臺灣博碩士論文加值系統

目的：過去職業流行病學研究顯示，健康照護工作者與一般族群相較，有較低之罹病風險；然而牙醫師工作環境中存在著各種潛在之健康危害因子，長時間暴露可能影響牙醫師之健康。（1）本研究目的之ㄧ為探討我國牙醫師族群較常被診斷之疾病病因，以及預測影響疾病發生之因子；並比較牙醫師與其他健康照護工作者罹病率之差異。（2）本研究同時也針對牙醫師工作環境之極低頻磁場進行暴露評估，藉以瞭解台灣地區牙醫師工作環境及個人之極低頻磁場暴露狀況。
方法：（1）利用國家衛生研究院全民健康保險學術研究資料庫，以回溯性世代追蹤研究方法分析2000 – 2004年7,760位牙醫師門診就醫之疾病發生密度與罹病相對風險。利用布瓦松迴歸模式預測影響疾病發生之因子，並分別與其他醫事人員及醫師2個對照組比較，推估牙醫師全病因及病因別之校正後相對罹病風險。（2）以便利取樣法選取65位牙醫師，自2008年6月至2009年2月間，進行牙醫師職場環境以及個人隨身之極低頻磁場暴露評估；並分別比較不同執業醫療機構之牙醫師極低頻磁場暴露值之差異及相關影響因素。
結果：（1）牙醫師最常被診斷的系統疾病為呼吸系統疾病（24.0%），全病因及病因別發生密度皆低於其他醫事人員或醫師族群；年齡、醫事機構權屬別及特約類別為牙醫師罹病率之預測因子。布瓦松多變量迴歸模式分析發現，牙醫師之內分泌、營養及新陳代謝疾病與免疫性疾患（與其他醫事人員相較aRR=1.04，95% CI=1.02 – 1.05）、精神疾患（與其他醫事人員相較aRR=1.04，95% CI=1.01 – 1.07）及腫瘤（與醫師相較aRR=1.06，95% CI=1.02 – 1.09）皆呈現略高之罹病危險性。（2）牙醫師職場極低頻磁場暴露評估研究顯示，牙醫師職業之環境與個人隨身測量之極低頻磁場幾何平均值分別為2.28±1.34及2.15±1.86 mG；然而牙醫師個人瞬間暴露值最高可達215.40 mG，有89.23%牙醫師瞬間最高暴露值>4 mG，平均值>4 mG的牙醫師比例則有16.62%。另外，私人牙醫診所診療區極低頻磁場算數平均值及幾何平均值顯著高於醫院牙科門診（5.54±5.69 vs. 1.51±0.77 mG，p =.008；2.66±1.34 vs. 1.35±0.68 mG，p =.026）；開業牙醫師極低頻磁場最小值平均值亦顯著高於醫院牙醫師（1.00±0.73 vs. 0.44±0.28 mG，p <.001）。儀器設備發生源之磁場強度隨著距離增加則快速減弱，在距離50公分處之數值可降低至與環境測量值相近。
結論：（1）在健康照護工作者族群中，牙醫師有較低之整體門診醫療利用率，亦呈現較低之罹病風險；然而在較嚴重之數種疾病，牙醫師卻有略高之罹病危險性。這可能與牙醫師承受高度工作壓力，並經常帶病工作及自我治療，因而忽視輕微疾病有關。（2）本研究亦發現部分牙醫師之極低頻磁場暴露強度高於背景值，有潛在職業極低頻磁場過度暴露情形。建議應考慮給予工作環境適當之空間規劃並謹慎避免暴露來源，以減少可能之職業過度暴露。

Objectives: Previous occupational epidemiological studies have showed that health care workers had lower risks of morbidity compared to the general populations. However, various occupational hazards can be found at the dental workplace, which may be a continued health threat to dentists. The purposes of this study were (1) to investigate diseases dentists may have, and potential risk factors associated with these diseases. We also investigated relative risks of the diseases associated with dentists compared to the other health care workers; (2) to assess occupational exposure of dentists to extremely-low-frequency magnetic field (ELF-MF), including the environmental and personal ELF-MF exposure status of dentists in Taiwan.
Methods: (1) The National Health Insurance Research Database between 2000 and 2004 from the National Health Research Institutes was used for this study. This study employed a retrospective cohort design to estimate incidence density and relative risk of morbidity among 7,760 dentists. We also performed Poisson regression model analysis to investigate the risk factors associated with the morbidity. We further estimated the dentists to other medical professional group and to physician group rate ratios respectively for the overall and specific disease. (2) Sixty-five (65) dentists were included to assess their environmental and personal exposures to ELF-MF at work from June 2008 to February 2009. The exposure of ELF-MF was compared between employed and self-employed dentists.
Results: (1) The most frequently reported diseases of dentists were diseases of the respiratory system (24.0%). The overall and disease-specific incidence densities of dentists were significantly lower than those of other medical professional or physician groups. Age, hospital ownership, and hospital accreditation level were the significant predictors for morbidity of dentists. The multivariate Poisson regression model analysis revealed no significant difference in risk of relatively mild diseases. However, dentists were found to experience significantly increased risks of endocrine, nutritional and metabolic diseases, and immunity disorders (compare to other medical professionals aRR=1.04, 95% CI=1.02 – 1.05), mental disorders (compare to other medical professionals aRR=1.04, 95% CI=1.01 – 1.07) and neoplasms (compare to physicians aRR=1.06, 95% CI=1.02 – 1.09). (2) Results of assessing the occupational exposure to ELF-MF of dentists showed that the geometric means (GM) of environmental and personal exposures were 2.28±1.34 and 2.15±1.86 mG, respectively. The maximum spot ELF-MF level was 215.40 mG, and 89.23% of participated dentists had a maximum instant exposure of >4 mG. The results also showed that 16.62% of dentists had a mean exposure of >4 mG. Compared with treatment areas at hospitals, the ELF-MF exposures at clinics was significantly higher according to the arithmetic mean (AM) (5.54±5.69 vs. 1.51±0.77 mG, p =.008) and GM (2.66±1.34 vs. 1.35±0.68 mG, p =.026). The mean of minimum exposure was also significantly higher of clinic dentists than that of hospital dentists (1.00±0.73 vs. 0.44±0.28 mG, p <.001). The ELF-MF intensity decreased with the increase of distance to the dental equipments, and reduced to the background level at a distance of 50 cm.
Conclusions: (1) Compared with other health care workers, dentists have less overall ambulatory care visits with lower risks of mild ailments. On the other hand, dentists have higher risks of relatively severe diseases, which could be accounted by work-related stress of dentists who might tend to work through illnesses and self-treating, thereby ignoring the minor disease. (2) This study also found that some dentists are exposed to ELF-MF higher than the background. It is suggested that appropriate space arrangement and prudential avoidance sources of exposure may be useful to further reduce the possible over-exposure.

致謝
摘要 i
Abstract iii
目錄 vii
表目錄 x
圖目錄 xiii
第壹章 緒論 1
第貳章 文獻探討 4
第一節 台灣地區牙醫師醫療人力現況與工作服務量 4
一、牙醫師醫療人力現況 4
二、牙醫師醫療人力分布 5
三、牙醫師醫療工作服務量 5
四、國際間牙醫師醫療人力密度比較 5
第二節 牙醫師職業之疾病罹病風險 6
第三節 牙醫師與健康照護工作者之極低頻磁場暴露 20
一、醫院環境及健康照護工作者之極低頻磁場暴露強度 21
二、牙科工作環境及牙醫師之極低頻磁場暴露強度 26
第參章 材料與方法 28
第一節 牙醫師門診就醫之常見疾病與罹病風險 28
一、研究資料來源 28
二、研究世代選取方法與流程 29
三、擷取醫事機構基本資料檔方法與流程 31
四、擷取承保資料檔方法與流程 32
五、擷取門診處方及治療明細檔方法與流程 32
六、研究變項操作型定義 33
七、追蹤與觀察人年數之計算 34
八、統計分析 35
第二節 牙醫師職場極低頻磁場暴露評估 37
一、研究樣本選取 37
二、測量工具 37
三、測量方法 38
四、統計分析 39
第肆章 結果 41
第一節 牙醫師門診就醫之常見疾病與罹病風險 41
一、牙醫師、其他醫事人員及醫師研究樣本人口學特性 41
二、牙醫師、其他醫事人員及醫師研究樣本門診就醫常見診斷病因 41
三、牙醫師樣本門診就醫之疾病發生密度 42
四、牙醫師樣本門診就醫之罹病風險預測因子 44
五、與其他醫事人員及醫師世代族群比較牙醫師世代門診就醫之罹病風險 50
第二節 牙醫師職場極低頻磁場暴露評估 51
一、牙醫師職場極低頻磁場測量之樣本特性與時間分布 51
二、醫院牙醫師及開業牙醫師職場極低頻磁場暴露強度分布與比較 52
三、牙科部門儀器設備固定發生源之極低頻磁場暴露強度分布 53
第伍章 討論 54
第一節 主要研究結果 54
第二節 牙醫師職業之疾病罹病風險 55
第三節 牙醫師職場極低頻磁場暴露評估 61
參考文獻 67

Aasen SE, Johnsson A, Bratlid D & Christensen T. Fifty-Hertz Magnetic Field Exposures of Premature Infants in a Neonatal Intensive Care Unit. Biol Neonate. 1996;70(5):249-64.

Ahola K & Hakanen J. Job Strain, Burnout, and Depressive Symptoms: A Prospective Study Among Dentists. J Affect Disord. 2007;104(1-3):103-10.

AI Wassan KA, Almas K, AI Shethri SE & AI Qahtani MQ. Back & Neck Problems Among Dentists and Dental Auxiliaries. J Contemp Dent Pract. 2001;2(3):1-10.

Alaujan AH & Alzahem AM. Stress Among Dentists. Gen Dent. 2004;52(5):428-32.

Alexopoulos EC, Stathi IC & Charizani F. Prevalence of Musculoskeletal Disorders in Dentists. BMC Musculoskelet Disord. 2004;5:16-23.

Andersen A, Barlow L, Engeland A, Kjærheim K, Lynge E & Pukkala E. Work-Related Cancer in the Nordic Countries. Scand J Work Environ Health. 1999;25(suppl 2):1-116.

Anton D, Rosecrance J, Merlino L & Cook T. Prevalence of Musculoskeletal Symptoms and Carpal Tunnel Syndrome Among Dental Hygienists. Am J Ind Med. 2002;42(3):248-57.

Antunes JL, Macedo MM & de Araujo ME. Comparative Analysis of Cause-specific Mortality for Dentists in the City of São Paulo. Cad Saude Publica. 2004;20(1):241:8. [In Portuguese: English abstract]

Bertoft G. Patient Reactions to Some Electromagnetic Fields From Dental Chair and Unit: A Pilot Study. Swed Dent J. 1996;20(3):107-12.

Bohay RN, Bencak J, Kavaliers M & Maclean D. A Survey of Magnetic Fields in the Dental Operatory. J Can Dent Assoc. 1994;60(9):835-40.

Bouchardy C, Schüler G, Minder C, Hotz P, Bousquet A, Levi F, Fisch T, Torhorst J & Raymond L. Cancer Risk by Occupation and Socioeconomic Group Among Men – A Study by The Association of Swiss Cancer Registries. Scand J Work Environ Health. 2002;28(suppl 1):1-88.

Boxer PA, Burnett C & Swanson N. Suicide and Occupation: A Review of the Literature. J Occup Environ Med. 1995;37(4):442-52.

Buković D Jr, Carek V, Durek D, Kuna T & Keros J. Measurement of Magnetic Field in Dentistry. Coll Antropol. 2000;24(suppl 1):85-9. [Abstract]

Bureau of Economic Research and Statistics. Mortality of Dentists, 1968 – 1972. J Am Dent Assoc. 1975;90(1):195-8.

Carpenter LM, Swerdlow AJ & Fear NT. Mortality of Doctors in Different Specialties: Findings from a Cohort of 20000 NHS Hospital Consultants. Occup Environ Med. 1997;54(6):388-95.

Ćermáková E. Study of Extremely Low Frequency Electromagnetic Fields in Infant Incubators. Int J Occup Med Environ Health. 2003;16(3):215-20.

Chie WC, Chen CF, Chen CJ, Chang CL, Liaw YP & Lin RS. Geographic Variation of Breast Cancer in Taiwan: International and Migrant Comparison. Anticancer Res. 1995;15(6B):2745-9.

Chowanadisai S, Kukiattrakoon B, Yapong B, Kedjarune U & Leggat PA. Occupational Health Problems of Dentists in Southern Thailand. Int Dent J. 2000;50(1):36-40.

Das S. The Incidence of Suicides Among Physicians and Dentists: An Unexplained Story. Occup Med (Lond). 2008;58(2):150-1.

Davanipour Z, Tseng C-C, Lee P-J & Sobel E. A Case-control Study of Occupational Magnetic Field Exposure and Alzheimer's Disease: Results from the California Alzheimer's Disease Diagnosis and Treatment Centers. BMC Neurol. 2007;9:7-13.

Deadman JE & Infante-Rivard C. Individual Estimation of Exposures to Extremely Low Frequency Magnetic Fields in Jobs Commonly Held by Women. Am J Epidemiol. 2002;155(4):368-78.

Dunlay SM, Weston SA, Jacobsen SJ & Roger VL. Risk Factors for Heart Failure: A Population-based Case-control Study. Am J Med. 2009;122(11):1023-8.

Eisner MD, Blanc PD, Omachi TA, Yelin EH, Sidney S, Katz PP, Ackerson LM, Sanchez G, Tolstykh I & Iribarren C. Socioeconomic Status, Race, and COPD Health Outcomes. J Epidemiol Community Health. 2009 Oct 23. http://jech.bmj.com/

Eriksson M, Hardell L, Malker H & Weiner J. Increased Cancer Incidence in Physicians, Dentists, and Health Care Workers. Oncol Rep. 1998;5(6):1413-8.

Fasunloro A & Owotade FJ. Occupational Hazards Among Clinical Dental Staff. J Contemp Dent Pract. 2004;5(2):134-52.

Feychting A, Ahlbom A & Kheifets L. EMF and Health. Annu. Rev. Public Health. 2005;26:165-89.

Feychting M, Pedersen NL, Svedberg P, Floderus B & Gatz M. Dementia and Occupational Exposure to Magnetic Fields. Scand J Work Environ Health. 1998;24(1):46-53.

Firth HM, Cooke KR & Herbison GP. Male Cancer Incidence by Occupation: New Zealand, 1972-1984. Int J Epidemiol. 1996;25(1):14-20.

Floderus B, Persson T & Stenlund C. Magnetic-field Exposures in the Workplace: Reference Distribution and Exposures in Occupational Groups. Int J Occup Environ Health. 1996;2(3):226-38.

Floderus B, Persson T, Stenlund C, Wennberg A, Öst Å & Knave B. Occupational Exposure to Electromagnetic Fields in Relation to Leukemia and Brain Tumors: A Case-control Study in Sweden. Cancer Causes Control. 1993;4(5):465-76.

Floderus B, Stenlund C & Persson T. Occupational Magnetic Field Exposure and Site-specific Cancer Incidence: A Swedish Cohort Study. Cancer Causes Control. 1999;10(5):323-32.

Foliart DE, Iriye RN, Tarr KJ, Silva M, Kavet R & Ebi KL. Alternative Magnetic Filed Exposure Metrics: Relationship to TWA, Appliance Use, and Dempgraphic Characteristics of Children in a Leukemia Survival Study. Bioelectromagnetics 2001;22:574-80.

Forssén UM, Feychting M, Rutqvist LE, Floderus B & Ahlbom A. Occupational and Residential Magnetic Field Exposure and Breast Cancer in Females. Epidemiology. 2000;11(1):24-9.

Forssén UM, Mezei G, Nise G & Feychting M. Occupational Magnetic Field Exposure Among Women in Stockholm Country, Sweden. Occup Environ Med. 2004;61(7):594-602.

Galdas PM, Cheater F & Marshall P. Men and Health Help-seeking Behaviour: Literature Review. J Adv Nurs. 2005;49(6):616-23.

Gijbels F, Jacobs R, Princen K, Nackaerts O & Debruyne F. Potential Occupational Health Problems for Dentists in Flanders, Belgium. Clin Oral Invest. 2006;10(1):8-16.

Gikas A, Sotiropoulos A, Panagiotakos D, Peppas T, Skliros E & Pappas S. Prevalence, and Associated Risk Factors, of Self-reported Diabetes Mellitus in a Sample of Adult Urban Population in Greece: MEDICAL Exit Poll Research in Salamis (MEDICAL EXPRESS 2002). BMC Public Health. 2004;14(4):2-10.

Gonzalez JM, Alegría M, Prihoda TJ, Copeland LA & Zeber JE. How The Relationship of Attitudes toward Mental Health Treatment and Service Use Differs by Age, Gender, Ethnicity/Race and Education. Soc Psychiatry Psychiatr Epidemiol. 2009 Nov 17. http://www.springerlink.com

Grau Martín A, Flichtentrei D,Suñer R, Prats M & Braga F. Influence of Personal, Professional and Cross-national Factors in Bunout Syndrome in Hispanic Americans and Spanish Health Workers (2007). Rev Esp Salud Publica. 2009;83(2):215-30. [In Spanish: English abstract]

Håkansson N, Gustavsson P, Johansen C & Floderus B. Neurodegenerative Disease in Welders and Other Workers Exposed to High Levels of Magnetic Fields. Epidemiology. 2003;14(4):420-6.

Håkansson N, Gustavsson P, Sastre A & Floderus B. Occupational Exposure to Extremely Low Frequency Magnetic Fields and Mortality from Cardiovascular Disease. Am J Epidemiol. 2003;158(6):534-42.

Hayes MJ, Cockrell D & Smith DR. A Systematic Review of Musculoskeletal Disorders Among Dental Professionals. Int J Dent Hygiene. 2009;7(3):159-65.

Hostettler M & Minder C. Mortality of Swiss Dentists. Schweiz Monatsschr Zahnmed. 2002;112(5);456-62. [In German: English abstract]

Juel K, Mosbech J & Hansen ES. Mortality and Causes of Death Among Danish Medical Doctors 1973-1992. Int J Epidemiol. 1999;28(3):456-60.

Kannel WB. Incidence and Epidemiology of Heart Failure. Heart Fail Rev. 2000;5(2):167-73.

Kay EJ & Lowe JC. A Survey of Stress Levels, Self-Perceived Health and Health-related Behaviours of UK Dental Practitioners in 2005. Br Dent J. 2008;204(11):E19-28.

Labrèche F, Goldberg MS, Valois M-F, Nadon L, Richardson L, Lakhani R & Latreille B. Occupational Exposures to Extremely Low Frequency Magnetic Fields and Postmenopausal Breast Cancer. Am J Ind Med. 2003;44(6):643-52.

Lee JH, Lee HC, Kim HD, Kim JY, Kim DW, Nam YT & Kim KJ. How Much are Anesthesiologists Exposed to Electromagnetic Fields in Operating Rooms? Yonsei Med J. 2003;44(1):133-7.

Leggat PA, Chowanadisai S, Kedjarune U, Kukiattrakoon B & Yapong B. Health of Dentists in Southern Thailand. Int Dent J. 2001;51(5):348-52.

Leggat PA, Kedjarune U & Smith Dr. Occupational Health Problems in Modern Dentistry: A Review. Ind Health. 2007;45(5):611-21.

Leggat PA & Smith DR. Musculoskeletal Disorders Self-reported by Dentists in Queensland, Australia. Aust Dent J. 2006;51(4):324-7.

Li CY, Lin RS, Wu CH & Sung FC. Occupational Exposures of Pharmacists and Pharmaceutical Assistants to 60 Hz Magnetic Fields. Ind Health. 2000;38(4):413-19.

Li CY & Sung FC. A Review of the Healthy Worker Effect in Occupational Epidemiology. Occup Med (Lond). 1999;49(4):225-9.

Liaw YP, Huang YC & Lien GW. The Patterns of Lung Cancer Mortality in 23 Countries: The Application of Age-Period-Cohort Model. BMC Public Health. 2005;5:22-9.

Lin CM, Yang CH, Sung FC & Li CY. Risks and Causes of Hospitalizations Among Physicians in Taiwan. Health Serv Res. 2008;43(2):675-92.

Liu SH, Li TH, Lin YL, Shiao YJ, Wu SC, Li CY, Sung FC, Yang CY & Wu TN. Lower Morbidity and Disease Risk Among the Chinese Medicine Physicians Taiwan. Tohoku J Exp Med. 2009;219(3):207-14.

Liu SH, Wu CS, Lin YL, Hsiao YC, Yang CY, Sung FC, Li CY & Wu TN. Lower Mortality in Male Physicians of Chinese Medicine than Male Population in Taiwan. Tohoku J Exp Med. 2008;216(2):187-194.

McComb D. Occupational Exposure to Mercury in Dentistry and Dentist Mortality. J Can Dent Assoc. 1997; 63(5):372-6.

Mccurdy AL, Wijnberg L, Loomis D, Savitz D & Nylander-French LA. Exposure to Extremely Low Frequency Magnetic Fields Among Working Women and Homemakers. Ann Occup Hyg. 2001;45(8):643-50.

Mee T, Whatmough P, Broad L, Dunn C, Maslanyj M, Allen S, Muir K, McKinney PA & Tongeren MV. Occupational Exposure of UK Adults to Extremely Low Frequency Magnetic Fields. Occup Environ Med. 2009;66(9):619-27.

Mell LK, Dignam JJ, Salama JK, Cohen EEW, Polite BN, Dandekar V, Bhate AD, Witt ME, Haraf DJ, Mittal BB ,Vokes EE & Weichselbaum RR. Predictors of Competing Mortality in Advanced Head and Neck Cancer. J Clin Oncol. 2009 Nov 23. http://www.jco.org.

Meltzer H, Griffiths C, Brock A, Rooney C & Jenkins R. Patterns of Suicide by Occupation in England and Wales: 2001 – 2005. Br J Psychiatry. 2008;193(1):73-6.

Miller AB, To T, Agnew DA,Wall C & Green LM. Leukemia following Occupational Exposure to 60-Hz Electric and Magnetic Fields Among Ontario Electric Utility Workers. Am J Epidemiol. 1996;144(2):150-60.

National Institute for Occupational Safety and Health, National Institute of Environmental Health Sciences, U.S. Department of Energy. Questions and Answers: EMF in the Workplace. Electric and Magnetic Fields Associated with the Use of Electric Power. 2002 Jun. http://www.niehs.nih.gov/emfrapid

Parsa P & Parsa B. Effects of Reproductive Factors on Risk of Breast Cancer: A Literature Review. Asian Pac J Cancer Prev. 2009;10(4):545-50.

Paul M, Hammond SK & Abdollahzadeh S. Power Frequency Magnetic Field Exposures Among Nurses in a Neonatal Intensive Care Unit and a Normal Newborn Nursery. Bioelectromagnetics. 1994;15(6):519-29.

Peidró EC, Romero SO & Sala EC. Prevalence of Smoking Among Dentists in Catalonia – Spain (2006). Literature Review of Smoking Cessation Practices in the Dental Office. Med Oral Patol Cir Bucal. 2008;13(10):E671-7.

Petersen MR & Burnett CA. The Suicide Mortality of Working Physicians and Dentists. Occup Med (Lond). 2008;58(1):25-9.

Petrucci N. Exposure of the Critically Ill Patient to Extremely Low-frequency Electromagnetic Fields in the Intensive Care Environment. Intensive Care Med. 1999;25(8):847-51.

Philips KL, Morandi MT, Oehme D & Cloutier PA. Occupational Exposure to Low Frequency Magnetic Fields in Health Care Facilities. Am Ind Hyg Assoc J. 1995;56(7):677-85.

Puriene A, Aleksejuniene J, Petrauskiene J, Balciuniene I & Janulyte V. Self-Reported Occupational Health Issues Among Lithuanian Dentists. Ind Health. 2008;46(4):369-74.

Radillo BEP, López TMT, Velasco M de LAA, Fernández MA & Perez GJG. Stress-associated Factors in Mexican Dentists. Braz Oral Res. 2008;22(3):223-8.

Riminesi C, Andreuccetti D, Fossi R & Pezzati M. ELF Magnetic Field Exposure in a Neonatal Intensive Care Unit. Bioelectromanetics. 2004;25(7):481-91.

Rix BA & Lynge E. Cancer Incidence in Danish Health Care Workers. Scand J Soc Med. 1996;24(2):114-20.

Roh JH, Kim DW, Lee SJ, Kim JY, Na SW, Choi SH & Kim KJ. Intensity of Extremely Low-frequency Electromagnetic Fields Produced in Operating Rooms during Surgery at the standing Position of Anesthesiologists. Anesthesiology. 2009;111(2):275-8.

Rolander B, Karsznia A, Jonker D, Öberg T & Bellner A-L. Perceived Contra Observed Physical Work Load in Swedish Dentists. Work. 2005;25(3):253-62.

Rolander B, Stenstrom U & Jonker D. Relationships Between Psychosocial Work Environmental Factors, Personality, Physical Work Demands and Workload in a Group of Swedish Dentists. Swed Dent J. 2008;32(4):197-203.

Shimpo H & Yokoyama E. Causes of Death and Life Expectancies Among Dentists. Int Dent J. 1998;48(6):563-70.

Simning A & Wijngaarden E. Literature Review of Cancer Mortality and Incidence Among Dentists. Occup Environ Med. 2007;64(7):432-8.

Smith DR & Leggat PA. A Comparison of Tobacco Smoking Among Dentists in 15 Countries. Int Dent J. 2006;56(5):283-8.

Smith DR & Leggat PA. An International Review of Tobacco Smoking in the Medical Profession: 1974 – 2004. BMC Public Health. 2007;20(7):115-26.

Smith LK, Pope C & Botha JL. Patients' Help-seeking Experiences and Delay in Cancer Presentation: a Qualitative Synthesis. Lancet. 2005;366(9488):825-31.

Stenlund C & Floderus B. Occupational Exposure to Magnetic Fields in Relation to Male Breast Cancer and Testicular Cancer: A Swedish Case-control Study. Cancer Causes Control. 1997;8(2):184-91.

Tanaka H, Nishio N, Tokunaga R & Tsukuma H. Liver Cancer Risk in Japanese Male Dentists: A Long-Trem Restrospective Cohort Study. J Occup Health. 2004;46(5):398-402.

Thompson WT, Cupples ME, Sibbett CH, Skan DI & Bradley T. Challenge of Culture, Conscience, and Contract to General Practitioners' Care of Their Own Health: Qualitative Study. BMJ. 2001;323(7315):728-31.

van Tongeren M, Mee T, Whatmough P, Broad L, Maslanyj M, Allen S, Muir K & McKinney P. Assessing Occupational and Domestic ELF Magnetic field Exposure in the UK Adult Brain Tumor Study: Results of a Feasibility Study. Radiat Prot Dosimetry. 2004;108(3):227-36.

Walker AM. Observation and Inference: An Introduction to the Methods of Epidemiology. 1st ed.. American: Epidemiology Resources Inc.. 1991;100-18.

World Health Organization. World Health Statistics 2009. In: Health Workforce, Infrastructure, Essential Medicines. Switzerland: WHO Press. 2009;95-105.

Zitzmann NU, Chen MD & Zenhäusern R. Frequency and Manifestations of Back Pain in the Dental Profession. Schweiz Monatsschr Zahnmed. 2008;118(7):610-8. [In German: English abstract]

Zwemer JD & Williams JE. Dentist Health Status and Risks. J AM Coll Dent. 1987;54(4):7-12.

中華民國醫院行政協會病歷委員會編：ICD-9-CM中英對照。增訂版。台北市：巨流圖書公司 1993年10月。

行政院主計處：統計地區標準分類。http://www.dgbas.gov.tw/lp.asp?ctNode=3217&CtUnit=226&BaseDSD=7 引用2008/12/17。

行政院衛生署：衛生統計系列（二）醫療機構現況及醫院醫療服務量統計。http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=9511&class_no=440&level_no=1 引用2009/9/7。

行政院衛生署：衛生統計系列（四）全民健康保險醫療統計。http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=9513&class_no=440&level_no=1 引用2009/9/7。

林姬妙：台灣地區醫事人員之住院風險分析。國立台北護理學院醫護管理研究所碩士論文 2005，89頁。

財團法人醫院評鑑暨醫療品質策進會：95 - 97年度醫院評鑑及教學醫院評鑑合格名單分類。http://www.tjcha.org.tw/hafee/list.aspx 引用2009/8/16。

黃怡瑾：女性護理人員之罹病風險及常見疾病之研究。天主教輔仁大學公共衛生研究所碩士論文 2006，154頁。

廖勇柏，羅珮云，徐書儀：利用行政區域重新分類臺灣地區為十一區以探索癌症死亡率之地理變異。中山醫學雜誌 2003；14(2)：287-95。

劉立文：紅外線及低頻電磁場量測方法建立研究。初版。台北縣：行政院勞工委員會勞工安全衛生研究所 1998；51-4。