• 沒有找到結果。

第五章 結論與建議

第三節 建議

提供後續相關研究建議:

1. 提高問卷回收樣本數,以減少估計參數變異性,而取得更佳之估計值。

2. 倘若無法有效增加研究樣本數,則研究範圍可細分建築工程業、土木工程 業、專門營造業內之從業人員,或專注在室內裝修工程、隧道工程等普遍 認知暴露濃度與頻率較高之較細項營造業。

3. 約兩成從業人員表明戴口罩不舒適或作業時不方便,故可進一步研究如 何讓戴口罩者能舒適工作,以減少影響作業時不便而不戴口罩。例如:市 售口罩是否有哪些款式對使用者之舒適性較高?

4. 本研究未探討營建業人員是否了解其工作環境肺癌致癌因子,問卷題目 可針對於認為工作環境會導致肺癌者,再詢問是否曉得致癌物有哪些。

5. 迴歸模型中,變數的意義與問卷內容的轉換仍有調整的空間。如:是否吃 檳榔、吸菸、飲酒之參數是否改為食用量衡量,以了解食用量多寡是否會 對身體狀況或認知產生效果;問卷中詢問頻率之選項,是否改為數值區間 (例:一週幾次,每次暴露時間),而較容易填答與解釋計量關係的意義。

6. 本研究取得主觀問卷與訪談資料,建議能以客觀地採樣與主觀地問卷搭 配,或是區域採樣、個人採樣與生物檢驗一起進行,可了解工作實際暴露 量與認知暴露量的差異,甚至能採用時間縱向之研究分析法(世代研究、

病例對照)進行職業歸因。

參考文獻

英文部分

Acutt, J. & Hattingh, S. (2003). Occupational Health: Management and Practice for Health Practitioners, Third Edition, JATA, p166, Retrieved from https://books.google.com.tw

Alavanja, M.C., Brown, C.C., Swanson, C., and Brownson, R.C. (1993). “Saturated fat intake and lung cancer risk among nonsmoking women in Missouri.” J Natl Cancer Inst., 85(23), 1906-1916.

Arheart, K.L., Lee, D.J., Dietz, N.A., Wilkinson, J.D., Clark, III J.D., LeBlanc, W.G., Serdar, B., and Fleming, L.E. (2008). “Declining Trends in Serum Cotinine Levels in U.S. Worker Groups: The Power of Policy.” Journal of Occupational and Envi ronmental Medicine, 50(1), 57–63

Armstrong, B., Hutchinson, E., Unwin, J., Fletcher, T. (2004). “Lung Cancer Risk after Exposure to Polycyclic Aromatic Hydrocarbons: A Review and Meta-Analysis.”

Environ Health Persp, 112(9), 970-978

Bakke, B., Ulvestad, B., Stewart, P., and Eduard, W. (2004). “Cumulative exposure to dust and gases as determinants of lung function decline in tunnel construction work ers.” Occup Environ Med, 61, 262–269

Garshick, E., Laden, F., Hart, J.E., Rosner, B., Davis, M.E., Eisen, E.A., and Smith, T.J.

(2008). “Lung Cancer and Vehicle Exhaust in Trucking Industry Workers.” Envi ronmental Health Perspectives, 116(10), 1327-1332

Goodman, M.T., Hankin, J.H., Wilkens, L.R., and Kolone, L.N. (1992). “High-Fat Foods and the Risk of Lung Cancer.” Epidemiology, 3(4), 288-299

Health and Safety Executive (2012). The burden of occupational cancer in Great Britain, 52-60, London : Crown

Hutchings, S.J., Rushton, L. with the British Occupational Cancer Burden Study Group (2012a). “Occupational cancer in Britain Industry sector results.” British Journal of Cancer,107, 92–103

Hutchings, S.J., Rushton, L. with the British Occupational Cancer Burden Study Group (2012b). “Occupational cancer in Britain Statistical methodology.” British Journal of Cancer,107, 8–17

International Agency for Research on Cancer (2013). Air Pollution and Cancer, IARC Scientific Publication, No.161, 75-94

ILO(2010). List of occupational diseases (revised 2010) Identification and recognition of occupational diseases: Criteria for incorporating diseases in the ILO list of occupa tional diseases, Occupational Safety and Health Series, No. 74

Ko, Y.C., Lee, C.H., Chen, M.J., Huang, C.C., and Chang, W.Y. (1997). “Risk Factors for Primary Lung Cancer among Non-Smoking Women in Taiwan.” International Journal of Epidemiology, 26(1), 24-31

Lo, W.C., Shie, R.H., Chan, C.C., and Lin, H.H. (2016). “Burden of disease attributable to ambient fine particulate matter exposure in Taiwan.”, Journal of the Formosan Medical Association,DOI: http://dx.doi.org/10.1016/j.jfma.2015.12.007

Melkonian, S.C., Daniel, C.R., Ye, Y., Pierzynski, J.A., Roth, J.A., and Wu, X. (2016).

“Glycemic Index, Glycemic Load, and Lung Cancer Risk in Non-Hispanic Whites.”

Cancer Epidemiol Biomarkers Prev, 25, 532

Tjoe Nij, E., Hilhorst, S., Spee, T., Spierings, J., Steffens, F., Lumens, M. and Heederik, D. (2003). “Dust Control Measures in the Construction Industry.” The Annals Oc-cupational of Hygiene, 47(3), 211–218

Pope, C.A., Burnett, R.T., Thun, M.J., Calle, E.E., Krewski, D., Ito, K., and Thurston, G.D. (2002). “Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution.” Journal of the American Medical Association, 287, 1132–1141.

Pope, C.A., Ezzati, M., and Dockery, D.W. (2009). “Fine-particulate matter air pollution and life expectancy in the United States.” New England Journal of Medicine, 360(4), 376-386

Liesbeth, P., van den Bosch L.M.C., van den Brandt P.A., Kauppinen T., Goldbohm R.A.

(2010). “Occupational exposure to silica and lung cancer risk in the Netherlands.”

Occup Environ Med, 67(10), 657-663

Rushton, L., Hutchings, S.J., Fortunato, L., Young, C., Evans, G.S., Brown, T., Bevan, R., Slack, R., Holmes, P., Bagga, S., et al., (2012). “Occupational cancer burden in Great Britain.” British Journal of Cancer, 107, S3-S7

Ulvestad, B. , Bakke, B., Eduard, W , Kongerud, J., and Lund, M.B. (2001). “Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers.” Oc cupational and Environmental Medicine, 58(10), 663-669

U.S. Department of Health and Human Services (2006), The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. At

lanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, pp.423-445

U.S. Department of Health and Human Services (2014), The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA:

U.S. Department of Health and Human Services, Centers for Disease Control and

Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, pp.139-293

中文部分

王國川譯;Peterson, R. A.著(2010),如何編製優質的問卷,臺北:五南圖書 王榮德、潘致弘(2010),增列職業性癌症診斷基準與實證研究(I),勞安所研究報告 王榮德、潘致弘(2013),我國職業性癌症推估模式之研究(I),勞安所研究報告 石曜堂等著;王榮德總編輯(2015),公共衛生學上冊,第五版,臺北:臺大出版 中心,陳拱北預防醫學基金會

如何早期發現及治療肺癌(2011),僧伽醫護會刊,第 68 期,18-25 頁 何肇基(2015),肺癌與一般肺疾異同點,台大醫網,118 期,10-12 頁 李岡遠(2014),肺癌與環境汙染,聲洋防癌之聲,143 期,9-12 頁

林志文、賴俊良、簡迺娟(2006),肺結核與肺癌之分合,慈濟醫學雜誌,18 卷 6 期,

47-53 頁

李書安、李和益、蔡杰孚、陳春萬、吳杰亮(2015),濾材與孔隙洩漏以及呼吸模式 對簡易型防塵口罩整體防護效率的影響,勞動及職業安全衛生研究季刊,23 卷 李俊賢、潘致弘(2015),我國職業性癌症推估模式之研究(II),勞安所研究報告 李聯雄、莊坤遠(2012),裝潢業矽酸鈣板遊離二氧化矽含量調查研究,勞安所研究

報告

邱清華等合著(2009),公共衛生學,臺北:華杏出版股份有限公司

林洺秀、郭智宇(2014),工作環境安全衛生狀況認知調查—2013 年,勞安所研究 報告

胥愛琦(2013),計量經濟學,五版,臺北:華泰文化

郭星華、譚國清(1997),問卷調查技術與實例,中國:中國人民大學出版社 湯大同(2003),建築用矽酸鈣板材中石綿釋出問題探討,勞安所研究報告

張芳全(2008),問卷就是要這樣編,臺北:心理出版社股分有限公司

葛應欽(1996),台灣空氣污染與社區居民健康效應,高雄醫學科學雜誌,12 卷,657- 669 頁

環保署(2015),認識細懸浮微粒,行政院環境保護署,1~17 頁

劉會平(2004),肺癌診斷與治療,腫瘤護理雜誌,第四卷,第二期,25-33 頁 潘致弘(2008),烹飪油煙對餐飲業員工氧化傷害與心血管效應研究,博士論文,臺

北:國立臺灣大學職業醫學與工業衛生研究所,

潘韻如、陳惠民(2010),利用腫瘤球體及晶片形態模型來研究抗癌胜肽藥物與肺癌 細胞之作用,奈米通訊卷期,17 卷 3 期,11-15 頁

鄭瑞雄(2014),不吸菸也得肺癌,臺灣醫界,57 卷 1 期,22-24 頁

網站資料

ABC(2015/10/23). Australians 'at risk' from asbestos in imported building products http://www.abc.net.au/news/2015-10-23/new-evidence-australians-at-risk-asbestos-imported-products/6879856

COMMISSION REGULATION (EU) No 1272/2013 http://eur-lex.europa.eu/legal-con-tent/EN/TXT/?uri=CELEX:32013R1272

Health and Safety Executive(HSE)(2015). Occupation and cancer in Britain.

http://www.hse.gov.uk/statistics/causdis/cancer/cancer.pdf

Health and Safety Executive(HSE). Health and safety in construction sector in Great British 2014-15 http://www.hse.gov.uk/statistics/industry/construction/construc-tion.pdf

IARC Monographs online http://monographs.iarc.fr/ENG/Monographs/PDFs/

International Ban Asbestos Secretariat By Laurie Kazan-Allen(2013) http://www.ibasec-retariat.org/prof_un.php

The world health report 2002 - Reducing Risks, Promoting Healthy Life http://www.who.int/whr/2002/en/

WHO Environmental and occupational cancer http://www.who.int/mediacentre/fact-sheets/fs350/en/

WHO(1975). Early detection of health impairment in occupational exposure to health

hazards : report of a WHO study group, p78 http://apps.who.int/iris/bit-stream/10665/41162/1/WHO_TRS_571_eng.pdf

Wikipedia: Asbestos https://en.wikipedia.org/wiki/Asbestos 中華民國統計資訊網:行政院主計處—就業統計

http://www.stat.gov.tw/ct.asp?xItem=37135&ctNode=517&mp=4 台大醫院健康電子報,2009 年第 15 期

http://epaper.ntuh.gov.tw/health/200902/teams.html 全國法規資料庫 http://law.moj.gov.tw/Index.aspx 行政院主計處—行業標準分類

http://www.dgbas.gov.tw/ct_view.asp?xItem=38959&ctNode=3374 行政院環境保護署http://www.epa.gov.tw/mp.asp?mp=epa

非小細胞肺癌實踐指南 NCCN,2015

http://www.nccnchina.org.cn/files/NSCLC_7.2015_ac-tive_122214_ZH_FULL_V2.pdf

英國職業安全衛生署局部排氣裝置指引-IOSH 翻譯版 101-12

http://laws.ilosh.gov.tw/book/Other_Public_Publish.aspx?PID=224&UID=F7413 美 國 疾 病 控 制 與 預 防 中 心 (Centers for Disease Control and Prevention , CDC)

http://www.cdc.gov/

植根法律網 http://www.rootlaw.com.tw/index.aspx

鹿特丹公約 http://www.pic.int/Home/tabid/855/language/en-US/Default.aspx

郭錦堂、高木敬彥、後藤純雄(2014),日本東北地震災區環境中石綿污染現況,2014 職業衛生研討會暨海峽兩岸職業衛生學術交流會,臺灣大學公共衛生學院 http://2014toha.rulingcom.com/files/archive/124_da0264b1.pdf

勞動部勞工保險局—職災統計資料

http://www.bli.gov.tw/sub.aspx?a=oAtWtl7cf%2bs%3d

勞動部勞動及職業安全衛生研究所—勞動部相關研究報告 http://www.ilosh.gov.tw/wSite/mp?mp=11

勞動部職業安全衛生署,石綿作業勞工特殊體格及健康檢查紀錄 http://www.osha.gov.tw/1106/1119/1141/13440/13570/

經濟部標準檢驗局(2004),隔間板材標示新規定,保障消費使用安全,檢度政資 訊,第七期,第 6 頁

http://www.bsmi.gov.tw/bsmiGIP/wSite/public/Data/f1221534098531.pdf 臺灣財政部關務署,統計資料庫查詢系統 https://portal.sw.nat.gov.tw/APGA/GA01 衛生服務部國民健康署,2014 臺灣菸害防制年報

http://www.hpa.gov.tw/BHPNet/Portal/file/FormCenter-File/201503030301563825/2014%E8%8F%B8%E5%AE%B3%E9%98%B2%E5

%88%B6%E5%B9%B4%E5%A0%B1%20(%E4%B8%AD%E6%96%87%E7%8 9%88)%20.pdf

職業安全衛生教育訓練中心,呼吸防護技術

http://ercs.tajen.edu.tw/downloads/newerc/93n02ppt.pdf

附錄

II. Part 2

□沒有 □灑水 □口罩 □抽風、通風設備 □其它____________________________

 您是否認為工作環境會導致肺部疾病? □是 □否

附錄 2 專家訪談內容

5. 您認為下列方面如何影響這些呼吸道疾病防護措施?

I. 國家作業規定有哪些?

II. 什麼樣的公司對規定、罰則要求較多、嚴格?(公司規模有關嗎?主要與 管理人有關?)

III.勞工個人態度及行為如何?

IV. 影響實際防護狀況之重要性排序(國家規定、公司要求、個人態度)?

6. 您印象中,是否會有師傅們罹患肺疾的比例比其它朋友高?

7. 您是否有上述之外,暴露於粉塵、石綿、柴油廢氣、有機溶劑等影響呼吸道

防護的資訊補充或建議?