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系統識別號 U0026-2708201517170100
論文名稱(中文) 應用遙測技術以探討環境綠蔽度對思覺失調症之影響
論文名稱(英文) Linking Surrounding Greenness and Schizophrenia using Remote Sensing
校院名稱 成功大學
系所名稱(中) 環境醫學研究所
系所名稱(英) Institute of Environmental and Occupational Health
學年度 103
學期 2
出版年 104
研究生(中文) 張皓庭
研究生(英文) Hao-Ting Chang
學號 S76021012
學位類別 碩士
語文別 英文
論文頁數 58頁
口試委員 指導教授-蘇慧貞
共同指導教授-吳治達
口試委員-莊佳蓉
口試委員-郭炤裕
中文關鍵字 環境綠蔽度  思覺失調症  心理健康  空間資訊學  常態化差異植生指標 
英文關鍵字 Greenness  Schizophrenia  Mental Health  Spatial Informatics  Normalized Difference Vegetation Index 
學科別分類
中文摘要 全球化促進了世界各國經濟體間之連結,然而,隨著都市化以及經濟的快速發展,強烈的競爭環境不僅造成了人類心理上的壓力,擁擠的生活空間以及環境汙染亦使得心理壓力與日俱增,無法得到適當的紓解;加上氣候變遷日益嚴重,極端氣候事件的發生頻率逐漸增加,此不僅造成全球生態系統的改變,進一步也影響人類的生活品質與身心健康。許多研究已證實,環境綠蔽度對於人類生理和心理均有正面助益。基於此,本研究擬應用地理資訊系統、遙感探測等空間資訊技術,搭配中央氣象局所提供的氣象數據,以探討台灣地區發生比例最高的思覺失調症與環境綠蔽度之風險關係。

本研究以台灣全島為研究地區,研究中使用全民健康保險研究資料庫中的承保抽樣歸人檔,並從中選出2000年到2010年思覺失調症新發生病例作為病例對象、以及使用中央氣象局各測站所提供的氣象資料進而模擬推估面尺度的氣象資料,包含:溫度、雨量、日照和濕度資料,還有使用美國地質調查局 (US. Geological Survey) 長期提供可用來代表植物生長情況的常態化差異植生指標,進而評估環境綠蔽度。研究中首先使用熱點效應來探討思覺失調症在空間上的群聚效應。接著,透過Cox比例風險模型(Cox Proportional Hazards Model),評估思覺失調症與環境綠蔽度之風險關係。然後,利用敏感度分析和分層分析來對結果進行驗證。敏感度分析的部分,研究是把環境綠蔽度以四分位做為分組依據;分層分析部分,是利用年齡的三分位和投保金額的中位數將其分層,進行後續分析。

研究結果顯示,思覺失調症盛行率隨著研究時間有上升的趨勢。熱點分析顯示研究初期宜蘭市、花蓮市、高雄市為思覺失調症的熱點地區,到了研究末期,熱點擴張,新增了新北市和台中市。接著,在校正可能的人口學變數、社會經濟變數、氣象因子後,從Cox比例風險分析中計算求得,不同尺度環境綠蔽度對思覺失調症的係數均達到統計上顯著的負相關 (P<0.05);再轉換成風險值後 (Hazard Ratio),所有的值均小於1,表示環境綠蔽度的暴露可以提供人們保護作用,降低罹患思覺失調症的風險。後續的敏感度分析和分層分析亦觀察到相似的結果。

本研究利用全台尺度的世代追蹤來探討環境綠蔽度和思覺失調症的關係,其結果顯示,當人們暴露愈多的環境綠蔽度,便能降低愈多罹患思覺失調症的風險。然而,現今台灣正臨都市興起,綠地面積減少之時,因此我們誠心建議都市設計規劃人員,在考量可見的經濟發展同時,不忘環境綠蔽度對於思覺失調症無形的正面效益。
英文摘要 With the globalization accompanied by rapid economic growth, human society suffers increased psychological stress arisen from internally competitions. The rapid progression of urbanization in each country worldwide produces more environmental pollution and unhealthy environment in urban cities that increases human mental burden, partly due to lack of comforting channels. Moreover, climate change is an emerging issue which causes more frequent extreme weather events such as the extreme precipitation and heat waves driven by global warming. This situation affects not only the ecosystem but also human health. Recent studies indicate that the extreme weather may potentially affect mental health, whereas some preliminary evidence suggests that forest and vegetation may alleviate the adverse effects driven by extreme weather though the findings are not conclusive. Therefore, it is important to utilize a well-designed study to further clarify the relationship between greenness and top three rank mental disorder in Taiwan, Schizophrenia.

In this study, we selected the whole Taiwan island as the study area. Databases employed in this study including the incident cases of schizophrenia from 2000 to 2010 were obtained form Longitudinal Health Insurance Database (LHID) of the Health Insurance Research Database (NHIRD); meteorological factors such as temperature, precipitation, solar radiation, and humidity were acquired from the Central Weather Bureau; and the long-term Normalized Difference Vegetation Index (NDVI) records serving as a surrogate of greenness was obtained from the US. Geological Survey (USGS). The hot-spot analysis was used to examine the spatial clustering of schizophrenia within the island. Cox proportional hazards model was utilized to assess the association between surrounding greenness and schizophrenia. Parameter estimates from various buffer size of greenness estimations were compared for the sensitivity test. Then, insurance amount and age were used as the stratification variables, stratifying the entirety of the data into several groups by the tertile and median of the two variables, respectively, such as young people/middle aged people/elderly, and poorer/richer people. The results were then applied to assess the effect of these different strata of people on greenness effects.

The results indicated that, the prevalence of schizophrenia showed an increasing trend over the study period. Hot-spot analysis showed that hot spot zones of schizophrenia were found in Yilan City, Hualien City and Kaohsiung City in 2000. The centers were then expanded to Yilan City, New Taipei City, Taichung City, Hualien City, and Kaohsiung City in 2010. As for the results of statistical analysis, after adjustments for the available demographic, social-economic, and meteorological factors, the coefficients of surround greenness showed a significantly (p<0.05) negative association with the occurrence of schizophrenia regardless of which buffer distance was considered. The values of hazard ratio obtained from various buffers sizes were consistently smaller than one, indicating exposure to surrounding greenness provides protective effects to people and therefore reducing their risk from schizophrenia. Results of sensitivity analysis and stratified analysis again demonstrated the robustness of the model estimates.

This study used a national scale longitudinal database to investigate the effect between surrounding greenness and schizophrenia. The results showed that people with higher exposure to greenness show lower risk to schizophrenia. Green space in Taiwan face a great challenge from the rapid urbanization. We suggest urban planners should not only consider the visible economic developments, but also the invisible effects of greenness on mental health.
論文目次 中文摘要 I
Abstract III
致謝 V
Table and Contents VI
List of Tables VIII
List of Figures IX
1. Introduction 1
2. Literature Review 2
2.1 Schizophrenia 2
2.1.1 Causes (Risk Factors) 3
2.1.1.1 Genes and Environment 3
2.1.1.2 Different Brain Chemistry and Structure. 4
2.1.1.3 Age 5
2.1.2 Signs and Symptoms 5
2.1.2.1 Positive Symptoms 5
2.1.2.2 Hallucinations 5
2.1.2.3 Delusions 6
2.1.2.4 Thought Disorders 6
2.1.2.5 Movement Disorders 6
2.1.2.6 Negative Symptoms 6
2.1.2.7 Cognitive Symptoms 7
2.1.3 The Health Benefits of Greenness 7
2.1.3.1 Physical Activity 8
2.1.3.2 Overweight/Obesity 9
2.1.3.3 Birth and Developmental Outcomes 9
2.1.3.4 Cardiovascular Outcomes 9
2.1.3.5 Mortality 10
2.1.3.6 Inequalities 10
2.1.3.7 Physiological Activity 11
2.1.3.8 Mental Health 15
3. Materials and Methods 17
3.1 Databases 17
3.1.1 Longitudinal Health Insurance Database 17
3.1.2 Remotely Sensed Greenness Database 18
3.1.3 Meteorological Database 22
3.3 Statistical Analysis 24
3.4 Sensitivity Test 29
3.5 Stratified Analysis 29
4. Results 30
4.1 Spatial-temporal Trends of Schizophrenia 30
4.2 Descriptive Statistics 34
4.3 Model Analysis and Sensitivity Test 36
4.4 Stratified Analysis 39
5. Discussion 44
6. Conclusion 47
Reference 48
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