42卷6期

• Link 政策論壇 Policy Forum
• 青少年心理健康與自殺防治：「上游」與「下游」議題孰輕孰重Youth mental health and suicide prevention: weighing in at issue over “Upstream” versus “Downstream”
• 廖士程
  Shih-Cheng Liao
• 無none
  無none
• 無none
  無none
• 587-589
• 10.6288/TJPH.202310_42(6).PF06

• Link 公衛論壇 Public Health Forum
• 社區支持能否落實：從政策執行研究的觀點談2022年精神衛生法修法A symptom of social support in Mental Health Act amendment: from the perspective of implementation studies
• 陳宗欣
  Tsung Hsin Chen
• 無none
  無none
• 無none
  無none
• 590-593
• 10.6288/TJPH.202312_42(6).112057

• Link 綜論 Review Article
• C型肝炎病毒抗體快篩試劑的運用Rapid diagnostic tests for detection of antibodies to hepatitis C virus
• 楊雯雯、吳慧敏、劉嘉玲、鄭國本、余明隆、蒲若芳、盧勝男、簡榮南
  Wen-Wen Yang, Grace Hui-Min Wu, Chia-Ling Liu, Kuo-Pen Cheng, Ming-Lung Yu, Raoh-Fang Pwu, Sheng-Nan Lu, Rong-Nan Chien
• C肝篩檢、C肝抗體快篩試劑、快篩、敏感度、特異度
  hepatitis C screening, anti-HCV rapid diagnostic test, RDT, sensitivity, specificity
• 慢性C型肝炎病人可能在沒有症狀或是沒有特異性症狀的狀態下持續數十年，等到症狀出現，病情往往已惡化到威脅生命的肝硬化或是肝癌階段。及早發現C型肝炎病毒（HCV）感染，對於防治後續併發症是十分重要的。傳統先經實驗室檢驗C肝抗體（anti-HCV）陽性，再以核酸檢驗來確認C肝病毒是否存在的兩階段檢定步驟，被認為是發掘及診斷HCV病毒感染的關鍵挑戰。除了傳統實驗室的血清抗體檢驗外，世界衛生組織亦建議以快篩試劑作為anti-HCV檢驗分析方法之一，並認為快篩將可改善篩檢到後續照護與治療的連結。2020年以來，C肝抗體快篩試劑的敏感度及特異度已有提升；目前我國已有3項C肝抗體快篩試劑取得上市許可證，依據文獻回顧結果，其敏感度及特異度分別至少都在92.8%及92.6%以上。本文蒐集文獻並彙整C肝抗體快篩試劑的檢驗效能和國際運用情境文獻，希望有助於提升國人對C肝快篩檢試劑的認識，並討論其在台灣推動C肝消除的可能應用。
  Most patients with chronic hepatitis C often remain asymptomatic or experience nonspecific symptoms for decades, and by the time symptoms manifest, the disease has deteriorated to life-threatening stages such as cirrhosis or liver cancer. Early detection of hepatitis C virus (HCV) infection is crucial for preventing and managing subsequent complications. The conventional twostep diagnostic process, involving initial enzyme immunoassay testing for HCV antibodies (anti-HCV) followed by nucleic acid testing in the laboratory to confirm the presence of HCV, presents a significant challenge in the discovery and diagnosis of HCV virus infection. In addition to traditional laboratory-based serum antibody testing, the World Health Organization recommends the use of rapid diagnostic tests (RDTs) as one of the methods for analyzing anti-HCV antibodies, with the potential to improve access and linkage to care and treatment. Since 2020, the studies have shown that both the specificity and sensitivity of the anti-HCV RDTs have been improved. Three anti-HCV RDTs in Taiwan have received market approval, each demonstrating a sensitivity and specificity of at least 92.8% and 92.6%, respectively, as indicated by literature reviews. This article collects and summarizes existing literature on the diagnostic performance of anti-HCV RDTs and their implementation scenarios. It aims to enhance awareness across various sectors regarding the utility of anti-HCV RDTs and to discuss their potential applications in accelerating hepatitis C elimination efforts in Taiwan.
• 594-611
• 10.6288/TJPH.202312_42(6).112031

• Link 原著 Original Article
• 新冠疫情下行動健康照護模式介入對健康行為及代謝症候群之影響—以台灣計程車駕駛為例Effects of mHealth model on health behavior and metabolic syndrome during COVID-19 epidemic: A case study of taxi drivers in Taiwan
• 呂淑青、黃偉新、劉潔心
  Shu-Ching Lu, Wei-Hsin Huang, Chieh-Hsing Liu
• 代謝症候群、計程車駕駛、行動健康照護模式、運動量、PRECEDE-PROCEED模式
  metabolic syndrome, taxi driver, mobile health care model (mHealth), physical activity, PRECEDE-PROCEED model
• 目標：計程車駕駛是罹患代謝症候群的高風險群，加上近三年受新冠疫情的影響，本研究想透過行動健康照護模式的介入，以手機等行動裝置結合社群軟體和相關配套措施，來提升健康行為和改善代謝症候群。方法：本研究設計為準實驗研究，篩選至少有一項代謝症候群的風險因子或BMI≥25的計程車駕駛加入，分派為實驗組與對照組，分別先進行前測包含問卷和生理數值檢測，十二週後進行後測。實驗組以行動健康照護模式介入十二週，結合PRECEDE-PROCEED模式中前傾因素、增強因素和使能因素，內容包括:「代謝症候群線上課程」、「自主健康管理」、「Line線上諮詢與追蹤聯繫」和「設立獎勵機制」四個部分，並使用計步器搭配線上運動課程。本研究主要以廣義估計方程式（GEE）進行統計分析。結果：共完成92位，實驗組48位和對照組44位。介入後能顯著提升計程車駕駛的健康行為（B = 0.22，95% CI =0.07-0.38）、自我效能（B = 0.18，95% CI = 0.02-0.33）和運動量（t = 2.648，95% CI = 140.6-1042.3）。結論：針對代謝症候群的高風險群，特別是在新冠疫情期間，行動健康照護模式不但可降低感染風險，並可以作為推廣代謝症候群衛生教育的一種方式。
  Objectives: Taxi drivers are a high-risk population for metabolic syndrome. This study thus developed a mobile health-care model (mHealth) that integrates mobile phones with social media and various supporting strategies to promote healthy behaviors and address metabolic syndrome. Methods: A quasi-experimental design was adopted. Taxi drivers with at least one risk factor for metabolic syndrome or body mass index ≥ 25 were recruited and divided into an experimental group and a control group. A pretest comprising questionnaires and physiological value tests were conducted, and a posttest was conducted after 12 weeks of intervention. For 12 weeks, the experimental group used the mHealth model, which incorporated the predisposing factor, reinforcing factor, and enabling factor of the PRECEDE-PROCEED model. The model’s content included the components of Metabolic Syndrome Online Course, Self-Health Management, Line Online Consultation and Contact Tracing, and Reward Mechanism. Additionally, a pedometer was used for online exercise courses. Generalized estimating equations were primarily used for statistical analysis. Results: In total, 92 participants completed this study (48 experimental group participants and 44 control group participants). The intervention yielded significant improvements in healthy behavior (β = 0.22, 95% confidence interval [CI] = 0.07–0.38), self-efficacy (β = 0.18, 95% CI = 0.02–0.33) and physical activity (t = 2.648, 95% CI = 140.6–1042.3). Conclusions: For high-risk populations with metabolic syndrome, especially those profoundly affected by the COVID-19 pandemic, the mHealth model can not only reduce their risk of infection but also can be a way to improve metabolic syndrome.
• 612-625
• 10.6288/TJPH.202312_42(6).112051

• Link 原著 Original Article
• COVID-19疫情時代文化維度對醫療旅遊的效果Effects of cultural dimensions on medical tourism in the COVID-19 era
• 蘇珉一
  Min-I Su
• COVID-19、Hofstede文化維度、醫療旅遊、不確定性規避
  COVID-19, Hofstede’s cultural dimensions, Medical tourism, Uncertainty Avoidance Index
• 目標：2019年COVID-19全球疫情大流行，不同國家由於醫療能力和文化背景的差異，在面對這場突如其來的疫情，為防疫紛紛採取各式各樣的旅遊限制措施，對醫療旅遊業造成重大負面影響。為更深入暸解此一影響，本研究採用Hofstede文化維度理論，探討疫情前後不同國家文化差異對醫療旅遊的影響。方法：分析2017年至2020年間29個來源國來台的醫療旅遊人次。研究數據包含時間序列與橫斷面資料，因此選用追蹤資料方法建構模型。結果：疫情背景下文化維度中的不確定性規避與醫療旅遊人次則呈顯著負相關。結論：結果表明，在疫情期間文化維度中的不確定性規避會導致各國對醫療旅遊的接受度發生變化。
  Objectives: In the COVID-19 pandemic that started in 2019, the world witnessed a wide variety of travel restrictions implemented by countries globally on the basis of their medical capabilities and cultural backgrounds. These restrictions exerted a strong negative effect on the international medical tourism industry. To explore this effect, the study employed Hofstede’s cultural dimensions model to determine how cultural differences affect international medical tourism. Methods: Data on the numbers of inbound travelers from 29 countries to Taiwan for the purpose of medical tourism between 2017 and 2020 were collected. Given that the data included both time-series and cross-sectional data, this study used a panel data approach for modeling. Results: In times of a pandemic, the number of inbound travelers for medical tourism purposes correlated significantly and negatively with the travelers’ national culture level of uncertainty avoidance. Conclusions: The cultural aspects of uncertainly avoidance in the home country also affected travelers’ openness to medical tourism during the pandemic.
• 626-635
• 10.6288/TJPH.202312_42(6).112059

• Link 原著 Original Article
• 台灣糧食不安全與個人相關因素探討Personal determinants of food insecurity in Taiwan
• 杜欣恬、林 嶔、張新儀、李美璇
  Sin-Tian Du, Chin Lin, Hsing-Yi Chang, Meei-Shyuan Lee
• 糧食不安全、糧食不安全經驗量表、國民營養健康調查、社會人口學
  food insecurity, FIES, NAHSIT, social demography
• 目標：檢視數種糧食不安全經驗量表（Food Insecurity Experience Scale, FIES）的個人化糧食不安全（Food insecurity, FI）分類方法（依序：安全、輕度、中度、重度），選取與FAO建議（FAO-FI）的族群估算結果一致性最佳之切點，據以探討影響台灣FI盛行率之個人因素。方法：使用2019年的台灣國民營養健康調查數據，納入之參與者為2266名16歲及以上且有回答完整FIES（0-8分）的國民。從數個FI計算方式中，選取與FAO-FI結果一致性最高者，進行個人層級分析。數據以SUDDAN加權並校正抽樣的設計效應，以序位羅吉斯迴歸探討FI之危險因子。結果：台灣2019年FAO-FI的「中重度」與「重度」FI盛行率分別為2.29%及0.44%。Ganhao-Arranhado等人的FI分類結果與FAO-FI差異最小。16-40歲、初中、專科或大學肄業、自覺經濟狀況困難，以及有吃檳榔習慣者有顯著較高的FI風險；偶爾抽菸者的風險比無抽菸習慣者低。調整所在縣市後，租屋或其他住屋狀況是FI的危險因子。結論：2019年的台灣糧食安全狀況較2014年進步，國人的FI與眾多的社會人口學及行為變項相關。
  Objectives: To assess available food insecurity (FI) classification (ranked as secure, mild, moderate and severe) approaches used to personalize the Food Insecurity Experience Scale (FIES) and select a method most consistent with the population Food and Agriculture Organization (FAO)-FI measure, so as to explore FI status in Taiwan for individuals. Methods: From the 2019 Nutrition and Health Survey in Taiwan (NAHSIT), 2266 participants ≥ 16 years who had completed the FIES (ranges 0-8) were recruited. To choose the best FIES classification fit, FIs derived by various cuts were weighted and adjusted for design effect by SUDAAN and compared with the FAO-FI. The associations between the chosen FI and socio-demographic data were explored further by ordinal logistic regression. Results: In 2019, the “moderate and severe” and “severe” FI prevalences in Taiwan were 2.29% and 0.44%, respectively. The cut-off proposed by Ganhao-Arranhado was most consistent with FAO-FI. The risk for FI was high for 16–40-year-olds; junior high school educated; junior college or university students; where selfperceived economic status was difficult; and where there was any betel nut chewing. However, with occasional smoking there was a lower risk. After adjustment for locality, housing instability became a significant risk factor for FI. Conclusions: Food security status, assessed as FIES in Taiwan, improved from 2014 to 2019. FI was associated with a range of potentially modifiable risk factors.
• 636-650
• 10.6288/TJPH.202312_42(6).112081

• Link 原著 Original Article
• 台灣小區域民眾就醫經驗之分析Patient experiences in small area of Taiwan
• 賴 旻、邱尚志、李佩珍、殷偉賢、林寬佳
  Min Lai, Shang-Jyh Chiou, Pei-Chen Lee, Wei-Hsian Yin, Kuan-Chia Lin.
• 95小區域分類、就醫經驗、多層次邏吉斯迴歸
  classification of 95 small areas, patient experiences, Hierarchical Logistic Regression Modeling
• 目標：本研究於台灣就醫權益調查之下的民眾就醫經驗進行小區域估計（Small Area Estimation; SAE）；並比較95小區域分類與醫療網50次區域之差異，強化在資料既有框架下改善其細微度且不需額外耗費其他人力及資源之推估方法。方法：研究係以健保民眾就醫權益調查之跨總額聯合資料為基礎，各分項調查樣本數均達1,030份以上（抽樣誤差為±3.05%），總有效回收樣本達5,152份。以等比機率抽樣（Probability Predictionate to Size Sampling, PPS）為基礎下向下切分至鄉鎮市區單位之區位內人口數、輔以性別、年齡與教育程度等三因子進行數值加權。爾後進一步透過多層次變異數成份估計組內相關係數，衡量組間變異數與組內變異數的相對程度。結果：95小區域分類與醫療網50次區域有四項民眾就醫經驗存在有顯著差異性，依序為『就診時醫師是否與您共同討論照護或治療方式？』、『就診時醫師是否有提供您問問題或表達顧慮的機會？』、『請問過去一年來，那家醫療院所的醫護人員有沒有為您進行衛生教育指導（例如：解說病情、營養及飲食諮詢、預防保健方法等）？』、『過去一年內，請問那家醫療院所的醫護人員，是否常用您簡單易懂的方式來向您解說病情與照護方法？』。若以醫療網50次區域為估計基礎，可能會因此低估了各區塊中不能忽視的小區域差異。結論：本研究於健保就醫權益調查的框架下，提出95個小區域的分類，可做為未來概觀式大型調查於小區域推估與城鄉差距比較之應用方法參考，進而掌握小區域間之差異性與重要趨勢。
  Objectives: This study conducted small area estimation on health care experiences in Taiwan, with a focus on health care rights. The study compared 95 small area classifications and 50 medical areas in terms of the health care experiences of their residents. This study’s leveraged an existing data framework, and the proposed method does not require additional resources. Methods: The study used a cross-sectional survey conducted nationwide in 2019 to evaluate public opinions on the National Health Insurance program in Taiwan. Each subgroup survey had a sample size of at least 1,030 respondents (with a sampling error of ±3.05%), resulting in a total of 5,152 valid responses. Proportional probability sampling was used to divide the population into district-level units within townships and municipalities. This division was further refined by factors including gender, age, and education level, and numerical weighting was applied. Multilevel variance component estimates were then used to measure the relative levels of between-group and within-group variances. Results: Health-care experiences significantly differed between the 95 small area classifications and the 50 medical areas. These differences pertained to whether the doctor discussed care or treatment options with the patient during the visit, whether the doctor provided an opportunity for the patient to ask questions or express concerns, whether health care personnel at the medical institution provided hygiene education, and whether health care personnel at the medical institution used accessible language to explain the patient’s medical condition and the available methods of care. Significant local differences within each block may be underestimated if only the 50 medical areas are used as a basis for estimation. Conclusions: This study proposed a classification system of 95 small areas that can serve as reference points for future large-scale surveys for fine-grained estimations and comparisons of regional disparities.
• 651-662
• 10.6288/TJPH.202312_42(6).112034

• Link 原著 Original Article
• 揮發性有機化合物暴露與失智症風險之相關性：回溯性世代研究Association between volatile organic compounds exposure and dementia risk: a retrospective cohort study in Taiwan
• 陳靖傑、張大元
  Jing-Jie Chen, Ta-Yuan Chang
• 空氣污染物、失智症、高溫、道路交通噪音、揮發性有機化合物
  air pollutants, dementia, high temperature, traffic noise, volatile organic compound
• 目標：本研究探討不同揮發性有機化合物（volatile organic compounds, VOCs）（包括苯、甲苯、乙苯、間/對-二甲苯）暴露和失智症發生的相關性。方法：本研究以臺灣人體生物資料庫中60歲以上的參與者作為研究對象，並使用土地利用迴歸模型評估揮發性有機化合物、空氣污染物、道路交通噪音及溫度的年平均暴露。我們基於自填問卷的醫師診斷結果及簡易心智量表（Mini-Mental State Examination, MMSE）低於24分來判斷受試者是否為失智症個案，總共參與人數為4,917人。我們使用Cox proportion hazards regression探討揮發性有機化合物與失智症發生的相關性，估計風險比及95%信賴區間，並調整道路交通噪音、空氣污染物（細懸浮微粒[particulate matter with an aerodynamic equivalent diameter ≤ 2.5 μm, PM2.5]及二氧化氮[nitrogen dioxide, NO2]）與年平均高溫，計算校正風險。結果：研究對象的苯、甲苯、乙苯、間/對-二甲苯暴露平均分別為3.91±4.31 μg/m3、2.50±0.35 μg/m3、2.04±1.20 μg/m3及10.27±5.78 μg/m3，其平均人年數為3.43±0.91年，失智症發生率為1.06%。調整空氣污染物、道路交通噪音及年均高溫後，甲苯對失智症發生的風險為0.67（95%CI: 0.51-0.90），且在不同年齡分組（≦65歲/＞65歲）有顯著的修飾效應（Pinteraction=0.023）。結論：甲苯在共同暴露中與失智症的發生風險有顯著保護相關，且不同年齡分組顯示存在修飾效應。
  Objectives: This study was designed to investigate the dementia risk associated with the exposure of volatile organic compounds (VOCs), including benzene, toluene, ethylbenzene, and m/p-xylene. Methods: Individuals aged 60 and above who had been recruited by Taiwan Biobank were identified for inclusion in this study. We used regression models to evaluate exposures to annual average of VOCs, road traffic noise, air pollutants, and temperature. New cases of dementia were determined based on self-reported questionnaires with a diagnosis by a physician and the Mini-Mental State Examination (MMSE) score of less than 24. A total of 4,917 individuals were included in the analysis. Cox proportion hazards regression was used to estimate the hazard ratio (HR) and 95% confidence interval (95%CI) of dementia associated with the VOCs after adjusting for traffic noise, air pollutants (particulate matter with an aerodynamic equivalent diameter ≤ 2.5μm[PM2.5] and nitrogen dioxide [NO2]), annual high temperature and other confounding factors. Results: The incidence of dementia was 1.06% after 3.43±0.91 years of follow-up for the exposure to average levels of benzene, toluene, ethylbenzene, and m/p-xylenes for 3.91±4.31 μg/m3, 2.50±0.35 μg/m3, 2.04±1.20 μg/m3, and 10.27±5.78 μg/m3, respectively. The adjusted HR of dementia was 0.67 (95%CI: 0.51-0.90) associated with toluene after adjusted for other air pollutants, road traffic noise, and annual high temperature, in the co-exposure model of VOCs. Increased risks were associated with traffic noise of 4.96 dBA (HR=1.62, 95%CI: 1.12-2.03) and annual high temperature of 2.86 °C (HR=1.85, 95%CI: 1.41-25 2.43). In effect modification analysis, we found that the risk associated with toluene was significantly modified by age (Aged≦65/>65) (Pinteraction=0.023). Conclusions: This study found that toluene has a significant protective association with dementia and significantly modified by age.
• 663-677
• 10.6288/TJPH.202312_42(6).112074

• Link 原著 Original Article
• 病人報告醫院品質的問卷發展與信效度分析Development and validation of the questionnaire for patient-reported hospital quality
• 蔡雅芳、陳啟禎、鄭守夏
  Ya-Fang Tsai , Chi-Chen Chen, Shou-Hsia Cheng
• 病人經驗、住院服務、照護品質、測量工具
  patient experience, inpatient services, quality of care, measurement tool
• 目標：1990年代起，病人權益逐漸受到照護提供者重視，醫療品質的測量從採取照護提供者的觀點，逐漸走向病人觀點。相較於歐美國家，亞洲國家用來測量病人就醫經驗的工具相對較少。本文為發展適合臺灣病人住院經驗調查的測量工具。方法：以多元調查方式收集資料，共回收11,202份有效問卷，並以項目分析、信度以及探索性因素分析的結果選取問卷題目，並以驗證性因素分析檢驗問卷效度。結果：病人住院經驗問卷共23題，包含六個面向：醫師照護、護理照護、醫病互動、尊重與心理支持、醫院環境與出院準備服務。信度方面，病人住院經驗六個面向Cronbach’s值介0.69至0.88之間，顯示內部一致性尚屬適切。效度方面，採用驗證性因素分析驗證病人住院經驗六因素模型的適配度，該模型通過適配度的檢定，顯示模型的建構效度良好。結論：本量表有良好信度與效度，可供醫院與衛生主管機關了解病人住院經驗，作為改善醫院照護品質之參考。
  Objectives: Since the 1990s, patient rights have garnered an increasing amount of attention from health-care providers. Assessments of health quality, which were traditionally conducted from the perspective of health-care providers, have gradually become more focused on the perspectives of patients. The current study developed a measurement tool specifically designed for evaluating inpatient experiences in Taiwan. Methods: Data were collected using various survey methods, with 11,202 valid questionnaire responses obtained. The selection of questionnaire items involved item analysis, reliability assessments, exploratory factor analysis, and confirmation of the questionnaire validity through confirmatory factor analysis. Results: In all, 23 questionnaire items focusing on inpatient experiences were selected, with these items spanning 6 dimensions, namely, physician care, nursing care, interaction with professionals, respect and mental support, hospital environment, and discharge plan. The Cronbach’s alpha values for each dimension ranged from 0.69 to 0.88, indicating acceptable reliability. The results of the confirmatory factor analysis revealed the data to have a good fit, affirming the strong discriminant validity of the inpatient experience dimensions. Conclusions: The questionnaire developed in this study exhibited satisfactory reliability and validity. This instrument may assist Taiwanese hospitals and health authorities in understanding patient experiences and in improving the quality of health care.
• 678-688
• 10.6288/TJPH.202312_42(6).112032

• Link 原著 Original Article
• 價值為基礎的支付與糖尿病照護品質之關係Association between value-based payments and quality of diabetic care
• 陳圓媛、董鈺琪
  Yuan-Yuan Chen, Yu-Chi Tung
• 糖尿病、論質計酬、家醫計畫、照護品質、溢出效應
  diabetes, value-based payment, Family Physician Integrated Care Program, quality of care, spill-over effect
• 目標：過去研究指出醫療院所參與價值為基礎支付方案之數量及溢出效應也許會影響照護品質，因此本研究探討醫療院所參與價值為基礎支付方案數量和參與方案滲透率與糖尿病照護品質之相關性。方法：本研究為橫斷性研究，共納入7,136家照護糖尿病人的醫院與診所，採中央健康保險署醫療品質資訊公開網之糖尿病照護品質資料，針對三種價值為基礎的支付方案（糖尿病醫療給付改善方案、初期慢性腎臟病醫療給付改善方案及家庭醫師整合性照護計畫）及糖尿病醫療給付改善方案滲透率，在控制醫療機構特質與病人特性後，以多元線性迴歸探討自變項與糖尿病照護品質（醣化血紅素、空腹血脂、眼底、尿液蛋白質及血清肌酸酐等5項檢查率）之相關性。結果：當院所參與較多價值為基礎的方案，與較多的糖尿病照護品質指標較佳有關；糖尿病論質計酬滲透率愈高，與5項糖尿病照護品質指標愈佳有關。結論：參與多種價值為基礎的支付方案及較高滲透率都與較佳的糖尿病照護品質有關。
  Objectives: Studies have indicated that the number of value-based payment (VBP) programs implemented by health-care facilities and the spill-over effects of such programs affect quality of care at these facilities. Therefore, this study examined how the number and the penetration rate for participation in VBP programs are associated with the quality of diabetes care. Methods: This cross-sectional study examined 7,136 hospitals and clinics in Taiwan that provide diabetes care. Using the Diabetes Care Quality Information from the Health-care Quality Information Disclosure Network, we examined the associations between various independent variables and the quality of diabetes care (based on the rates for HbA1c, fasting lipid profile, fundus, urine albumin, and creatinine screening); this was achieved by performing multiple linear regressions controlled for health-care facility characteristics and patient characteristics. The independent variables comprised several VBP programs (i.e., the diabetes mellitus pay-for-performance [P4P] system, early chronic kidney disease P4P programs, and Family Physician Integrated Care Program) and the penetration rate for the DM P4P programs. Results: The number of VBP programs that a facility participated in was positively associated with the quality of diabetes care. A higher penetration rate for the DM P4P programs was associated with the higher quality of diabetes care in terms of five quality indicators. Conclusions: Participation in multiple VBP programs and a high penetration rate for the DM P4P programs were associated with the improved quality of diabetes care.
• 689-699
• 10.6288/TJPH.202312_42(6).112062

• Link 原著 Original Article
• 赴越工作者的工作與社會生活狀況與其健康影響：初探調查Working and social life conditions of Taiwanese expatriates in Vietnam and their impacts on health: an exploratory survey
• 劉映辰、林承寬、李柏翰、鄭雅文
  Ying-Chen Liu, Cheng-Kuan Lin, Po-Han Lee, Yawen Cheng
• 外派工作者、越南、工作、心理健康、職業災害
  Taiwanese expatriate, Vietnam, work, mental health, occupational injury
• 目標：探討赴越工作者的工作與社會生活狀況及其健康影響。方法：於2023年2-5月間，針對赴越工作至少六個月以上的台灣籍工作者進行問卷調查，有效樣本388份。在工作面向，檢視產業類別、聘僱型態、職務類型、工時、收入等資訊；在社會生活面向，蒐集居住越南時間、越語能力、赴越居住安排；在健康面向，蒐集自評健康、心理健康、個人疲勞，及過去一年因工作受傷或罹病之狀況與經驗。結果：調查結果顯示，赴越工作者以男性、40歲以下、大學或以上學歷者居多，產業類型以製造業居多，大多為受僱者且以管理職及專業職居多；每週工作天數五天以上（73.2%）與每日平均工時10小時或以上（20.0%）比例偏高，而工作收入以每月八萬元或以上居多（64.7%）。超過七成工作者赴越年資超過2年，但能以越語溝通比例不到三成；超過半數工作者獨自居住於廠區宿舍；而心理健康不佳、疲勞程度屬嚴重，與曾因工作受傷或罹病比例較國內工作者普遍。迴歸分析顯示，每日工時大於10小時，為心理健康不佳、疲勞、因工作受傷或罹病的預測因子；赴越工作資歷5年或以上，是健康不佳的顯著預測因子。結論：赴越工作者工時過長、心理健康不佳、疲勞與職業傷病風險偏高，值得勞動主管單位、企業與外派工作者關注。
  Objectives: To investigate the work and social life and their influences on health among Taiwanese expatriates in Vietnam. Methods: Taiwanese expatriates who had worked in Vietnam for at least 6 months were invited to participate in an online survey from February to May 2023. A total of 388 valid questionnaires were collected. Information regarding the participants’ industry, employment status, occupation, work hours, wage or income, duration of stay, language proficiency, and living arrangements was obtained. In addition, data regarding the participants’ self-reported health, mental health, personal burnout, and experiences of work-related injuries or illnesses over the preceding year were obtained. Results: Taiwanese expatriates working in Vietnam were predominantly men under 40 years of age with a college degree or above and were working primarily as employees in manufacturing sectors in managerial and professional positions. Their work hours were long, with 73.2% working more than 5 days per week and 20.0% working 10 hours or more per day, but they had a relatively high income. Although over 70% of the participants stayed in Vietnam for over 2 years, less than 30% of them were able to communicate in Vietnamese. Over half of the participants lived alone in factory dormitories. Compared with general workers in Taiwan, the participants reported more mental health problems, higher burnout, and more work-related injuries and illnesses. Regression results revealed that working for over 10 hours per day was associated with increased risks of poor mental health, burnout, and work-related injuries or illnesses. In addition, staying in Vietnam for 5 years or more was associated with an increased risk of poor psychophysical health. Conclusions: Labor authorities and businesses should pay attention to the fact that expatriates work overly long hours and are at an increased risk of psychophysical health problems and occupational injuries.
• 700-712
• 10.6288/TJPH.202312_42(6).112065