committee on Tobacco and Health, Stationery Office, 1998.
22. Gidding SS, Schydlower M. Active and passive tobacco exposure: a serious pediatric health problem. Pediatrics 1994;94:750-1.
23. Jedrychowski W, Flak E. Maternal smoking during pregnancy and postnatal exposure to environmental tobacco smoke as predisposition factors to acute respiratory infections. Environ Health Perspect 1997;105:302-6.
24. Young NK. Effects of alcohol and other drugs on children. J Psychoactive Drugs 1997;29:23-42
25. Day NL, Zuo Y, Richardson GA, Goldschmidt L, Larkby CA, Cornelius MD. Prenatal alcohol use and offspring size at 10 years of age. Alcohol Clin Exp Res 1999;23;863-9.
26. Children of Alcoholics Foundation. Children of alcoholics in the medical system: Hidden problems, hidden costs. New York: Children of alcoholics Foundation 1990.
27. Yang MJ, Chung TC, Yang MJ, Hsu TY, Ko YC. Betel quid chewing and risk of adverse birth outcomes among aborigines in eastern Taiwan. J Toxicol Environ Health Part A 2001;64:465-72.
28. Yang MS, Chang FT, Chen SS, Lee CH, Ko YC. Betel quid chewing and risk of adverse pregnancy outcomes among aborigines in southern Taiwan. Public Health 1999;113:189-92.
29. Hytten FE. Restriction of weight gain in pregnancy: is it justidied? J Hum Nutr 1979;33:461-3.
30. Abrams BF, Laros RK. Prepregnancy weight, weight gain, and birth weight. Am J Obstet Gynaecol 1986;15:503-9.
31. Lumey LH. Screening for preterm delivery and low birth weight using maternal height and weight. In Wildschut HIJ, Weiner CP, Peters TJ (eds) When to Screen in Obstetrics and Gynecology, pp. 146-53. London: W.B. Saunders. 1996.
32. Kramer MS. Intrauterine growth retardation and gestational duration determinants. Pediatircs 1987;80:502-11.
33. Spuy ZM, Steer PJ, McCusker M, Steele SJ, Jacobs HS. Outcome of pregnancy in underweight women after spontaneous and induced ovulation. BMJ 1988;296:962-5.
34. Kline J, Stein Z, Susser M. Ch 12: preterm delivery-II. Risk factors; Ch 13: Fetal growth and birthweight-I. Indices, patterns and risk factors. In Kline J, Stein Z, Susser M (eds) Conception to Birth: Epidemiology of Prenatal Development, pp. 191-230. New York: Oxford University Press. 1989.
35. Ramsey CN, Abell TD, Baker LC. The relationship between family functioning, life events, family structure, and the outcome of pregnancy. J Fam Pract 1986;22:521-7.
36. McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 1985;312:82-90.
37. Lieberman E, Ryan KJ, Monson RR, Schoebaum SC. Risk factors accounting for racial differences in the rate of premature birth. N Engl J Med 1987;317:743-8.
38. Blackmore ChA, Savitz Da, Edwards LJ, Harlow SD, Bowes WA. Racial differences in patterns of preterm delivery in central North Carolina, USA. Paediatr Perinat Epidemiol 1995;9:281-95.
39. Connoly G, Byren P. Teenage pregnancies and risk of late fetal death and infant mortality. Br J Obstet Gynaecol 1999;106:1230.
40. Orvos H, Nyirati I, Hajdu J, Pal A, Nyari T, Kovacs L. Is adolescent pregnancy associated with adverse perinatal outcome? J Perinat Med 1999;27:199-203.
41. Olausson PO, Cnattingius S, Haglund B. Teenage pregnancies and risk of late fetal death and infant mortality. Br J Obstet Gynaecol 1999;106:116-21.
42. Frazer AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med 1995;332:1113-7.
43. Satin AJ, Leveno KJ, Sherman ML, Reedy NJ, Lowe TW, McIntire DD. Maternal youth and pregnancy outcomes: middle school versus high school age groups compared with women beyond the teen years. Am J Obstet Gynecol 1994;171:184-7.
44. Lee MC, Lu TH, Chou MC. Characteristics of adolescent pregnancy in Taiwan. Int J Adolesc Med Health 1997;9:213-6.
45. Lee MC. Adolescent Sexuality, Pregnancy and Childbearing: An International Perspective. Taichung: School of Medicine, Chung Shan Medical University, Taiwan, 2003.
46. Berkowitz GS, Skovron ML, Lapinski RH, Berkowitz RL. Delayed childbearing and the outcome of pregnancy. N Engl J Med 1990;322:659-64.
47. Stein ZA. A woman’s age: childbearing and child rearing. Am J Epidemiol 1985;121:327-42.
48. Smith GF, Berg JM. Down’s Anomaly, 2nd edn. Edinburg: Churchill Livingstone 1976.
49. Hook EB. Rates of chromosome abnormalities at different maternal ages. Obstet Gynaecol 1981;58:282-5.
50. American Academy of Pediatrics. Work group on breast-feeding: breast-feeding and the use of human milk. Pediatrics 1997;100:1035-9.
51. Heinig MJ, Dewey KG. Health advantages of breast feeding for infants: a critical review. Nutr Res Rev 1996;9:89-110.
52. Cesar JA, Victora CG, Barros FC, Santos IS, Flores JA. Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case– control study. BMJ 1999;318:1316-20.
53. Chen Y, Yu S, Li W-X. Artificial feeding and hospitalization in the first 18 months of life. Pediatrics 1988;81:58-62.
54. Piscane A, Granata G, Coppola A, Dolezalova H, Graziano L, Zona G, Ummarino M, Cafiero M, Sacrpellino B. Breast feeding and acute lower respiratory infection. Acta Paediatr 1994;83:714-8.
55. Dagan R, Pridan H. Relationship of breast feeding versus bottle feeding with emergency room visits and hospitalization for infectious diseases. Eur J Pediatr 1982;139:192-4.
56. Sears MR, Greene JM, Willan AR, Taylor DR, Flannery EM, Cowan JO, Herbison GP, Poulton R. Long-term relation between breast-feeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet 2002;360:901-7.
57. World Health Organization, UNICEF. Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization, 2002.
58. Department of Health. Infant Feeding Recommendation. London: Department of Health, 2003.
59. Jones IG, Cameron D. Social class analysis: an embarrassment to epidemiology. Community Med 1984;6:37-46.
60. Antonovsky A, Bernstein J. Social class and infant mortality. Soc Sci Med 1977;11:453-70.
61. Chalmers I. Short, Black, Himsworth and social classdifferences in fetal and neonatal mortality rates. BMJ 1985;2:231-3.
62. Kleinman JC, Kessel SS. Racial differences in low birth weight: trends and risk factors. New Engl J Med 1987;317:749-53.
63. Strobino DM, Ensminger ME. Kim YJ. Nanda J. Mechanisms for maternal age differences in birth weight. Am J Epidemiol 1995;142:504-14.
64. Chen PC, Patricia ED, Lu P, Wang JD. Parental socioeconomic status and low birthweight, preterm delivery, and small for gestational age in Taiwan. Chin J Public Health (Taipei) 1999;18:105-15.
65. Houdek JM, Newton N. Activity and work during pregnancy and the postpartum period: a cross-cultural study of 202 societies. Am J Obstet Gynecol 1979;135:171-6.
66. Barron Sl. Birthweight and ethnicity. Br J Obstet Gynecol 1983;90:289-90.
67. Helman C. Culture factors in epidemiology. In Helman C (ed.) Culture, Health and Illness, pp. 267-284. Bristol: John Wright. 1990.
68. Crowe TK, McClain C, Provost B. Motor development of Native American children on the Peabody Developmental Motor Scales. Am J Occup Ther 1999;53:514-8.
69. McClain C, Provost B, Crowe TK. Motor development of two-yearold typically developing Native American Children on the Bayley Scales of Infant Development–II Motor Scale. Pediatr Phys Ther 2000;12:108-13.
70. Kerfeld CI, Guthrie MR, Stewart KB. Evaluation of the Denver II as applied to Alaskan Native children. Pediatr Phys Ther 1997;9:23-31.
71. Cohen E, Boettcher K, Maker T, Phillips A, Terrel L, Nixon-Cave K, Shepard K. Evaluation of the Peabody Gross Motor Scales for young children of African American and Hispanic ethnic backgrounds. Pediatr Phys Ther 1999;11:191-7.
72. Stanitski DF, Nietert PJ, Stanitski CL, Nadjarian RK, Barfield W. Relationship of factors affecting age of onset of independent ambulation. J Pediatr Orthop 2000;20:686-8.
73. Goto A, Yasumura S, Yabe J, Reich MR. Addressing Japan’s fertility decline: influences of unintented pregnancy on child bearing. Reprod Health Matters 2006;14:191-200.
74. Joyce TJ, Kaestner R, Korenman S. The effect of pregnancy intention on child development. Demography 2000;37:83-94.
75. Wood D. Effect and child and family poverty on child health in the United States. Pediatrics 2003;112:707-11.
76. Smith JR, Brooks-Gunn J, Klebanov P. The consequences of living in poverty for young children’s cognitive and verbal ability and early schooling achievement. In: Duncan GJ, Brooks-Gunn J, eds. The Consequences of Growing Up Poor. New York, NY: Russell Sage Foundation;1997:132-89.
77. Nick S. Social, economic, and political determinants of child health. Pediatrics 2003;112:704-6.
78. David G. Health policy in relation to improving equity in child health. Pediatrics 2003;112:725-6.
79. Jeffrey G. Children’s rights and the United Nations convention on the rights of the child. Pediatrics 2003;112:742-5.
80. Walker R. Ending Child Poverty: Popular Welfare For the 21st Century. Bristol, United Kingdom: The Policy Press; 1999.
81. Maynard R. Teenage childbearing and welfare reform: lessons froma decade of demonstration and evaluation research. Child Youth Serv Rev 1995;17:309-32.
82. Centers for Disease Control and Prevention. (2001). Early release of selected estimates from the 2000 and early 2001 national health interview surveys: Influenza vaccination. Hyattsville, MD: CDC, U.S. Departmentof Health and Human Services. Retrieved from http://www.cdc.gov/nchs/about/major/nhis/earlyrelease2000.htm


QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top