| Abstract: | 本文採用Andersen行為模式探討台灣高齡人口醫療服務使用情形，研究對象為國民健康局2007年的台灣地區中??身心社會生活?況長期追蹤調查資料，納入條件為78歲以上的高齡受訪個案，有效樣本數為1,261人。本研究結果發現，高齡老人的疾病盛行率前三名為白內障(55.4%)、高血壓(48.5%)、心臟病(28.7%)，對日常生活影響較大者則為髖骨骨折(64.7%)、中風(55.6%)、關節炎/風濕(38.2%)。自認一年內的健康狀態變差者佔半數以上(57.0%)，自評健康狀態良好者僅有21.0%，曾使用急診醫療服務者約為23.6%，曾使用西醫門診者則高達92.1%。影響高齡老人使用急診或西醫門診的醫療服務行為的傾向因素為獨居，使能因素為經濟滿意度或居住地區，需要因素則為自評健康狀態、疾病種類、行走能力等。本研究提出台灣地區高齡人口主要的健康問題，以及影響其使用醫療服務行為的可能因素，可供政府未來制定老人醫療照護政策的政要參考依據。本研究結果可供制定高齡老人醫療服務政策及後續相關研究的參考，並期能夠使高齡老人獲得更好的醫療服務及較佳的老年生活品質。
Klebsiella pneumoniae belongs to the Enterobacteraceae family. It is a community-acquired and nosocomial pathogen which can causes pneumonia, sepsis, meningitis, liver abscess, endophthalmitis, urinary tract infection, and wound infections. Liver abscess in Taiwan is mostly caused by K. pneumoniae. This is different from Western countries, where liver abscess is mainly attributed to mixed infections of Escherichia coli, Streptococcus and anaerobes. Although K. pneumoniae-caused liver abscess (KLA) has its clinical importance and uniqueness in Taiwan, our knowledge about its pathogenesis mechanism is still limited. The goal of this study is to determine the detailed mechanism of how the intestine-colonized K. pneumoniae disseminate into the liver tissues. Based on the oral infection model established in our lab, this study determined the bacterial loads of mouse tissues by using a CFU counting method and an immunohistochemistry staining method. At the early stage of infection, a large quantity of K. pneumoniae was detected in mesenteric lymph nodes (MLN), Peyer's patches (PP) and the liver. Similarly, the intraperitoneal-injected K. pneumoniae were observed in the right and left abdominal lymph nodes with the aid of in vivo imaging system (IVIS). The results suggested that the lymph system might provide K. pneumoniae a pathway to spread from intestines to the liver. To further investigate whether a specific subset of immune cells can deliver K. pneumoniae, FACS analysis of T cells, B cells, and macrophages, which were isolated from the GFP-K. pneumoniae infected mice showed that this bacterium might be carried inside B cells. As compared to the control mouse, an elevated level of IL-10 was detected in the K. pneumoniae-infected mice at 2 and 6 hour post-inoculation (hpi), suggesting that immune evasion might have a role in the early stage of K. pneumoniae infections. At 48 hpi, inflammation and apoptosis were detected in the K. pneumoniae-infected lymph nodes and liver tissues. |
