43卷2期

• Link 政策論壇 Policy Forum
• 新興傳染病的控制—台灣面對Mpox的應變措施Control of emerging infectious diseases - response measures against Mpox in Taiwan
• 詹珮君
  Pei-Chun Chan
• M痘、傳染病控制、避免汙名化、新興傳染病整備應變
  Mpox, infectious disease control, avoid stigmatization, preparedness and response to emerging infectious disease
• 2022年Mpox疫情流行之IIb分支，主要傳播方式不易造成大規模疫情，且有安全、具保護力的疫苗，然而汙名及疫苗涵蓋不足使得全球難以將其消除。我國透過機場症狀監測、疫苗及藥物進口並制定分配原則、制定多元防制及照護指引等方式，控制疫情同時避免汙名化。最後提出面對突發疫情應採行之六項基本整備應變工作。
  Clade II b mpox, which is the predominant lineage in the 2022 outbreak, is not easily transmitted to cause large-scale epidemics. Although there are vaccines that are safe and effective, stigmatization and inadequate vaccine coverage have made it challenging to eliminate the disease worldwide. Taiwan has taken measures such as monitoring symptoms at airports, importing vaccines and medications with established distribution guidelines, and developing diverse prevention and care guidelines to control the outbreak while avoiding stigmatization. The author concludes by proposing six key preparedness and response measures that should be adopted in the face of sudden outbreaks.
• 109-112
• 10.6288/TJPH.202404_43(2).PF02

• Link 公衛論壇 Public Health Forum
• 社會療癒、重建與團結：轉型正義中的衛生福利工作Social healing, reconstruction, and solidarity: on the role of health and welfare systems in transitional justice
• 葉明叡
  Ming-Jui Yeh
• 社會療癒、轉型正義、健康社會福祉
  social healing, transitional justice, health and social well-being
• 本文提出衛生福利體系相關「轉型正義與社會療癒」工作或政策之思考，既有個人療癒政策以外，發展社會療癒政策、檢討現行政策以符合人權保障之要求，促使社會整體的和解、重建與團結，進一步支持衛生福利體系之永續經營。
  This article presents ideas for work or policies related to "transitional justice and social healing" within the health and welfare system. Beyond individual healing policies, developing social healing policies and reviewing current policies to meet the requirements for human rights protection are proposed to foster reconciliation, reconstruction, and solidarity within the society. These efforts ultimately support the sustainable operation of the health and welfare system.
• 113-120
• 10.6288/TJPH.202404_43(2).112076

• Link 綜論 Review Article
• 道歉法對醫療糾紛之影響：實證回顧與對台灣之啟示Impact of apology laws on medical malpractice: an empirical review and implications for Taiwan
• 林欣柔
  Shin-Rou Lin
• 道歉法、醫療糾紛、醫療錯誤
  apology law, medical malpractice, medical error
• 目標：過去二十年道歉法成為減少醫療糾紛的重要改革策略，但其對醫療傷害責任之實際影響尚不清楚。本文藉由回顧實證性文獻，分析道歉法之影響，以及對台灣醫療爭議預防及處理法之啟示。 方法：於PubMed資料庫進行英文文獻搜尋，經排除重複、納入及排除條件篩選，再逐一查閱文末參考資料，納入符合篩選條件之文獻。 結果：共納入14篇文獻，研究地區均為美國，全國性資料的研究顯示道歉法對降低整體醫療責任效果不明顯，但由道歉法帶動、在機構層次推行之溝通與紛爭解決計畫（Communication and Resolution Program, CRP），有較顯著減少訴訟、降低成本、縮短爭議解決時間之成效。有成功經驗的機構通常具備強有力領導者、責任保險人、醫師及品質與風險人員認同、專業經理負責執行以及主動提出補償等條件。 結論：台灣目前欠缺揭露醫療錯誤之倫理共識，機構層次之政策及橫向組織連結不明確，亦無補償機制，道歉法在台灣之執行成效需要持續關注與分析。
  Objectives: Over the last two decades, apology laws have emerged as a crucial strategy for reducing medical malpractice liabilities. However, the effectiveness of these laws is unclear. This study investigated the effect of apology laws on medical malpractice by conducting a systematic literature review, providing insights into Taiwan' s Medical Accident Prevention and Dispute Resolution Act. Methods: A search for relevant articles in the PubMed database was conducted. Articles lacking abstracts or not written in English were excluded. Eight studies that met the inclusion criteria were identified. The reference lists of these eight articles were checked, and six additional eligible studies were identified. Results: We included 14 studies in the analysis. All the studies were conducted in the United States. The studies revealed that apology laws have a negligible effect on reducing medical malpractice liabilities. However, communication and resolution programs implemented at institutional levels do effectively reduce litigation frequency and costs and expedite dispute resolution. Organizations with successful outcomes typically exhibit strong leadership, support from liability insurers, physicians, and quality and risk personnel, dedicated management by skilled professionals, and proactive reimbursement. Conclusions: Taiwan currently lacks an ethical consensus regarding the disclosure of medical errors. Institutional-level policies and horizontal organizational relationships are not well-defined, and a mechanism for compensation is absent. The effectiveness of apology laws necessitates continuous monitoring and discussion.
• 121-132
• 10.6288/TJPH.202404_43(2).112127

• Link 原著 Original Article
• COVID-19不同階段對台灣醫事人員與家屬生活與心理健康之衝擊初探Impact of different stages of the COVID-19 pandemic on the life and mental health of medical workers and their family members in Taiwan
• 葉曉姍、陳妍瑄、林郁婷、李紀瑩、鍾國彪
  Hsiao-San Yeh, Yen-Hsuan Chen, Yu-Ting Lin, Ji-Ying Lee, Kuo-Piao Chung
• 醫事人員、醫事人員家屬、嚴重特殊傳染性肺炎、心理健康
  health professionals, health professional's family members, COVID-19, mental health
• 目標：本研究旨在更深入的了解疫情不同階段，醫事人員與其家屬的生活與心理健康之衝擊。 方法：本研究共計訪談16位醫事人員及12位醫事人員之家屬，採取主題分析法做資料分析。 結果：醫事人員整理出五主題，分別為「疫情對工作生活的衝擊」、「疫情對個人生活的衝擊」、「疫情間的心理衝擊」、「疫情期間的心理轉變」、「期望獲得的支持與幫助」；醫事人員家屬整理出四主題，分別為「疫情對家庭生活的衝擊」、「疫情期間的心理衝擊」、「疫情期間的心理轉變」、「家屬獲得的支持與幫助」。 結論：疫情對醫事人員的工作與個人生活皆造成衝擊，且也影響醫事人員的擔心，在不同階段有不同的心理轉變，也期待能獲得防疫政策的調整與津貼的調整。對醫事人員家屬而言，疫情對家庭生活產生了衝擊，同時也影響了他們的心理轉變與擔心，在疫情期間，他們也獲得了相關的協助與支持。
  Objectives: This study investigated the effect of the COVID-19 pandemic on the lives and mental health of health-care professionals and their families at different stages of the crisis. Methods: We interviewed 16 health-care professionals and 12 relatives of health-care professionals. Thematic analysis was performed for data analysis. Results: We identified five main themes for the health-care professionals: "effect of the pandemic on work life," "effect of the pandemic on personal life," "psychological effect during the pandemic," "psychological changes during the pandemic," and "expected support and assistance." Furthermore, we identified four main themes for the relatives of health-care professionals: "effect of the pandemic on family life," "psychological effect during the pandemic," "psychological changes during the pandemic," and "support and assistance received by family members." Conclusions: The findings revealed the substantial effects of the pandemic on the professional and personal lives of the health-care professionals, influencing their concerns and causing various psychological changes at different stages. The health-care professionals expressed the need for modifications in epidemic prevention policies and support measures. Furthermore, in terms of the relatives of health-care professionals, the pandemic has altered family dynamics and affected their psychological states and concerns. During the pandemic, they received relevant assistance and support.
• 133-143
• 10.6288/TJPH.202404_43(2).112100

• Link 原著 Original Article
• 台灣COVID-19疫情流行期間之超額死亡估計Estimation of excess mortality during COVID-19 pandemic in Taiwan
• 孔常喜、梁立霖、呂宗學
  Chang-Xi Kung, Li-Lin Liang, Tsung-Hsueh Lu
• 新冠肺炎、疫情、超額死亡、三級警戒、醫療資源
  COVID-19, pandemic, excess mortality, level 3 alert, medical resources
• 目標：全死因超額死亡率能全面性的量化疫情的影響程度，包含直接與間接影響。本研究旨在估計COVID-19疫情流行期間，台灣及各縣市的超額死亡。 方法：收集2010年至2019年各縣市歷月死亡人數資料、各年齡層人口數及總人口數資料進行準卜瓦松迴歸分析。在考慮月份效應、人口老化程度及總人口數之後，獲得加權迴歸係數建立死亡預測訓練後模型，預測2020年至2022年歷月之預期死亡數。超額死亡率定義為觀察死亡數減去預期死亡數，再除以 總人口數，並以每十萬人為單位計算。 結果：2020年各縣市未出現超額死亡。 2021年全國歷月加總後未觀察到超額死亡，但三級警戒期間台北市及新北市有超額死亡產生。 2022年5月之後受到大規模Omicron侵襲，各縣市的超額死亡均大幅提升，全國超額死亡數20,702人，間接(非COVID-19)超額死亡比例佔29.9%。間接超額死亡比例前五名分別為新竹縣、嘉義縣、雲林縣，苗栗縣及新北市，介於42%–61%之間。 結論：超額死亡可反應疫情的嚴重程度；其中，間接超額死亡似乎對醫療資源較少的縣市影響較大，需要政策來均衡醫療資源分配，避免更多間接超額死亡。
  Objectives: Excess mortality (EM) is a comprehensive indicator for quantifying the direct and indirect effects of the COVID-19 pandemic. This study estimated EM in Taiwan during the COVID-19 pandemic. Methods: Monthly mortality data (2010–2019) and population statistics of counties and cities in Taiwan were collected for quasi-Poisson regression analysis. After the effects of month, aging, and total population were adjusted, weighted regression coefficients were obtained to construct a predictive model for the expected number of deaths in 2020–2022. EM is obtained using the following formula: reported number of deaths − expected number of deaths. Results: In 2020, no EM was observed at either national or regional levels. In 2021, EM was observed during the Level 3 alert period in Taipei City and New Taipei City. A COVID-19 variant (Omicron) broke out in May 2022, after which EM substantially increased. In 2022, EM of 20,702 was observed, of which 29.9% was indirect EM (not related to COVID-19). The five regions with the highest proportions of indirect EM were Hsinchu County, Chiayi County, Yunlin County, Miaoli County, and New Taipei City (42%–61%). Conclusions: EM can serve as an indicator of pandemic severity. Notably, regions with limited healthcare resources reported a higher proportion of indirect EM, highlighting the pandemic's role in impairing healthcare accessibility in these regions. Thus, policy interventions are necessary to balance the distribution of medical resources and mitigate indirect EM.
• 144-154
• 10.6288/TJPH.202404_43(2).112125

• Link 原著 Original Article
• 口腔健康識能新式量表發展暨相關影響因素的探討Exploring related factors and validating an oral health literacy instrument
• 沈季璇、李坤宗、鄧乃嘉、黃詠愷
  Chi-Hsuan Shen, Kun-Tsung Lee, Nai-Chia Teng, Yung-Kai Huang
• 牙科公共衛生、初級預防、牙科診間、生活品質、人口學
  dental public health, primary prevention, dental clinic, quality of life, demography
• 目標：口腔健康識能與個案口腔健康行為與口腔健康狀態有關。本研究目標為發展口腔健康識能量表及探討影響相關因子。 方法：本研究經人體研究委員會同意後，以橫斷式研究，收集244位個案。口腔健康識能量表包含字彙理解能力、功能性與互動性口腔健康識能。量表經 專家內容效度檢定外，以曼惠特尼U檢定與皮爾森迴歸分別檢定鑑別度與信度。另以一般或邏輯式逐步迴歸分析選取口腔健康識能量表相關因素。 結果：三種口腔健康識能量表均具鑑別度與各自相關性。逐步迴歸結果顯示，個案教育程度越高，互動性口腔健康識能分數也越高（全模型調整判定係數為0.21，p<0.001）。功能性口腔健康識能分數增加，有較高比值個案使用正確牙縫清潔工具（p=0.04）或每天清潔牙縫（p<0.001）行為。 結論：本研究以驗證口腔健康識能量表探勘影響因子，除年齡與社經地位為重要影響因子外，口腔健康識能與口腔衛生清潔行為顯著相關。本研究結果可應用於深入探討口腔健康識能導致口腔健康行為中介因子，達到口腔疾病預防。
  Objectives: Oral health literacy and oral health behavior have an impact on one' s oral health status. The aim of this study is to validate the oral health literacy instrument and explore influencing factors. Methods: A cross-sectional study involving 244 clients was conducted. Three oral health literacy instruments assessed vocabulary comprehension, functional literacy, and interactive literacy, respectively. The content of the instruments was reviewed by professionals with expertise in oral health literacy and dentistry. Discrimination and reliability were assessed using the Mann-Whitney U test and Pearson correlation coefficient, respectively. Stepwise linear and logistic regression were used to select factors. Results: Every domain of the oral health literacy instrument displays discrimination and correlations with the others. The results from the Stepwise analysis reveal that clients with higher educational levels or younger ones are more likely to achieve higher scores in interactive oral health literacy (model R-square 0.21, p<0.001). Clients with higher scores in functional oral health literacy are more likely to use the correct interdental cleaning tools (p=0.04) and engage in daily interdental cleaning (p<0.001). Conclusions: In this study, the oral health literacy instrument has been validated and utilized to investigate related factors. Besides socioeconomic status, which has been identified as an important influencing factor, oral health literacy also proves to have a significant relationship to a subjects' oral health cleaning behavior. The results of this study can be used to further explore the mediating factors that lead to oral health literacy and oral health behaviors that achieve oral disease prevention.
• 158-168
• 10.6288/TJPH.202404_43(2).112105

• Link 原著 Original Article
• 社區女性非法藥物使用者童年逆境經歷與不良親密關係之相關性探討Association linking adverse childhood experiences with unhealthy intimate relationships among women who used illegal drugs in community
• 蕭其蓁、雷文玫、謝丹雯、陳娟瑜
  Rosetta Siew, Wenmay Rei, Tan-Wen Hsieh, Chuan-Yu Chen
• 童年逆境經歷、未成年性行為、藥愛、親密暴力
  adverse childhood experiences, early sexual initiation, sexualized drug use (SDU), chemsex, intimate partner violence
• 目標：針對生育年齡女性毒品使用者，探討其童年逆境經歷暴露與不良親密關係的相關性。 方法：2021年9月至2023年5月於十所台灣北部、南部服務毒品使用者之社區機構進行收案，219名以電腦輔助自我訪談方式完成問卷。十項童年逆境經歷含家庭失能、疏忽、虐待三構面，不良親密關係為未成年性行為、藥愛及親密暴力；相關性分析以邏輯斯迴歸模型進行檢驗。 結果：75.3%女性毒品使用者經歷至少一項童年逆境，其中四項（含）以上者佔其中38.8%；四項（含）以上童年逆境經歷暴露顯著增加藥愛以及親密暴力勝算126%及368%。目睹女性照顧者受暴（調整後勝算比=3.08）和性虐待（調整後勝算比=3.55）與藥愛風險增加相關性最強；情感疏忽（調整後勝算比=2.63）、同住家人有物質濫用（調整後勝算比=2.45）則分別與親密暴力和未成年性行為風險增加有關。 結論：童年逆境經歷為女性毒品使用者不良親密關係樣態的重要生命早期危險因子。服務方案應考慮將童年逆境經歷納入評估及介入依據，以期減少毒品施用族群之健康傷害。
  Objectives: This study investigated the association between adverse childhood experiences (ACEs) and unhealthy intimate relationships among community-dwelling women of reproductive age (16-45 years) who use illegal drugs in Taiwan. Methods: Based on a cross-sectional study design, data were collected using computer-assisted self-interviewing questionnaires (n=219) from September 2021 to May 2023. A 10-item checklist was used to assess the three domains of ACEs (i.e., household dysfunctions, neglect, and abuse). Unhealthy intimate relationships include early sexual initiation, sexualized drug use (SDU)/chemsex, and intimate violence victimization (IPV). Logistic regression analysis was used to evaluate the association estimates. Results: 75.3% had experienced at least one ACEs and 38.8% had four or more ACEs. Exposure to 4+ACEs may increase the odds of early sexual initiation by 101%, and the corresponding risks for SDU/chemsex and IPV were 126% and 368%, respectively. Having a substance-using family member in the household was associated with early sexual initiation (adjusted odds ratio [aOR]=2.45). Witnessing domestic violence (aOR=3.08) and sexual abuse (aOR=3.55) were strongly associated with SDU/chemsex, while parental divorce/separation (aOR=2.21), emotional neglect (aOR=2.63), and emotional abuse (aOR=2.13) were strongly associated with increased IPV. Conclusions: These findings indicate that childhood adversity is common in women who use drugs. The observed increased risk of unhealthy intimate relationships associated with ACEs may highlight the need to address ACEs in addiction intervention or treatment to reduce unfavorable outcomes.
• 169-182
• 10.6288/TJPH.202404_43(2).112128

• Link 原著 Original Article
• 登革熱防治專責人員對於應用沃爾巴克氏菌做為防治技術之態度Attitudes of dengue fever specialists toward application of Wolbachia for mosquito vector control
• 郭世文、吳佩修、王裕宏
  Shih-Wen Kuo, Pei-Hsiu Wu, Yu-Hung Wang
• 健康信念模型、登革熱防治、沃爾巴克氏菌防治法
  Health Belief Model, dengue fever prevention and control, Wolbachia method
• 目標： 以社區登革熱防治專責人員為研究對象，探討他們對於以沃爾巴克氏菌防治登革熱 策略之態度及影響因素。 方法： 以健康信念模型為理論基礎發展研究架構：以個人健康信念 四個變項為自變項，對Wb防治法的態度為依變項，對Wb防治法的知識為控制變項，並以自己 或親友有無感染登革熱經驗為調節變項；研究工具為經專家效度審查及預試項目分析的自編研 究問卷，於專責人員教育訓練課程中發放，共回收758份有效問卷；以結構方程模型進行資料 分析，並以群組比較來了解有無感染登革熱經驗在自變項對依變項的影響是否具有顯著差異。 結果： 統計結果顯示健康信念模型的四個變項（自覺罹患性、自覺嚴重性、自覺益處、自覺障 礙）以及Wb防治法的知識對Wb防治法的態度均有顯著影響，其中自覺障礙呈現負向影響。此 外，是否有感染登革熱的經驗也對自覺嚴重性和自覺障礙的認知與Wb防治法態度之間的影響 具有顯著的調節作用。 結論： 建立Wb防治法健康信念模型，並提出Wb防治法社區溝通推廣策 略的建議。
  Objectives: This study surveyed community dengue fever specialists, exploring their attitudes toward the application of the Wolbachia method for dengue fever prevention and control and the related influencing factors. Methods: The study framework was based on the health belief model and had four personal health belief variables as independent variables, attitudes toward the Wolbachia method as the dependent variable, knowledge of the Wolbachia method as the control variable, and personal or family experience with dengue fever as a moderator variable. A self-designed and validated questionnaire was distributed to specialist staff during training courses, and 758 valid responses were collected. Structural equation modeling was used to analyze the relationships among variables. Results: The statistical results revealed that the four variables of the health belief model (i.e., perceived susceptibility, perceived severity, perceived benefits, and perceived barriers) and knowledge of the Wolbachia method significantly influenced the respondents' attitudes toward the Wolbachia method; notably, the influence of perceived barriers was negative. Additionally, the experience of being infected with dengue fever was identified as a significant moderator of the relationships between two independent variables (i.e., perceived severity and perceived barriers) and the dependent variable. Conclusions: A health belief model for the Wolbachia method should be established, and strategies for promoting and communicating the Wolbachia method to the public should be extensively employed.
• 183-198
• 10.6288/TJPH.202404_43(2).112111

• Link 實務 Public Health Practice
• 新北市與其他縣市新生兒死亡率與證明書填寫行為之比較Comparing neonatal mortality rates and certification behaviors between New Taipei City and other cities/counties in Taiwan
• 呂宗學、陳潤秋、黃閔照、彭純芝、陳佳慧、蔡卉妮、張雅筑
  Tsung-Hsueh Lu, Ran-Chou Chen, Ming-Chao Huang, Chun-Chih Peng, Chia-Huei Chen, Hui-Ni Tsai, Ya-Jhu Jhang
• 新生兒死亡率、出生當天死亡、出生證明書、出生登記、台灣
  neonatal mortality rate, death on the day of birth, birth certificate, birth registration, Taiwan
• 目標：比較新北市與其他縣市新生兒死亡率與證明書填寫行為。 方法：首先分析2002至2022年各縣市新生兒（<28天）與出生當天（0天）死亡率趨勢，以連結回歸模型檢定趨勢改變是否顯著差異。接著連結2018至2021年五個資料庫，計算不同縣市產科醫師開具死亡證明書佔0天死亡者的比例與相關特徵差異。最後分析2021年50位新北市出生當天死亡個案母親生產當日病歷與訪談醫院管理者，瞭解影響填寫行為相關因素。 結果：只有新北市與高雄市出現0天死亡率先降後升轉折趨勢型態。新北市是在2012年開始出現每年11.4%上升趨勢，高雄市是在2006年開始出現每年8.1%上升趨勢。2018至2021年合計台灣0天死亡數為778名，產科醫師開具 死亡證明書404名（ 52%）。新北市72%遠高於其他縣市（約55%），而且出現逐年上升趨勢：2018至2021年分別是63%， 73%， 74%與78%。2019至2021年懷孕週數<24週比例超過九成，主要是人工流產個案增加。訪談醫院表示在2014與2020年有相關決議，會影響開具出生證明書與死亡證明書行為。 結論：新北市新生兒死亡率增加與高於其他縣市，有相當部份受到證明書開具行為影響。要正確比較新生兒死亡率高低，必須排除這些行為因素。
  Objectives: This study compared the neonatal mortality rates (NMRs) and certification behaviors between New Taipei City (NTC) and other cities/counties in Taiwan. Methods: We first examined the NMR trends for days <28 and day 0 for each city or county for the years 2002 to 2022. Joinpoint regression was performed to identify significant changes in the trends. We then linked five population-based data sets to calculate the proportion of day-0 deaths for which the death certificate was issued by an obstetrician and to examine the related characteristics. Finally, we reviewed the charts for 50 day-0 deaths in NTC in 2021 and interviewed hospital managers regarding the regulation of certification behaviors. Results: Only the day 0 NMR trends for NTC and Kaohsiung City (KC) exhibited a decline-and-rise pattern. The annual percent change was 11.4% since 2012 for NTC and 8.1% since 2006 for KC. In total, 788 day-0 deaths occurred between 2018 and 2021, and the death certificates of 404 (52%) were issued by obstetricians. The percentage of day-0 deaths with obstetrician-issued death certificates was 72% in NTC, which was higher than those of other cities/counties (approximately 55%), and a rising trend was also identified (63% in 2018, 73% in 2019, 74% in 2020, and 78% in 2022). More than nine-tenths of these deaths involved a gestational age of <24 weeks, and most of them were the result of artificial abortions. The interviewed hospital managers indicated that various regulations for certification behaviors have been introduced. Conclusions: The higher NMRs and rising NMR trend in NTC compared with other cities/counties were partially due to certification-related behavioral artifacts. To properly interpret the regional variations in NMRs we should first remove this behavioral artifact.
• 199-210
• 10.6288/TJPH.202404_43(2).112122

• Link 評論 Commentary
• 評論：台灣COVID-19疫情流行期間之超額死亡估計Commentary: estimation of excess mortality during COVID-19 pandemic in Taiwan
• 羅偉成
  Wei-Cheng Lo
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• 155-156
• 10.6288/TJPH.202404_43(2).11212501

• Link 作者回覆 Authors' response to commentary
• 作者回覆：台灣COVID-19疫情流行期間之超額死亡估計Authorsʼ response to commentary: estimation of excess mortality during COVID-19 pandemic in Taiwan
• 孔常喜、梁立霖、呂宗學
  Chang-Xi Kung, Li-Lin Liang, Tsung-Hsueh Lu
• 無none
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• 無none
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• 157
• 10.6288/TJPH.202404_43(2).11212502