臺灣博碩士論文加值系統

背景：近年來，醫療照顧的目的被認為不單是延長病人生命而已，更重要的是提昇病患的生活品質。腸躁症為一種慢性且週期性腹痛、便秘、腹瀉症狀，原因不明又難以根治的疾病。腸躁症病患較不易入睡、較易曠課曠職、較常尋求醫生協助、較差的生活品質等，顯著地低於未罹病者，且當病患有共病症時，生活品質會顯著降低，也會浪費許多直接和間接的醫療社會成本。
目標：評估花蓮地區一般族群的生活品質，進行族群間生活品質比較，及評估腸躁症及其它共病症是否影響生活品質。
方法：本研究採橫斷性研究設計，調查時間為97年6月至8月，研究樣本為居住於花蓮縣北部兩個平地鄉村落，且年齡介於18歲到70歲的成年居民，以結構性問卷及面訪收集研究資料。問卷內容包含基本人口學變項、羅馬準則第三版、生活品質問卷(SF-36台灣版問卷)、健康行為、及個人病史等部分。
結果：SF-36生活品質八大構面平均分數範圍介於63.67分至91.29分，年輕人、男性、高學歷者、漢人、及未婚者，均有較高的生活品質得分。腸躁症患者在「身體疼痛」、「一般健康狀況」、「活力狀態」、「社會功能」和「心理健康」五個面向的生活品質平均分數，顯著地低於未罹患者約5.8分~10.7分；罹患慢性病者的各面向生活品質分數，均比未罹患慢性病者低。控制年齡、性別、種族等變項影響後，罹患共病症者的生活品質分數較未罹患慢性病者低約20.3分~56.9分。
結論：本社區調查研究顯示，罹患腸躁症或其它慢性病的患者，生活品質得分顯著較低。且控制多因子的影響後，罹患共病症者的生活品質仍舊顯著較低。

Background: In recent year, the purpose of medical care not only to extend the life of patients and, more importantly, to improve the quality of life of patients. Irritable bowel syndrome (IBS) is a chronic condition that manifests with cyclical abdominal pain, constipation, and diarrhea. Currently, IBS has no well established determinant and is incurable. IBS patients are more likely to have sleep problems and to absent from school and work, and more frequently to seek for medical assistance. As a result, IBS not only reduce the life quality of patients but also cause waste of direct and indirect medical expenditures.
Aim: The specific aims of the research are to assess the quality of life of Taiwan indigenous peoples (TIP) and Hans Chinese (HC) of Hualien area and to assess the determinants of the quality of life. We also assumed that residents affected with multiple chronic diseases have lower quality of life.
Methods: This cross-sectional study was carried out during June to August in 2008. The study areas of the present survey were randomly selected from villages that locate at the northern rural area of Hualien County and have a TIP-to-HC ratio of approximate 1-to-1. All adults (age: 18-70 years) of the selected villages were interviewed in-person. The present study used a structured questionnaire, which includes items associated with demographic characteristics, Rome III, SF-36, health behavior, and personal and family history of major diseases.
Results: The mean scores of the eight domains of the SF-36 range from 63.7 to 91.3. Younger age, male sex, unmarried status, and higher educational level are correlated with have higher scores of SF-36. Subjects affected with multiple chronic conditions have significantly lower SF-36 scores than subjects without any chronic conditions. The mean scores of ‘bodily pain’, ‘general health’, ‘vitality’, ‘social functioning’, and ‘mental health’ for IBS patients were significantly lower than those of subjects without IBS. As compared with subjects without any chronic conditions and adjusted for the influences of age, sex and ethnicity, the SF-36 scores for subjects affected with multiple chronic conditions were lower for 20.3~56.9.
Conclusions: This community survey shows that there are significant associations between quality of life and either demographic characteristics or the presence of multiple chronic conditions.

誌謝 I
摘要 II
Abstract III
表目錄 VII
圖目錄 VIII
第一章 研究背景及研究目的 1
第二章 文獻探討 2
2.1 腸躁症 2
2.1.1 定義與診斷 2
2.1.2 腸躁症之致病機轉 3
2.1.3 腸躁症盛行率 3
2.1.4 腸躁症相關因素 3
2.2 生活品質(QUALITY OF LIFE ,QOL) 5
2.2.1 生活品質的測量 6
2.2.2 SF-36 6
2.2.3 SF-36之比較研究 9
2.3 腸躁症(或FGIDS)與SF-36 12
第三章 研究架構及研究假說 14
3.1 研究架構 14
3.2 研究假說 15
依據本研究之架構及參考文獻探討的結果，研究主要假說包括： 15
第四章 研究材料與方法 16
4.1 研究地區及對象 16
4.2 資料蒐集及測量 16
4.3 樣本數及統計檢定力估計 18
4.4 資料處理與統計分析 18
第五章 結果 20
5.1 研究對象的基本資料 20
5.2 慢性病之基本資料分析 20
5.3 生活品質量表之分析 22
5.4 健康行為與生活品質得分之比較 24
5.5 慢性病種類生活品質得分比較 24
5.6 多因子迴歸分析 28
第六章 討論與結論 33
6.1 研究結果摘要 33
6.2 一般族群生活品質分數之討論 34
6.3 罹患慢性病及共病症時對生活品質之影響 34
6.4 結論 37
6.5 建議 37
6.6 研究限制 38
參考文獻 39
附件一 問卷 88

1.Lea R, Whorwell PJ. Quality of life in irritable bowel syndrome. Pharmacoeconomics. 2001;19(6):643-653.
2.Chang L. Review article: epidemiology and quality of life in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2004;20 Suppl 7:31-39.
3.Wilson S, Roberts L, Roalfe A, Bridge P, Singh S. Prevalence of irritable bowel syndrome: a community survey. Br J Gen Pract. 2004;54(504):495-502.
4.Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130(5):1377-1390.
5.Minocha A, Johnson WD, Abell TL, Wigington WC. Prevalence, sociodemography, and quality of life of older versus younger patients with irritable bowel syndrome: a population-based study. Dig Dis Sci. 2006;51(3):446-453.
6.Shiotani A, Miyanishi T, Takahashi T. Sex differences in irritable bowel syndrome in Japanese university students. J Gastroenterol. 2006;41(6):562-568.
7.Faresjo A, Grodzinsky E, Johansson S, Wallander MA, Timpka T, Akerlind I. Psychosocial factors at work and in every day life are associated with irritable bowel syndrome. Eur J Epidemiol. 2007;22(7):473-480.
8.Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17(5):643-650.
9.Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ. 1992;304(6819):87-90.
10.Gwee KA. Irritable bowel syndrome and the Rome III criteria: for better or for worse? Eur J Gastroenterol Hepatol. 2007;19(6):437-439.
11.Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480-1491.
12.Thompson WG. The road to rome. Gastroenterology. 2006;130(5):1552-1556.
13.莊琇真、黃信彰. 腸躁症的最新觀念、診斷與治療. 基層醫學. 2008;23(9).
14.Kanazawa M, Endo Y, Whitehead WE, Kano M, Hongo M, Fukudo S. Patients and nonconsulters with irritable bowel syndrome reporting a parental history of bowel problems have more impaired psychological distress. Dig Dis Sci. 2004;49(6):1046-1053.
15.Luscombe FA. Health-related quality of life and associated psychosocial factors in irritable bowel syndrome: a review. Qual Life Res. 2000;9(2):161-176.
16.Boyce PM, Koloski NA, Talley NJ. Irritable bowel syndrome according to varying diagnostic criteria: are the new Rome II criteria unnecessarily restrictive for research and practice? Am J Gastroenterol. 2000;95(11):3176-3183.
17.Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L. Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci. 2002;47(1):225-235.
18.Kwan AC, Hu WH, Chan YK, Yeung YW, Lai TS, Yuen H. Prevalence of irritable bowel syndrome in Hong Kong. J Gastroenterol Hepatol. 2002;17(11):1180-1186.
19.Lu CL, Chen CY, Lang HC, et al. Current patterns of irritable bowel syndrome in Taiwan: the Rome II questionnaire on a Chinese population. Aliment Pharmacol Ther. 2003;18(11-12):1159-1169.
20.Patrick DL, Drossman DA, Frederick IO, DiCesare J, Puder KL. Quality of life in persons with irritable bowel syndrome: development and validation of a new measure. Dig Dis Sci. 1998;43(2):400-411.
21.Park KS, Ahn SH, Hwang JS, et al. A survey about irritable bowel syndrome in South Korea: prevalence and observable organic abnormalities in IBS patients. Dig Dis Sci. 2008;53(3):704-711.
22.Kim YJ, Ban DJ. Prevalence of irritable bowel syndrome, influence of lifestyle factors and bowel habits in Korean college students. Int J Nurs Stud. 2005;42(3):247-254.
23.Lu CL, Chang FY, Lang HC, Chen CY, Luo JC, Lee SD. Gender difference on the symptoms, health-seeking behaviour, social impact and sleep quality in irritable bowel syndrome: a Rome II-based survey in an apparent healthy adult Chinese population in Taiwan. Aliment Pharmacol Ther. 15 2005;21(12):1497-1505.
24.Boyce PM, Talley NJ, Burke C, Koloski NA. Epidemiology of the functional gastrointestinal disorders diagnosed according to Rome II criteria: an Australian population-based study. Intern Med J. 2006;36(1):28-36.
25.Lu CL, Lang HC, Chang FY, et al. Prevalence and health/social impacts of functional dyspepsia in Taiwan: a study based on the Rome criteria questionnaire survey assisted by endoscopic exclusion among a physical check-up population. Scand J Gastroenterol. 2005;40(4):402-411.
26.Son YJ, Jun EY, Park JH. Prevalence and risk factors of irritable bowel syndrome in Korean adolescent girls: A school-based study. Int J Nurs Stud. 2009;46(1):76-84.
27.姚開屏. 健康相關生活品質概念與測量原理之簡介. 台灣醫學. 2002;6(2):183-192.
28.Zhan L. Quality of life: conceptual and measurement issues. J Adv Nurs. 1992;17(7):795-800.
29.張慈惠、黃秀梨. 生活品質評量之臨床應用. 台灣醫學. 2000;4(1):86-90.
30.Talley NJ, Wiklund I. Patient reported outcomes in gastroesophageal reflux disease: an overview of available measures. Qual Life Res. 2005;14(1):21-33.
31.劉文良, 盧瑞芬, 吳淑瓊. 長期照護需求量表的建立— SF-36 中文版. 行政院衛生署八十七年度科技發展計劃研究報告. 1998.
32.Ware JE, Jr., Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51(11):903-912.
33.Ware JE, Jr. SF-36 health survey update. Spine. 2000;25(24):3130-3139.
34.Larson JS. The MOS 36-item short form health survey: A conceptual analysis. Evaluation & the Health professions. 1997;20(1):14-27.
35.曾旭民、盧瑞芬、蔡益堅. 國人生活品質評量(II):SF-36 台灣版的常模與效度檢測. 台灣公共衛生雜誌. 2003;22(6):512-518.
36.Tseng HM, Lu JF, Gandek B. Cultural issues in using the SF-36 Health Survey in Asia: results from Taiwan. Health Qual Life Outcomes. 2003;1:72.
37.Fuh JL, Wang SJ, Lu SR, Juang KD, Lee SJ. Psychometric evaluation of a Chinese (Taiwanese) version of the SF-36 health survey amongst middle-aged women from a rural community. Qual Life Res. 2000;9(6):675-683.
38.曾旭民、盧瑞芬、蔡益堅. 國人生活品質評量(I):SF-36台灣版的發展及心理計量特質分析. 台灣公共衛生雜誌. 2003;22(6):501-511.
39.姚開屏. 淺談信度與效度. 職能治療學會雜誌. 1988;6(51-54).
40.Lim LL, Seubsman SA, Sleigh A. Thai SF-36 health survey: tests of data quality, scaling assumptions, reliability and validity in healthy men and women. Health Qual Life Outcomes. 2008;6:52.
41.Perneger TV, Leplege A, Etter JF, Rougemont A. Validation of a French-language version of the MOS 36-Item Short Form Health Survey (SF-36) in young healthy adults. J Clin Epidemiol.1995;48(8):1051-1060.
42.李采娟、劉秋松、林正介、李毅達、賴俊雄、李佳霙. Validation of the Chinese Version of the SF-36 Health Survey Questionnaire in People Undergoing Physical Examinations. Mid-Taiwan Journal of Medicine. 2005;10(1):8-17.
43.Wang R, Wu C, Zhao Y, et al. Health related quality of life measured by SF-36: a population-based study in Shanghai, China. BMC Public Health. 2008;8:292.
44.趙安娜、高美玲、林壽惠. 鄉村社區老年人健康狀況與生活品質相關性之探討. 長期照護雜誌. 2004;8(1):41~55.
45.Li L, Wang HM, Shen Y. Chinese SF-36 Health Survey: translation, cultural adaptation, validation, and normalisation. J Epidemiol Community Health. 2003;57(4):259-263.
46.Hopman WM, Towheed T, Anastassiades T, et al. Canadian normative data for the SF-36 health survey. Canadian Multicentre Osteoporosis Study Research Group. CMAJ. 8 2000;163(3):265-271.
47.Thumboo J, Fong KY, Machin D, et al. A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore. Qual Life Res. 2001;10(2):175-188.
48.劉淑娟. 罹患慢性病老人生命態度及生活滿意度之探討. 護理研究. 1999;7(4):294~306.
49.Chen HC, Chou FH, Chen MC, et al. A survey of quality of life and depression for police officers in Kaohsiung, Taiwan. Qual Life Res.2006;15(5):925-932.
50.Lyons RA, Lo SV, Littlepage BN. Comparative health status of patients with 11 common illnesses in Wales. J Epidemiol Community Health. 1994;48(4):388-390.
51.Sabbah I, Drouby N, Sabbah S, Retel-Rude N, Mercier M. Quality of life in rural and urban populations in Lebanon using SF-36 health survey. Health Qual Life Outcomes. 2003;1:30.
52.Alonso J, Ferrer M, Gandek B, et al. Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project. Qual Life Res. 2004;13(2):283-298.
53.Bardage C, Isacson DG. Hypertension and health-related quality of life. an epidemiological study in Sweden. J Clin Epidemiol. 2001;54(2):172-181.
54.Graham JE, Stoebner-May DG, Ostir GV, et al. Health related quality of life in older Mexican Americans with diabetes: a cross-sectional study. Health Qual Life Outcomes. 2007;5:39.
55.Aaronson NK, Muller M, Cohen PD, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol.1998;51(11):1055-1068.
56.Tsai SY, Chi LY, Lee LS, Chou P. Health-related quality of life among urban, rural, and island community elderly in Taiwan. J Formos Med Assoc. 2004;103(3):196-204.
57.El-Serag HB, Olden K, Bjorkman D. Health-related quality of life among persons with irritable bowel syndrome: a systematic review. Aliment Pharmacol Ther. 2002;16(6):1171-1185.
58.Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther. 1997;11(6):1019-1030.
59.Akehurst RL, Brazier JE, Mathers N, et al. Health-related quality of life and cost impact of irritable bowel syndrome in a UK primary care setting. Pharmacoeconomics. 2002;20(7):455-462.
60.Halder SL, Locke GR, 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ, 3rd. Impact of functional gastrointestinal disorders on health-related quality of life: a population-based case-control study. Aliment Pharmacol Ther. 2004;19(2):233-242.
61.Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2(3):217-227.
62.李佳霙. 探討中部五縣市民眾的健康狀況與醫療利用間的相關研究：SF-36 健康量表的合適性. 中國醫樂學院環境醫學研究所碩士論文. 1996.
63.林保萱. 肺功能及抽煙和SF-36 健康量表相關性之研究. 中國醫樂學院環境醫學研究所碩士論文. 2000.
64.Aydemir O, Ozdemir C, Koroglu E. The impact of co-morbid conditions on the SF-36: a primary-care-based study among hypertensives. Arch Med Res.2005;36(2):136-141.
65.Scott KM, Tobias MI, Sarfati D, Haslett SJ. SF-36 health survey reliability, validity and norms for New Zealand. Aust N Z J Public Health.1999;23(4):401-406.
66.Thumboo J, Fong KY, Machin D, et al. Quality of life in an urban Asian population: the impact of ethnicity and socio-economic status. Soc Sci Med.2003;56(8):1761-1772.
67.Gutteling JJ, de Man RA, Busschbach JJ, Darlington AS. Overview of research on health-related quality of life in patients with chronic liver disease. Neth J Med.2007;65(7):227-234.
68.張玉佩. 腸躁症. 嘉基藥訊. 2005(56):5-8.
69.黃麗卿, 黃偉新, 鄒孟婷, 蔡悅琪. 睡眠疾患影響門診高血壓老年病患生活品質狀況之探討. 台灣老年醫學雜誌. 2007;2(3):190-200.
70.Mena-Martin FJ, Martin-Escudero JC, Simal-Blanco F, Carretero-Ares JL, Arzua-Mouronte D, Herreros-Fernandez V. Health-related quality of life of subjects with known and unknown hypertension: results from the population-based Hortega study. J Hypertens.2003;21(7):1283-1289.
71.Ten Berg MJ, Goettsch WG, van den Boom G, Smout AJ, Herings RM. Quality of life of patients with irritable bowel syndrome is low compared to others with chronic diseases. Eur J Gastroenterol Hepatol. 2006;18(5):475-481.

網頁資料：
1.http://sf36.cgu.edu.tw/guideline.htm
2.95 年度糖尿病醫療服務品質報告；2007