44卷3期

• Link 政策論壇 Policy Forum
• 邁向無菸品新世代：新型菸品的戒除議題 Towards a new era of tobacco-free generation: issues of quitting novel tobacco products
• 郭斐然
  Fei-Ran Guo
• 無none
  無none
• 無none
  無none
• 207-208
• 10.6288/TJPH.202506_44(3).PF03

• Link 公衛論壇 Public Health Forum
• 高齡友善住院照護政策分析與建言 Analysis and recommendations on policies for age-friendly inpatient care
• 彭暄茹、謝佳容
  Hsuan-Ju Peng, Chia-Jung Hsieh
• 無none
  無none
• 無none
  無none
• 211-220
• 10.6288/TJPH.202506_44(3).113083

• Link 公衛今與昔 Public Health Now and Then
• 1950年蘭安生(John B. Grant)設立台灣大學公共衛生學系的建議 John B. Grant's recommendations on establishment of Department of Public Health, National Taiwan University in the 1950
• 容世明
  Shih-Ming Jung
• 無none
  無none
• 無none
  無none
• 221-227
• 10.6288/TJPH.202506_44(3).114009

• Link 原著 Original Article
• 國民營養調查(2013-2016)之成人體位指標常模建立：腰圍、臀圍、上臂圍與手握力分析 Establishment of normative data for waist, hip, mid-upper-arm circumference and hand grip strength for Taiwanese adults: analysis of 2013-2016 National Nutrition Survey results
• 彭巧珍、劉美媛、何宗翰
  Cheau-Jane Peng, Mei-Yuan Liu, Chung-Han Ho
• 台灣國民營養健康狀況變遷調查、體位測量、腰圍、上臂圍、手握力
  the Nutrition and Health Survey in Taiwan, anthropometric measurement, waist circumference, mid-upper arm circumference, hand grip strength
• 目標：運用具代表性的調查資料，分析建立國人體位與體適能常模。方法：本研究運用2013-2016年國民營養健康狀況變遷調查數據，分析成年人體位指標（腰圍、臀圍、上臂圍）與手握力，建立其性別與年齡常模。樣本涵蓋5,581名19歲以上成年人，依年齡層與百分位數進行分析。結果：男性、女性腰圍中位數在65歲以前皆呈現隨年齡層上升而增加，男性55歲中位數達90 cm，女性45歲以上中位數超過80 cm，表示此年齡後半數以上為腹部肥胖。男性臀圍中位數在30-44歲達最高，隨年齡遞減；女性全年齡層臀圍中位數穩定在93~94 cm，但女性95百分位明顯高於男性。男性上臂圍中位數自45歲起隨年齡增加而遞減，女性則一直維持穩定。不論男女性，手握力均隨年齡增加而下降，30~44歲男性握力中位數44.5 kg、女性25.9 kg，男女相比，同年齡層、同百分位男性握力數據較女性均高出10 kg。以亞洲肌少症篩檢建議，男性65~69歲超過15%、70歲以上超過25%、女性65~69歲超過25%、75歲以上超過50%符合「低肌肉強度」參考值。結論：本研究建立年齡與性別分層之腰圍、臀圍、上臂圍與手握力常模，也以國民營養調查資料報導國人體位偏差問題嚴重度、和證實年齡層對於不同體位指標的不同影響趨勢。建議評估高齡者營養狀況，需對照適當的國人常模，以提升健康監測與慢性病風險評估的正確性。
  Objectives: This study established normative data for anthropometric indicators, namely waist circumference, hip circumference, and mid-upper arm circumference, and handgrip strength for Taiwanese adults, with the data stratified by age and sex. The study analyzed nationally representative data to evaluate physical condition trends in Taiwan and provide reference values for health monitoring and sarcopenia risk assessment. Methods: Data were derived from the 2013-2016 Nutrition and Health Survey in Taiwan, with the data covering a total of 5,581 adults aged 19 years and older. Waist, hip, and mid-upper-arm circumference and handgrip strength measurements were analyzed by age group and sex. Percentile distributions were used to develop normative values for each indicator. Results: The median waist circumference increased with age up to 65 years in both sexes. In men, the median reached 90 cm by age 55, whereas in women, it exceeded 80 cm from age 45 onward, indicating that more than half of these individuals had abdominal obesity. Male hip circumference peaked between ages 30 and 44 and declined with age, whereas female hip circumference remained stable at 93–94 cm across all age groups, with the 95th percentile being significantly higher than that in men. In men, mid-upper-arm circumference declined after age 45, whereas in women, the values remained stable. Handgrip strength decreased with age for both sexes. Among individuals aged 30–44, the median handgrip strength was 44.5 kg for men and 25.9 kg for women. Furthermore, the median handgrip strength was consistently approximately 10 kg higher in men than in women of the same age and in the same percentile. According to Asian sarcopenia criteria, in this study, more than 15% of the men aged 65-69 and more than 25% of those aged 70 and older had low handgrip strength. For women, more than 25% of those aged 65-69 and more than 50% of those aged 75 and older met the criteria for low handgrip strength. This study confirmed that age-related changes occur in body composition and physical function in Taiwanese adults, which demonstrates the importance of considering age- and sex-specific norms in assessing the nutritional and functional status of older adults. Conclusions: This study established sex- and age-specific normative data for waist, hip, and mid-upper arm circumference and handgrip strength for Taiwanese adults. It highlighted the degree of deviation in body size distribution and confirmed the differential effects of aging on various body indicators. The findings suggest that nutritional assessments in older adults should be conducted with reference to appropriate national norms to improve accuracy in health monitoring and chronic disease risk evaluation.
• 228-242
• 10.6288/TJPH.202506_44(3).114013

• Link 原著 Original Article
• 耳穴貼壓對血液透析患者口乾症狀的改善成效：系統性文獻回顧與統合分析 Efficacy of auricular acupressure in alleviating xerostomia symptoms among patients undergoing hemodialysis: a systematic review and meta-analysis
• 劉嘉玲、郭素娥、張佑瑄
  Chia-Ling Liu, Su-Er Guo, Yu-Hsuan Chang
• 血液透析、耳穴療法、耳穴貼壓、口乾症、系統性文獻回顧
  hemodialysis, auriculotherapy, auricular acupressure, xerostomia, systematic review
• 目標：口乾為血液透析患者常見的困擾症狀，也是患者無法確實遵行體液限制，從而導致透析期間體重增加(IDWG， interdialytic weight gain) 的主因。高IDWG與心血管死亡風險有關，因此，本研究旨在透過系統性文獻探討耳穴貼壓介入改善血液透析患者口乾之成效，以作為日後實施減輕口乾相關照護策略的實證基礎。方法：本文以P：renal dialysis, hemodialysis、I：auricular acupressure、O：Xerostomia 等關鍵字並運用MeSH及布林邏輯，搜尋2025年3月31日前之CEPS、PubMed、Cochrane Library、EmBase、台灣碩博士論文、CNKI等文章，搜尋12篇，再依納入及排出條件篩選，最後納入5篇研究，以Cochrane系統之ROB 2.0及ROBINS-I進行評讀。結果：因異質性高，無法全部執行統合分析。但多數研究顯示耳穴貼壓能改善口乾或口渴；4週後IDWG的統合分析也達成效(Z=3.25， p=0.001)。結論：耳穴貼壓介入4週後，對口乾、口渴、唾液流速及IDWG有較好的改善效果；但由於統合分析文獻數量較少且異質性大，應謹慎看待結果。此外，考慮到一些研究的年代和方法學限制，建議未來投入大樣本的雙盲或三盲的隨機對照試驗，以利於日後提供更為精準的依據。
  Objectives: Xerostomia is a common symptom among patients undergoing hemodialysis, often hindering adherence to fluid restrictions and leading to increased interdialytic weight gain (IDWG). Elevated IDWG is associated with an increased risk of cardiovascular mortality. This study systematically reviewed the efficacy of auricular acupressure in alleviating xerostomia and provided an evidence-based foundation for future management strategies. Methods: Using the keywords ""renal dialysis,"" ""hemodialysis,"" “auricular acupressure,"" and ""xerostomia,"" along with MeSH terms and Boolean logic, we searched CEPS, PubMed, Cochrane Library, EmBase, Taiwan Thesis and Dissertation Database, and CNKI for articles published before March 31 2025. Twelve articles met the criteria. After screening for inclusion and exclusion criteria, we identified five eligible clinical trials for quality assessment. Research quality was appraised using the Cochrane risk of bias tool, ROB 2.0, and the Risk of Bias in Non-randomized Studies of Interventions. Results: Because of the high heterogeneity among the studies, a comprehensive meta-analysis was not feasible. However, most studies have indicated that auricular acupressure effectively alleviates xerostomia. Additionally, a meta-analysis conducted after four weeks demonstrated a significant reduction in IDWG (Z=3.25, p=0.001). Conclusions: Auricular acupressure was effective for xerostomia, thirst, salivary flow rate, and IDWG in patients undergoing hemodialysis after four weeks. However, owing to the small number of meta-analyses and heterogeneity, the results should be cautiously viewed. Considering the age and methodological limitations of some studies, further large-scale double- or triple-blind randomized controlled trials are recommended to establish more robust evidence for this intervention.
• 243-256
• 10.6288/TJPH.202506_44(3).113108

• Link 原著 Original Article
• 人工智慧輔助診斷糖尿病視網膜病變之成本效用分析 Cost-utility analysis of artificial intelligence-based screening for diabetic retinopathy
• 郭玟妤、連加恩、蕭鈺靜、滕欣、謝佩芬、楊惇筑、董鈺琪
  Wen-Yu Kuo, Chia-En Lien, Amy Y. Hsiao, Shin Teng, Pei-Fen Hsieh, Dun-Jhu Yang, Yu-Chi Tung
• 人工智慧、糖尿病視網膜病變、成本效用分析、遞增成本效用比
  artificial intelligence, diabetic retinopathy, cost-utility analysis, incremental cost-utility ratio
• 目標：糖尿病視網膜病變可能影響視力及降低生活品質，眼底檢查是診斷糖尿病視網膜病變的重要工具，眼底檢查率也是糖尿病照護品質的重要指標，隨著醫療科技的進步，人工智慧於糖尿病視網膜病變的影像判讀是最受重視的應用之一，也被視為一項執行眼底檢查的重要策略。因此，本研究以中央健康保險署觀點，探討以人工智慧輔助診斷糖尿病視網膜病變的成本效用。方法：本研究以決策樹及馬可夫的混合模型，比較兩種眼底檢查策略之成本及健康生活品質校正生命年：人工智慧(VeriSee DR) 輔助眼底檢查、傳統非眼科醫師眼底檢查。以衛生福利部衛生福利資料科學中心資料庫與文獻回顧，估計模型參數，並透過單維及機率敏感度分析評估結果的穩健度。結果：人工智慧輔助眼底檢查較傳統非眼科醫師檢查具備成本效用，遞增成本效用比為每增加一個健康生活品質校正生命年需增加9,555元，敏感度分析結果亦同。結論：人工智慧輔助眼底檢查係具成本效用的檢查策略，並能提升糖尿病病人的照護結果。
  Objectives: Diabetic retinopathy (DR) can impair vision and reduce quality of life. It is primarily diagnosed through fundus screening, and the rate of fundus screening is among the most crucial health-care quality indicators for patients with diabetes. Innovations in medical technology have led to artificial intelligence (AI) being applied to assist with DR screening, and it is considered a crucial strategy. Accordingly, the objective of this study was to conduct a cost-utility analysis of AI-based DR screening from the perspective of Taiwan's National Health Insurance Administration. Methods: Using a decision tree-Markov hybrid model, we compared the costs and quality-adjusted life years (QALYs) for AI-based (VeriSee DR) fundus screening and traditional nonophthalmologist fundus screening. We analyzed the Health and Welfare Data Science Center Database and conducted a literature review to estimate the model parameters. Additionally, one-way sensitivity analysis and probabilistic sensitivity analysis were performed to evaluate the robustness of the assessment. Results: Compared with traditional nonophthalmologist fundus screening, AI-based fundus screening was more cost-effective, with an incremental cost-utility ratio (ICUR) of $9,555 per QALY gained. Similar results were also obtained from the sensitivity analysis. Conclusions: AI-based fundus screening is a cost-effective means of conducting DR screening, and therefore, it can lead to improved health-care outcomes for patients with diabetes.
• 257-268
• 10.6288/TJPH.202506_44(3).113080

• Link 原著 Original Article
• 運動軌跡與憂鬱情緒軌跡的性別差異：13-22歲學生的長期追蹤研究 Sex differences between exercise trajectories and depressive mood trajectories in students aged 13-22 years
• 張以和、張弘潔、吳其臻、張新儀
  Yi-Ho Chang, Hung-Chieh Chang, Chi-Chen Wu, Hsing-Yi Chang
• 憂鬱情緒軌跡、運動軌跡、雙軌跡模型、性別研究
  depressive mood trajectories, exercise trajectories, dual trajectory model, gender studies
• 目標：青少年心理健康問題日益嚴重，過去研究顯示運動與憂鬱為負向關係，但缺乏長期追蹤研究。本研究使用雙軌跡模型，分析13至22歲間不同性別之運動軌跡與憂鬱情緒軌跡的長期發展關係。方法：採用「兒童與青少年行為之長期發展研究」(CABLE)資料，分析13-22歲追蹤樣本，共1,969人。透過群體基礎軌跡模型，將男性與女性的運動軌跡與憂鬱情緒軌跡進行分組，再進行多元羅吉斯迴歸分析。結果：運動軌跡在男女均分為三組：持續高運動、運動下降、持續低運動；憂鬱情緒軌跡，男性有四組：持續低憂鬱、憂鬱偏低、中等憂鬱、持續高憂鬱；女性有五組：持續低憂鬱、憂鬱偏低、中憂鬱緩升、高憂鬱下降、持續高憂鬱。其軌跡分布具性別差異，男性在「持續高運動組」最多(45.69%)，女性卻在「持續低運動組」最多(50.80%)，且女性運動軌跡，從國中便持續下降，男性則是高中才開始下降；女性相較男性有較高比例為「持續高憂鬱」(9.35% vs 14.71%)，和較低比例為「持續低憂鬱組」(15.58%vs. 5.07%)。不論男女，與持續高運動者相比，持續低運動者更可能有高憂鬱情緒軌跡。結論：無論男女，運動軌跡和憂鬱情緒軌跡呈現負向關係。部分國中階段高憂鬱情緒之學生，之後會發展為持續高憂鬱。建議從國中開始監測學生憂鬱情緒，並對高憂鬱情緒者適時介入；維持並提升學生的運動頻率，規劃具性別敏感的運動政策，尤其鼓勵女性運動，以促進心理健康。
  Objectives: Adolescent mental health is generally declining. Although research has revealed a negative correlation between exercise and depression, long-term studies on this topic remain limited. In this study, we used a dual-trajectory model to investigate the long-term developmental relationship between exercise trajectories and depressive mood trajectories in students (age: 13-22 years) stratified by sex. Methods: Relevant data were obtained from the Child and Adolescent Behaviors in Long-term Evolution (CABLE) study. Our cohort comprised 1,969 individuals aged 13-22 years. Exercise trajectories and depressive mood trajectories were stratified by sex through group-based trajectory modeling; this was followed by multinomial logistic regression. Results: Exercise trajectories were classified as follows for both male and female students: consistently high, declining, and consistently low. Depressive mood trajectories were categorized into four types for male students—consistently low, mild, moderate, and consistently high— and five types for female students—consistently low, mild, moderate with a gradual increase, high with a decline, and consistently high. These trajectories differed by sex. Most male students engaged in consistently high levels of exercise (45.69%), whereas most female students engaged in consistently low levels of exercise (50.80%). Both sexes exhibited a general decline in exercise trajectories, with this beginning in junior high school for female students and in high school for male students. However, no significant association was observed between declining exercise trajectories and high depressive mood risks. Notably, the percentage of ‘consistently high depression’ group was higher among female students than among male students (14.71% vs. 9.35%), whereas that of ‘constantly low depression’ group was lower among female students than among male students (5.07% vs. 15.58%). Regardless of sex, students in the ‘consistently low exercise’ group were more likely to be consistently high depressive mood trajectory. Conclusions: Exercise trajectories and depressive mood trajectories have negative relationship in both male and female individuals. Those with high depressive mood levels in junior high school later exhibited consistently high depression levels. Thus, we recommend monitoring depressive mood from junior high school and implementing timely interventions. Enhancing exercise frequency and developing sex-sensitive policies, particularly those aimed at increasing female participation, may support adolescent mental health.
• 269-284
• 10.6288/TJPH.202506_44(3).113109

• Link 原著 Original Article
• 住院照顧者之照顧意願如何轉化為幸福感?以中介序列模式探討照顧者掌握感與負荷之心理層面作用How caregiving intention translates into well-being: a sequential mediation model of the psychological effects of caregiver mastery and burden on inpatient caregivers
• 詹佑平、孫守涓
  Yu-Ping Chan, Shou-Chuan Sun
• 醫院照顧者、照顧意願、照顧者掌握感、照顧負荷、幸福感
  hospital caregivers, caregiving willingness, caregiver mastery, caregiving burden, well-being
• 目標：在住院人口持續大量增加、醫療照顧需求提升的情形下，家庭照顧者的負荷顯著增加。本研究探討台灣醫院住院患者主要照顧者之照顧意願、掌握感、照顧負荷與幸福感之間的關係。方法：採「牛津幸福量表」、「照顧者負荷量表」、「照顧者掌握量表」、「照顧意願量表」及「日常生活活動量表」問卷進行橫斷性調查，調查對象為台灣中部地區醫療體系轄下之地區醫院住院患者主要照顧者，運用SPSS PROCESS 6序列中介模型，依序探討掌握感與照顧負荷在照顧意願與幸福感間之中介關係。結果：共收案112人，序列中介模型顯示：照顧意願對幸福感無直接效果，但可以藉由提升照顧意願，接著依序透過增加掌握感來降低整體照顧負荷，最後正向影響照顧者之幸福感；在不同負荷類型中，情緒負荷對幸福感的直接影響不顯著，而生理負荷與束縛感負荷則通過掌握感表現出顯著的間接影響。結論：掌握感為影響幸福感的重要中介變項，能有效緩解負荷對幸福感的負面影響。因此，提供針對醫院主要照顧者的相關培力課程與心理支持，以提升掌握感，作為政策與實務之參考方向。
  Objectives: With the continual and substantial increase in the population of inpatients and the increasing demand for medical care, the burden placed on family caregivers has increased considerably. Accordingly, this study explored the relationships among caregiving intention, sense of mastery, caregiver burden, and well-being in primary caregivers of inpatients admitted to Taiwanese hospitals. Methods: A cross-sectional survey was conducted using the Oxford Happiness Questionnaire, Caregiver Burden Scale, Caregiver Mastery Scale, Caregiving Intention Scale, and Activities of Daily Living Scale. Primary caregivers of inpatients admitted to district hospitals in central Taiwan were recruited as participants. A sequential mediation analysis was conducted using SPSS PROCESS Model 6 to sequentially explore the mediating roles of sense of mastery and caregiver burden in the relationship between caregiving intention and well-being. Results: A total of 112 participants were included in the study. The sequential mediation model revealed that caregiving intention had no direct effect on well-being. However, when caregiving intention was enhanced, overall caregiver burden was progressively reduced through an increased sense of mastery, ultimately leading to a positive influence on caregivers' well-being. Among different types of burden, emotional burden did not have a significant direct effect on well-being, whereas physical burden and confinement burden demonstrated significant indirect effects mediated by sense of mastery. Conclusions: Sense of mastery is a crucial mediating variable influencing well-being and can alleviate the negative impact of burden on well-being. Therefore, offering relevant empowerment courses and psychological support specifically for primary hospital caregivers to enhance their sense of mastery is recommended as a direction for policymaking and practice.
• 285-305
• 10.6288/TJPH.202506_44(3).114001

• Link 原著 Original Article
• 從障礙形成過程模型看台灣高齡身心障礙者之社會參與 Exploring barriers to social participation among Taiwanese older adults with disabilities by using the Disability Creation Process Model
• 姚奮志、鍾武中
  Fen-Zhi Yao, Wu-Chung Chung
• 社會參與、身心障礙者、障礙形成過程模型、國際健康功能與身心障礙分類系統
  social participation, individuals with disabilities, DCP Model, ICF
• 目標：本研究以障礙形成過程模型(Disability Creation Process, DCP)為理論基礎，探討台灣高齡身心障礙者社會參與之限制情形，並分析個人、社會角色與環境因素對參與障礙之影響。方法：採用2015至2019年通過身心障礙鑑定之全國性FUNDES (the Functioning Disability Evaluation Scale, FUNDES)」資料，篩選65歲以上樣本共33,716筆。進行敘述性統計、t檢定、單因子變異數分析、積差相關與多元邏輯迴歸，分析社會參與困難程度與相關變項之關聯。結果：1. ICF (International Classification of Functioning, Disability and Health, ICF)第三、五、七類障礙者的社會參與困難程度顯著較高。2.教育程度較高 (國中以上) 與仍具就業身分者，參與障礙程度較低。3.居住於南部或非都市地區者，其參與限制相對較低。4.家庭經濟弱勢者、無照顧者者，其社會參與困難程度較高。5.四處走動、自理與居家活動功能與社會參與呈顯著相關。結論：本研究所觀察之教育、就業、居住區域等變項，皆可透過DCP模型中所提及的『社會角色』與『環境因子』予以整合詮釋，進而理解參與障礙非單一結果，而是多層次交互過程的產物。
  Objectives: This study applied the Disability Creation Process model to explore barriers to social participation among older adults with disabilities in Taiwan. The study focused on the influence of personal, social, and environmental factors. Methods: A total of 33,716 adults aged 65 years or older were selected from Taiwan's national FUNDES (the Functioning Disability Evaluation Scale) disability assessment database (2015-2019). Descriptive statistics, Student t tests, analysis of variance, Pearson correlation, and multinomial logistic regression were used for analysis. Results: Older adults with disabilities under International Classification of Functioning, Disability, and Health grades 3, 5, and 7 experienced major social participation difficulties. Higher educational levels and current employment were associated with reduced barriers to social participation. Older adults residing in southern or less urbanized areas experienced fewer limitations. Moreover, older adults from economically disadvantaged households or without caregivers exhibited greater social participation difficulties. Functional mobility, self-care, and household activities were strongly associated with positive social participation outcomes. Conclusions: The findings regarding the study variables, including educational level, employment status, and residential area, can be explained through the Disability Creation Process model, particularly through its constructs of social roles and environmental factors. These findings suggest that barriers to social participation arise not from a single factor but from a complex, multilayered interaction process.
• 306-324
• 10.6288/TJPH.202506_44(3).113095