42卷4期

• 政策論壇 Policy Forum
• 失智症預防策略The strategies of dementia prevention
• 陳怡君
  Yi-Chun Chen
• 無none
  無none
• 無none
  無none
• 349-351
• 無none

• 公衛論壇 Public Health Forum
• 過度登錄與台灣新生兒死亡率上升Over-registration and increasing neonatal mortality in Taiwan
• 梁富文、呂宗學、江東亮
  Fu-Wen Liang, Tsung-Hsueh Lu, Tung-liang Chiang
• 無none
  無none
• 無none
  無none
• 352-359
• 無none

• 公衛論壇 Public Health Forum
• 公衛學會五十周年紀念專文一：公共衛生師報考資格與執業範圍之研議始末Taiwan Public Health Association 50th Anniversary Commemorative Article I: deliberation on the eligibility and scope of practice for Public Health Specialists
• 李玉春、陳保中、楊佳樺、吳肖琪、邱弘毅、陳美蓮、郭鐘隆、楊銘欽、蕭朱杏、王姿乃、李中一、吳章甫、鄭守夏、鄭其嘉、蔡文正
  Yue-Chune Lee, Pau-Chung Chen, Jia-Hwa Yang, Shiao-Chi Wu, Hung-Yi Chiou, Mei-Lien Chen, Jong-Long Guo, Ming-Chin Yang, Chu-Hsing Hsiao, Tsu-Nai Wang, Chung-Yi Li, Chang-Fu Wu, Shou-Hsia Cheng, Chi-Chia Cheng, Wen-Chen Tsai
• 無none
  無none
• 無none
  無none
• 360-373
• 無none

• Link 原著 Original Article
• 台灣男性工作者的年度噪音暴露劑量和聽閾及耳石-前庭功能之相關Study on hearing thresholds shift and otolith-vestibular function associated with annual noise exposure doses in male workers in Taiwan
• 郭姿吟、張宸瑋
  Tzu-Yin Kuo, Chen-Wei Chang
• 年度噪音暴露劑量、男性工作者、耳石-前庭功能、聽閾變化
  annual noise exposure doses, male worker, otolith-vestibular function, hearing thresholds shift
• 目標：本研究旨在探究男性工作者年度噪音暴露劑量（ANE）和聽力及前庭功能之相關。方法：我們給予噪音暴露組（NE）51人和對照組（CR）29人，施測純音聽力檢查、頸部和眼部前庭誘發肌電位測驗（VEMPs），並以台灣華語版職業暨休閒娛樂噪音暴露問卷，分別計取得聽力閾值、耳石-前庭功能以及ANE。結果：NE組的平均ANE（85.8 dBA, SD = 5.05）顯著高於CR組（67.9 dBA, SD = 2.93）（p < .001）。聽力方面，ANE和3,000及4,000 Hz純音聽閾有顯著低至中度正相關（r = 0.283-0.385, p < .05），ANE數值越高，此兩個頻率聽閾值則越差。此外，噪音暴露和年齡增長都會加重高頻3,000，4,000，6,000 Hz的聽閾值。兩種前庭肌電位檢查均顯示兩耳間振幅差異比在NE組（cVEMPs: 28.9%; oVEMPs: 26.7%）的異常比例高於CR組（cVEMPs: 17.4%; oVEMPs: 0%），且NE組整體VEMPs異常的風險比是CR組的4.54倍（95%CI [1.33, 15.49]）。結論：年度噪音暴露劑量（ANE）過高的工作者，不僅是噪音型聽力損失高風險族群，其耳石-前庭神經路徑功能檢測異常的比例也較高。建議職場高噪音暴露人員，除監控其聽閾變化，也應關注內耳前庭系統的潛在傷害。
  Objectives: This study explores the relationships between personal annual noise exposure doses (ANE), and hearing thresholds, and otolith-vestibular function. Methods: We recruited 51 male workers who had exposed to noise in the past year for the noise-exposed group (NE) and 29 men without noise exposure for the control group (CR). We used pure tone audiometry, cervical and ocular vestibular-evoked myogenic potentials (VEMPs) tests, and “the annual noise exposure questionnaire-Taiwan Mandarin version” to evaluate hearing thresholds, otolith-vestibular neural pathway and the ANE doses, respectively. Results: The mean ANE was higher in the NE group (85.8 dBA, SD = 5.05) than in the CR group (67.9 dBA, SD = 2.93) (p < .001). There were significant low-to-moderate positive correlations between ANE and hearing thresholds at 3,000 and 4,000 Hz, with higher ANE associated with poorer hearing thresholds. We also found that both noise exposure and aging aggravated the high-frequency hearing thresholds (3,000, 4,000, 6,000 Hz). The findings of the interaural amplitude difference ratio showed that percentages of abnormalities for two VEMPs tests were higher in the NE group (cVEMPs: 28.9%; oVEMPs: 26.7%) than in the CR group (cVEMPs: 17.4%; oVEMPs: 0%). Furthermore, the odds ratio of abnormal VEMPs for the NE group was 4.54 (95% CI = 1.33, 15.49) compared to the CR group. Conclusions: The excessively elevated ANE is a strong risk factor for noise-induced hearing loss and abnormal otolith-vestibular function. This research recommends that individuals with high occupational noise exposure should be monitored for their hearing threshold shifts and be aware of the potential damage to the vestibular system.
• 374-388
• 10.6288/TJPH.202308_42(4).112043

• Link 原著 Original Article
• 台灣醫院市場競爭程度、地區付費能力與醫院收費水準Association between hospital competition, patient ability to pay, and hospital charges
• 蔡偉德、鄭守夏、詹怡如
  Wei-Der Tsai, Shou-Hsia Cheng, Yi-Ru Chan
• 醫院市場競爭程度、地區付費能力、個人所得、醫院收費
  hospital competition, regional ability to pay, individual income, hospital charges
• 目標：本研究旨在探討醫院市場競爭程度、地區付費能力及個人所得與醫院收費之間的相關性。方法：本研究資料來源為2018-2019年健保署委託之「住院病人就醫經驗調查運作模式之先驅研究」計畫的「住院病人就醫經驗（PEHC）」調查結果，調查對象為20歲以上之出院病人，並使用序列羅吉特模型，估計醫院向住院病患收費金額多寡之決定因素。結果：研究結果顯示，當醫院所在地為高度競爭的環境時，其收費較高的機率是位於低度競爭市場之醫院的1.51倍。再者，若醫院所在地區付費能力高、病患家戶所得較高及中等者，醫院收取較高費用的機率亦較高。最後，病人特性（住院日數、病房類型、年齡、自覺疾病嚴重度）也與出院收費呈顯著正相關。結論：醫院收費與市場競爭、地區與個人付費能力呈正相關，通常醫院高收費隱含高品質，政府應正視過量品質可能衍生高成本的隱憂，以及與付費能力相關之醫療品質的城鄉差距，並採取相應措施，以促進醫療資源的有效利用，防範城鄉之間健康不均現象的惡化。
  Objectives: This study investigated the association between hospital competition, patient ability to pay, and hospital charges. Methods: The data source was the results of the “Patient Experience of Hospital Care” survey, which were extracted from the research project “A Pioneering Study on the Operation Mode of the Inpatient Medical Experience Survey,” which Taiwan’s National Health Insurance Administration commissioned for completion in 2018–2019. Participants were discharged hospital patients over the age of 20 years. The determinants of hospital charges were estimated through the ordered logit model. Results: Hospitals in more competitive markets charge more than those in less competitive markets, with the corresponding odds ratio being 1.51. Moreover, hospital charges are higher if the patient is more capable of paying, as measured by township and mean household income. Patient characteristics—such as length of stay, ward type, age, and self-assessed disease severity—also significantly contribute to variation in hospital charges. Conclusions: Hospital charges are positively associated with market competition and patient ability to pay. The relevant authorities should be concerned about the nexus of cost, competition, and the urban–rural gap in quality related to patient ability to pay and take steps to promote the effective use of medical resources and prevent an increase in health inequality between urban and rural areas.
• 389-406
• 10.6288/TJPH.202308_42(4).112040

• Link 評論 Commentary
• 評論：越來越高的病人自付費用是過量品質還是就醫障礙？Commentary: does increasing patients’ out of pocket expenditures create over quality or barriers to healthcare access?
• 楊哲銘
  Che-Ming Yang
• 無
  none
• 無
  nnone
• 407
• 10.6288/TJPH.202308_42(4).11204001

• Link 作者回覆 Authors' response to commentary
• 作者回覆：越來越高的病人自付費用是過量品質還是就醫障礙？Authors' response to commentary: does increasing patients’ out of pocket expenditures create over quality or barriers to healthcare access?
• 蔡偉德、鄭守夏、詹怡如
  Wei-Der Tsai, Shou-Hsia Cheng, Yi-Ru Chan
• 無
  none
• 無
  none
• 408
• 10.6288/TJPH.202308_42(4).11204002

• Link 原著 Original Article
• 以系統性文獻回顧及統合分析法探討芳香療法對於緩解護理人員工作壓力的效果Effects of aromatherapy on work stress among nurses -- a systematic review and meta-analysis
• 方 莉、方景林、方淑慧
  Li Fang, Chin-Lin Fang, Shu-Hui Fang
• 護理人員、芳香療法、工作壓力、統合分析
  nurses, aromatherapy, work stress, Meta-Analysis
• 目標：本研究之目的是以系統性文獻回顧與統合分析法，整合及探討芳香療法對於緩解護理人員工作壓力的效果。方法：搜尋的資料庫包含：搜尋於2023年5月前發表於PubMed、CINAHL、Cochrane Library、華藝線上圖書館、台灣博碩士論文知識加值系統等電子資料庫。擷取後之資料採用RevMan 5.4軟體進行統合分析（Meta-Analysis），以檢視芳香療法介入對護理人員工作壓力之效果。結果：納入結果分析的有9篇文章，共納入523位受試者（實驗組262人&對照組261人），95% CI [-0.75, -0.40]，Z=6.38, p < 0.00001，顯示綜合效果量為-0.57（95% CI: - 0.75, -0.40），表示芳香療法介入可改善護理人員之工作壓力，且成效為中等程度。在次群體分析部份呈現：芳香療法使用途徑為「嗅吸」方式、使用「玫瑰」或「薰衣草」精油且精油濃度「大於等於40%」，可有效緩護理人員工作壓力。結論：建議醫院的管理者，可提供護理人員濃度「大於等於40%」「玫瑰」或「薰衣草」精油置於休息室，護理人員自備精油瓶並於每日兩次的休息時間添加0.5 c.c.精油於瓶中進行「嗅吸」，以緩解工作壓力。未來希望納 入更多實證研究，針對芳香療法介入的種類、濃度、單次使用時間、頻率及介入多久進行分析，以對於芳香療法介入改善護理人員工作壓力的措施，提出更完整方案。
  Objectives: The objective of this article is to integrate and explore the effects of aromatherapy on relieving job stress of nurses by systematic literature review and meta-analysis. Methods: The searched database included electronic databases published before May, 2023 in PubMed, CINAHL, Cochrane Library, Index to Taiwan Periodical Literature System, and Taiwan Journal Paper Index system. Meta-Analysis was used by RevMan 5.4 software to examine the effects of the exercise interventions on depression in the elderly. Results: There were 9 articles (9 samples) included in the analysis. 523 subjects (exercise: 262; control: 261) with 95% CI [-0.75, -0.40], Z = 6.38, p < 0.00001, showed a combined effects of -0.57 (95% CI: -0.75, -0.40), indicating that aromatherapy intervention could moderately improve the work stress degree among nurses. According to the subgroup analysis, the use of aromatherapy is to “inhale” the “rose” or “lavender” essential oil, and the essential oil concentration should be “greater than or equal to 40%”, which can effectively relieve the work pressure of nurses. Conclusions: It is recommended that hospital managers provide nurses with “rose” or “lavender” essential oil to be placed in the lounge, the concentration of which should be “greater than or at least equal to 40% and the nursing staff should bring their own essential oil bottles and add 0.5 c.c. essential oil to the bottle twice a day during the rest time to “inhale” to relieve work stress. In the future, it is hoped that more empirical studies will be included to analyze the type, concentration, single use time, frequency and duration of aromatherapy interventions, so as to propose more complete solutions for aromatherapy interventions to improve the work stress of nurses.
• 409-422
• 10.6288/TJPH.202308_42(4).112047

• Link 原著 Original Article
• 影響成年毒品施用者生活品質之相關因素探討Factors influencing the quality of life of adults who use drugs
• 陳玟如
  Wen-Ju Chen
• 成年毒品施用者、生活品質、物質資本、創傷經驗
  adult drug user, quality of life (QOL), physical capital, traumatic experience
• 目標：近年台灣毒品政策已隨世界趨勢朝向減少犯罪與傳染疾病蔓延，從監禁與再犯預防觀點，轉向對毒品施用者營造友善醫療環境、提供跨專業成癮治療及完善社會支持網絡，以協助回歸正常生活。本研究旨在探討影響成年毒品施用者生活品質之因素，以找尋有效影響因子。方法：利用結構式問卷，立意抽樣探討380位年滿20歲居住在社區且有使用毒品經驗者。運用台灣簡明版世界衛生組織生活品質問卷、創傷經驗量表，以階層迴歸模型檢視象徵個人復元資本之物質資本與創傷經驗對成年毒品施用者生活品質在生理、心理、社會關係、環境等四個子範疇之影響。結果：階層迴歸證實物質資本與創傷經驗對生活品質四個子範疇均有顯著解釋力（35-38%），且創傷經驗得分越高者，在生生活品質四個子範疇之得分越差。結論：代表物質資本之財務自評（含每月收入與收支自評）、居住、可獲得公共福利資源數量，對生活品質各子範疇均發揮預測力，創傷經驗對成年毒品施用者生活品質各子範疇亦具顯著預測方向。
  Objectives: Following global trends, drug policy in Taiwan has shifted from goals of imprisonment and recidivism prevention to fostering a friendly medical environment and offering interdisciplinary addiction treatment and comprehensive social support networks to enable drug users to return to normal lives. This study investigated factors associated with the quality of life (QOL) of adults who use drugs. Methods: Using a structured questionnaire, this study investigated 380 individuals aged 20 years with experience of drug use through purposive sampling. Data were collected using the World Health Organization Quality Of Life Scale-BREF (Taiwan) to investigate the impacts of traumatic experiences and physical capital on QOL, and hierarchical regression was conducted. Results: Traumatic experiences and physical capital exhibited significant predictive power (35%–38%) for subcategories of QOL. Higher trauma experience scores were associated with lower QOL subcategory scores. Conclusions: Physical capital, including monthly income, revenue, expenditures, housing, and amount of accessible public welfare resources predicted subcategories of QOL. Furthermore, traumatic experience significantly predicted QOL among adults who used drugs.
• 423-435
• 10.6288/TJPH.202308_42(4).112022

• Link 原著 Original Article
• 從開發人員需求探討開放政府資料於公眾健康領域之應用Why do data practitioners utilize open government data for public health?
• 鄭惟中、邱銘心
  Wei-Chung Cheng, Ming-Hsin Phoebe Chiu
• 開放政府資料、開發人員、需求、資料再利用、質性分析
  open government data, data practitioner, needs, data reuse, qualitative analysis
• 目標：近年受COVID-19疫情影響，開放政府資料於公眾健康領域的應用性漸受重視。本研究以使用過開放政府資料開發出健康資訊產品的人員為對象，分析其使用此類資料的需求並向公部門提出實務建議，以期活化開放政府資料於公共健康領域之科技應用。方法：本研究為質性取向，共訪談11位開發人員，並基於紮根理論研究法之精神，透過三階段譯碼過程分析訪談內容。結果：開發人員會因為職場任務（業務型）、成本效益（經濟型）、產品功能（功能型）、參加競賽（規範型）、參與公益（社會型）及個人需要（自我型）等需求使用開放政府資料，且開發人員評估需求是否獲得滿足時，其判斷具有個體（內在期待有無獲得滿足）及互動（有無順利回應外界情境）兩種屬性。結論：開發人員將開放政府資料轉化為可用的健康資訊服務後，有助民眾提升健康知能及素養，各種創新成果更可促進各界對公衛議題的理解及參與，顯見開發人員及開放政府資料兩者對於提升公眾健康領域的發展實為不可或缺。
  Objectives: Governments have long encouraged professionals in various sectors to innovatively apply open government data (OGD). Because of the COVID-19 pandemic, the application of OGD in civil services to improve public health–related literacy has been discussed comprehensively. This study investigated the needs of practitioners utilizing OGD to develop specific products concerning public health to demonstrate the value of utilizing OGD to improve the quality of life of citizens. Methods: This study qualitatively analyzed 11 interviews with practitioners utilizing grounded theory. Results: (1) Six types of needs of practitioners utilizing OGD were identified, namely mission-oriented, cost-oriented, functionality-oriented, compliance-oriented, social-oriented, and self-oriented needs. (2) Two factors determining whether the practitioners’ needs were met were identified. Conclusions: Practitioners can use OGD to provide services for citizens to use to access public health information. These OGD-based services not only enhance individuals’ abilities to address questions about public health but also foster an understanding of and participation in public health. Because practitioners are crucial to the implementation of OGD, these findings enable governments to optimize policies to improve OGD utilization on the basis of data practitioners’ experiences.
• 436-449
• 10.6288/TJPH.202308_42(4).112024

• Link 原著 Original Article
• 運用社群媒體於消防隊員之健康飲食介入成效:準實驗研究Effectiveness of a social-media-delivered healthy dietary intervention among firefighters: a quasi-experimental study
• 張斯蘭、胡益進、吳文琪、許青雲、陳 中、陳南福、陳靜怡、張晏蓉
  Ssu-Lan Chang, Yih-Jin Hu, Wen-Chi Wu, Ching-Yun Hsu, Chung Chen, Nan-Fu Chen, Ching-Yi Chen, Yen-Jung Chang
• 健康信念模式、社群媒體介入、消防員、營養教育
  Health Belief Model, social media intervention, firefighters, nutrition education
• 目標：運用健康信念模式作為基礎，以社群媒體進行介入，探討對新北市消防員的健康信念模式變項以及健康飲食行為之影響。方法：採準實驗設計，立意選取共80位消防員，其一分隊40位消防員為實驗組，另一分隊40位為對照組；實驗組以社群媒體進行12周介入，介入策略包括：定時推播提供健康飲食知識、簡易料理食譜、線上教練給予回饋、利用餐點照片上傳進行飲食記錄、集點活動進行競賽與獎勵。對照組給予健康飲食手冊一本。使用廣義估計方程式（GEE）來評估介入對各變項之測量分數的影響。結果：在前測時，實驗組和對照組之社會人口學變項和主要測量變項均無顯著的組間差異。實驗組的健康飲食知識、自覺健康狀態、自覺罹患性、自覺嚴重性自覺利益、自我效能以及健康飲食行為等後測得分均顯著高於前測，自覺障礙得分則是後測時顯著降低。GEE分析結果顯示，介入後，實驗組在「健康飲食知識」、「自覺健康狀態」、「自我效能」、「自覺利益」、「健康飲食行為」等變項相較對照組顯著進步。但本次介入對於提升自覺罹患性、自覺嚴重性、自覺障礙以及行動線索則無顯著效果。有73.3%的實驗組參與者對於介入策略表示滿意。結論：運用社群媒體進行健康飲食介入能有效改善健康飲食知識、自覺健康狀態、自我效能、自覺利益、健康飲食行為。建議未來善用社群媒體不受時間與空間限制之優點，持續為其他族群設計及進行健康飲食教育介入。
  Objectives: This study used the Health Belief Model and a social media–delivered intervention to investigate changes in healthy eating behaviors among firefighters in New Taipei City. Methods: This quasi-experimental study recruited 40 firefighters from each of two fire station branches: Branch A (experimental group) and Branch B (control group). The experimental group participated in a 12-week intervention that entailed following recipes to prepare meals, receiving online health coach feedback, and completing a food diary. This group also received push notifications on information about healthy eating habits and collected reward points. The control group received a healthy eating manual. Generalized estimating equations were used to assess the influence of the intervention on the participants’ scores. Results: The two groups differed significantly after the 12-week social media–delivered intervention. Specifically, the experimental group exhibited higher scores in healthy eating knowledge, superior perceived health status, greater self-efficacy, greater perceived benefits of healthy eating, and more positive changes in healthy eating behavior than did the control group. A satisfaction survey regarding the intervention revealed that 80% of the participants in the experimental group expressed satisfaction with the intervention strategies. Conclusions: The 12-week social media–delivered intervention effectively improved healthy eating knowledge, perceived health status, self-efficacy, perceived benefits of healthy eating, and healthy eating behaviors among the firefighters in the experimental group. Accordingly, the use of social media as an intervention tool holds promise for the implementation of nutritional education interventions in similar populations.
• 450-464
• 10.6288/TJPH.202308_42(4).112003