44卷5期

• Link 政策論壇 Policy Forum
• 從菸草到新興菸品—邁向無菸新境界或公共衛生的新災難？ From tobacco to novel nicotine and tobacco products–towards a tobacco-free future or a new public health catastrophe?
• 李志恒、林英琦
  Jih-Heng Li, Ying-Chi Lin
• 無none
  無none
• 無none
  無none
• 445-448
• 10.6288/TJPH.202510_44(5).PF05

• Link 公衛論壇 Public Health Forum
• 人工智慧於公共衛生教育中的課程設計原則、核心能力與教學整合策略 Curriculum design principles, core competencies, and pedagogical integration strategies for artificial intelligence in public health education
• 李達宇、沈楷博、盧子彬、鄭守夏、杜維洲、劉政亨、李建璋、莊秋華、陳曉慧、楊銘欽、陳保中
  John Tayu Lee, Toby Kai-Bo Shen, Tzu-Pin Lu, Shou-Hsia Cheng, Wei-Zhou Du, Cheng-Heng Liu, Chien-Chang Lee, Chiou-Hwa Chuang, Hsiao-Hui Chen, Ming-Chin Yang, Pau-Chung Chen
• 公共衛生教育、教學核心能力、人工智慧、機器學習
  Public Health Education; Core Teaching Competencies; Artificial Intelligence; Machine Learning
• 人工智慧與機器學習(Artificial Intelligence/Machine Learning, AI/ML)相關技術日益精進，對公共衛生教育帶來前所未有的挑戰與契機。我國全民健康保險制度與整體醫療照護體系素以完善聞名，為公共衛生實踐奠定堅實基礎，憑藉數位建設與制度的優勢，AI/ML具備推動教育轉型與創新的潛力。然而，當前AI技術在公衛教育中的發展仍屬零星，缺乏統整性與系統架構。本文綜整多位公共衛生領域中熟稔AI/ML教師的觀點，探討相關科技納入臺灣公衛教育之課程設計建議方向、核心能力目標、具體教學策略及可能面臨的制度風險。最後，本文將提出具體的實務建議與未來發展方向，期望為政策規範與教育實踐提供系統性的參考依據。
  Artificial Intelligence and Machine Learning (AI/ML) technologies are advancing rapidly, bringing unprecedented challenges and opportunities to public health education. Taiwan’s National Health Insurance system and integrated care network provide a strong foundation for public health practice; leveraging this digital infrastructure and institutional maturity, AI/ML holds great promise for driving educational transformation and innovation. Yet AI integration in public health education remains fragmented and lacks a coherent framework. This study synthesizes the perspectives of experienced AI/ML public health educators to offer recommendations on curriculum design, core competency targets, concrete teaching strategies, and potential institutional risks. Finally, it presents practical suggestions and future development pathways to inform policy and educational practice.
• 449-459
• 10.6288/TJPH.202510_44(5).114034

• Link 公衛論壇 Public Health Forum
• 降低台灣兒童死亡率需要怎樣的電子地圖導航？ What kind of digital roadmap is needed to reduce child mortality in Taiwan?
• 呂宗學、方麗容、呂立、李元暉、李昆樺、杜苡榛、沈瓊桃、張文昌、謝奇璋、謝凱生、黃碧桃、江東亮、呂鴻基
  Tsung-Hsueh Lu, Li-Jung Fang, Frank Leigh Lu, Yuan-Hui Lee, Kun-Hua Lee, Sophia Yi-Chen Tu, April Chiung-Tao Shen, Wen-Chang Chang, Chi-Chang Shieh, Kai-Sheng Hsieh, Betau Hwang, Tung-liang Chiang, Hung-Chi Lue
• 兒童死亡率、健康臺灣、監測資料
  child mortality, Healthy Taiwan, surveillance data
• 為達成2030年兒童死亡率降至每千活產4.0以下之目標，必須建立蒐集預防相關數據監測系統，並運用資料訂定防制計畫。本文整理臺灣兒童死因現況與目前衛生福利部所屬單位既有監測系統，也參考國際經驗提出改善建議，包含精進出生通報及死亡通報系統、監測安全睡眠環境。透過跨部門公私協力，並提供兒童照顧者新的照顧觀念，才有機會達成健康台灣之目標。
  To achieve the goal of reducing the child mortality rate to below 4.0 per 1,000 live births by 2030, it is essential to establish a data collection and monitoring system for prevention-related information, and to use these data to formulate prevention and control programs. This paper summarizes the current causes of child mortality in Taiwan and reviews the existing monitoring systems within the Ministry of Health and Welfare. It also draws on international experiences to propose improvement suggestions, including enhancing the birth and death reporting systems and monitoring safe sleep environments. Through cross-sector collaboration between public and private entities, and by promoting new caregiving concepts among child caregivers, Healthy Taiwan can be realized.
• 460-467
• 10.6288/TJPH.202510_44(5).114035

• Link 公衛今與昔 Public Health Now and Then
• 1950年代蘭安生(John B. Grant)對台灣大學公共衛生研究所與台灣公共衛生的影響 John B. Grant’s impacts on Institute of Public Health, National Taiwan University and public health in Taiwan in the 1950’s
• 容世明
  Shih-Ming Jung
• 無none
  無none
• 無none
  無none
• 468-477
• 10.6288/TJPH.202510_44(5).114041

• Link 綜論 Review Article
• 職業粉塵相關疾病與其政策因應：台灣近年經驗 Occupational dust-related diseases and policy responses: Taiwan’s recent experience
• 魏怡平、李俊賢、鄭雅文
  Yi-Ping Wei, Lukas Jyuhn-Hsiarn Lee, Yawen Cheng
• 粉塵疾病、病例報告、流行病學、職災保險、政策因應
  dust diseases, case reports, epidemiology, workers' compensation benefits, policy responses
• 因新興產業製程出現，粉塵導致的職業性肺部疾病案例增加。本文回顧台灣近年病例報告、流行病學研究、近年職災保險給付統計，並盤點主管部門對此議題的政策因應。以關鍵字搜尋2014年至2024年間台灣學者針對粉塵疾病發表的中英文醫學病例報告與流行病學文獻，檢視近年職業病通報及職災保險統計數據，並蒐集以勞動部職業安全衛生相關機構發布的新聞稿、指引、報告書、宣傳品等資料進行檔案分析。在2014-2024間，台灣學者針對職業性肺部疾病發表24篇醫學病例報告，涵蓋29名案例;罹病者從事的產業類型多元，近期案例則以人造石產業勞工居多。在此期間另針對職業性肺部疾病發表12篇流行病學研究，大多以健保、勞保與醫院病歷資料為材料，分析罹病者地理分佈、高風險產業、趨勢變化、罹病者的共病與預後狀況。職業性肺部疾病的職災給付件數變化幅度大，近年呈現下降趨勢，而整體而言，職災給付件數遠低於流行病學數據。勞動部依據《職業安全衛生法》訂有粉塵危害預防相關規範，政府職業安全衛生部門近年亦積極回應人造石粉塵危害，針對粉塵危害高風險產業進行調查與介入。職業健康學界與勞動主管部門關注職場粉塵危害與其健康風險，然而政策手段能否有效預防職業粉塵疾病，仍有待進一步探究。
  The advancement of manufacturing processes has led to the emergence of new occupational dust-related diseases. This systematic review was conducted to review current studies, analyze workers’ compensation statistics and policy responses by occupational health authorities regarding occupational dust-related diseases. Data were collected from peer-reviewed medical case reports and epidemiological studies published in Chinese and English by researchers in Taiwan between 2014 and 2024. Workers’ compensation statistics from 2000 to 2024 were analyzed. An archival analysis was performed using press releases, official guidelines, reports, and educational materials issued by Taiwan’s Ministry of Labor. Between 2014 and 2024, researchers in Taiwan published 24 medical case reports documenting 29 cases of dust-related diseases among workers from diverse industries, with contemporary cases predominantly occurring in those engaged in the artificial stone industry. During the same period, 12 epidemiological studies were published. These studies were conducted primarily using national health insurance records, labor insurance data, and hospital medical records to identify geographic patterns, high-risk industries, temporal trends, comorbidities, and disease prognoses. The numbers of occupational lung disease cases and compensation claims fluctuated but exhibited a downward trend in recent years. Overall, compensation cases were far fewer than epidemiological data. The Ministry of Labor have issued multiple administrative orders and guidelines on dust hazards under the Occupational Safety and Health Act. Occupational safety and health departments have also actively addressed artificial-stone related hazards through investigations and interventions in high-risk industries. The occupational health community and labor authorities are concerned about dust exposure in the work place and its health implications. However, their effectiveness in preventing dust-related diseases requires further evaluation.
• 478-490
• 10.6288/TJPH.202510_44(5).114054

• Link 綜論 Review Article
• 剖腹產後父嬰肌膚接觸對新生兒生理、行為與父親心理的影響：隨機控制試驗之系統性文獻回顧 Effects of father–newborn skin-to-skin contact after cesarean delivery on neonatal physiological, neonatal behavioral, and paternal psychological outcomes: a systematic review of randomized controlled trials
• 林筱青、李碧娥、張文亭、方淑嫻、林肇柏
  Hsiao-Ching Lin, Bih-O Lee, Wun-Ting Chang, Shu-Hsien Fang, Chao-Po Lin
• 剖腹產、父嬰肌膚接觸、新生兒照護、親職適應
  cesarean section, father skin-to-skin contact, neonatal care, paternal adaptation
• 剖腹產後，母親常因手術無法立即與新生兒進行肌膚接觸(skin to skin contact, SSC)，錯失建立親密連結的黃金時間，而輔以父親暫代照護受到關注，系統性回顧剖腹產後父嬰SSC對新生兒生理、行為與父親心理的影響。本研究依據PRISMA指引，檢索六大資料庫PubMed、CINAHL、Scopus、Embase、Cochrane Library、華藝線上圖書資料庫，搜尋至2024年10月的文獻，於2025年5月進行補充更新。文獻品質以Modified Jadad Score (MJS)評估，證據等級以Oxford CEBM評定。採取敘述性統整新生兒的生理指標、行為反應和父親的心理狀態。最後納入六篇隨機對照試驗，324位剖腹產足月新生兒，發現父嬰SSC有助於穩定新生兒生理和行為，減輕父親焦慮與憂鬱，提升親職角色認同。文獻品質MJS得分為5-6.5分，證據等級屬Oxford CEBM為Level 2，各研究未有報告與介入相關的不良反應。父嬰SSC能促進新生兒的生理穩定與行為調節，增強父親的心理適應與親職參與。未來應擴大樣本數與多中心設計，長期追蹤與標準化介入，強化臨床實證與應用價值。
  After cesarean delivery, mothers often miss early skin-to-skin contact (SSC) because of surgical recovery. This review explored the effects of father-initiated SSC on neonatal physiological stability, neonatal behavioral responses, and paternal psychological well-being. This study adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Six databases were searched for relevant articles published until October 2024; an updated literature search was performed in April 2025. Randomized controlled trials (RCTs) involving full-term cesarean-born newborns receiving paternal SSC were included in this review. Study quality was assessed using the modified Jadad scale. Evidence level was determined on the basis of the criteria outlined by the Oxford Centre for Evidence-Based Medicine. In total, six RCTs (N = 324) revealed that father–infant SSC promoted thermal stability, regulated heart rate and oxygen saturation, reduced crying, and enhanced prefeeding behaviors. Fathers reported reduced anxiety and depression and strengthened parent–child bonding after SSC. No adverse events were noted. The modified Jadad score for study quality ranged from 5 to 6.5, corresponding to Level 2 evidence. Father-initiated SSC is a safe and effective alternative when maternal SSC is delayed. It supports neonatal physiological regulation and paternal psychological adaptation. Further large, multicenter RCTs are warranted.
• 491-504
• 10.6288/TJPH.202510_44(5).114051

• Link 評論 Commentary
• 評論：剖腹產後父嬰肌膚接觸對新生兒生理、行為與父親心理的影響：隨機控制試驗之系統性文獻回顧 Commentary: effect of father–newborn skin-to-skin contact on neonatal physiological, behavioral, and paternal psychological outcomes after cesarean section: a systematic review of randomized controlled trials
• 王淑芳
  Shu-Fang Wang
• 無none
  無none
• 無none
  無none
• 505-506
• 10.6288/TJPH.202510_44(5).11405101

• Link 原著 Original Article
• 結合可近性與空間自相關評估嘉義縣身心障礙者牙科醫療資源配置 Evaluating accessibility and spatial autocorrelation of dental resource allocation for people with disabilities in Chiayi County
• 鍾秉宸、詹大千
  Ping-Chen Chung, Ta-Chien Chan
• 醫療可近性、資源分布、身心障礙
  accessibility, resource distribution, disabilities
• 目標：考量到身心障礙者牙科就醫不便性，如何讓醫療資源均勻分配及有效利用，並提升醫療量能為重要議題，本研究探討嘉義縣身心障礙者牙科醫療資源可近性與資源分布。方法：醫療需求只考慮嘉義縣2023年6月身心障礙統計人口數，但因嘉義縣人口會跨區移動至嘉義市就醫，醫療供給將同時考慮嘉義縣、市的醫療資源，包含醫療機構位址和牙醫師數。使用兩階段流動搜尋法(two-step floating catchment area)，估計其就醫可近性，並用區域空間自相關指標(local indicators of spatial association)探討資源分配。結果：本研究納入嘉義縣5，593個最小統計區，總計34，346名身心障礙者。排除沒有身心障礙者區域，資源可近性為0有211個區域，佔最小統計區的3.8%，在這些區域內包含1，768位身心障礙者，資源可近性中位數為0.002(四分位距：0.003)，可近性變異係數(coefficient of variation)為1.3，吉尼係數(Gini coefficient)為0.5，醫療資源集中在嘉義市周圍，資源可近性低的區域位於阿里山鄉、番路鄉、梅山鄉、竹崎鄉、大埔鄉、布袋鄉與東石鄉。空間自相關結果顯示醫療熱點集中在嘉義市周圍，醫療冷點多分布於嘉義縣西部沿海地區及東部山區。結論：嘉義縣醫療資源集中在都會區，資源稀缺處於嘉義縣西部沿海零星地區與東邊山區，目前有巡迴醫療、到宅醫療服務等，可藉由預防保健觀念的衛生教育推廣，提升口腔健康的認識及口腔疾病的早期發現。
  Objectives: Considering the inconvenience of dental care for people with disabilities, it is essential to evenly distribute and effectively utilize dental resources to improve dental capacity. In this study, we explored the accessibility and equal distribution of dental resources among people with disabilities. Methods: We used open datasets of a population with disabilities in Chiayi County in June 2023. Due to the community, the dental supply, such as the locations of dental institutions and the number of dentists, was considered in both Chiayi City and Chiayi County. We used a two-step floating catchment area to estimate the accessibility and distribution equalities and applied local indicators of spatial association to examine the clusters of dental resources. Results: This study included 5,593 basic statistical areas in Chiayi County and with 34,346 people with disabilities. After excluding areas with no people with disabilities, 211 areas had a resource accessibility of 0, which accounted for 3.8% of the basic statistical areas. The median accessibility was 0.002 (interquartile range, 0.003), the coefficient of variation was 1.3, and the Gini coefficient was 0.5 across 1,768 people with disabilities. Dental resources are concentrated around Chiayi City and are less available in Alishan, Fanlu, Meishan, Jhuci, Dapu, Budai and Dongshih Townships. Spatial autocorrelation reported that dental hotspots were concentrated around Chiayi City, whereas dental cold spots were identified in the western coastal areas and eastern mountainous regions of Chiayi County. Conclusions: The dental resources in Chiayi County are concentrated in urban areas, with scarce resources in the western coastal region and eastern mountainous areas. Mobile and home healthcare systems are currently available. Through preventive health education, we can raise public awareness of oral health and promote the early detection of oral diseases.
• 507-515
• 10.6288/TJPH.202510_44(5).114037

• Link 原著 Original Article
• 心理資本對離職意圖的影響機制探討：醫療職場負向情緒展現與氛圍的脈絡效果 Influence of psychological capital on turnover intention: the contextual effects of negative emotional display and atmosphere in health-care workplaces
• 蘇珉一、楊國彬、馬瑞菊、張國義
  Min-I Su, Kuo-Pin Yang, Jui-Chu Ma, Kuo-I Chang
• 心理資本、工作壓力、團隊負向展示規則、團隊負面情感基調、離職意圖
  psychological capital, work pressure, negative team display rules, team negative affective tone, turnover intention
• 目標：面對即將到來的全球護理人力短缺危機，台灣正面臨護理人力流失與照護失衡問題，僅靠制度面的改善仍難以有效留才。本研究從心理資本出發，探討其如何透過工作壓力影響護理人員的離職意圖，以及團隊負向展示規則與負面情感基調在其中的調節效果。方法：採跨層次分析設計，調查期間為2024年12月至2025年3月針對台灣東部某區域教學醫院任職的護理師進行兩波問卷調查，問項包含心理資本、工作壓力、團隊負向展示規則、團隊負面情感基調、離職意圖及控制變項，總計回收432份有效問卷。結果：心理資本對離職意圖會產生顯著的直接負向影響，同時也會透過減緩工作壓力進而降低離職意圖。在中介模型中進一步檢驗團隊層級因素的調節效果，發現團隊負向展示規則具有弱化工作壓力影響離職意圖的調節效應，而團隊負面情感基調則會強化此影響，顯示團隊情緒規範與負向氛圍對於工作壓力與離職意圖間的關係會產生脈絡性影響。結論：從強化心理資本與營造情感安全的團隊文化雙軌介入，以促進護理職場穩定與永續。
  Objectives: In the face of an imminent global nursing workforce shortage, Taiwan is experiencing severe nurse attrition and care imbalances. Although Taiwan has implemented institutional reforms, reforms alone appear to be insufficient to address nurse retention problems. The present study investigated how psychological capital influences nurse turnover intention through job stress and examined the moderating effects of team-level negative team display rules and negative affective tone on the association between work pressure and turnover. Methods: This study conducted a multilevel analysis. Data were collected from registered nurses working at a regional teaching hospital in eastern Taiwan between December 2024 and March 2025. A questionnaire was distributed that measured psychological capital, job stress, negative team display rules, team negative affective tone, turnover intention, and control variables, and a total of 432 valid responses were obtained. Results: Analysis revealed that psychological capital has a direct, negative influence on turnover intention. Additionally, mediation analysis indicated that psychological capital reduces turnover intention by alleviating job stress. Team-level negative display rules were discovered to weaken the effect of job stress on turnover intention, whereas team-level negative affective tone strengthened this effect. These findings suggest that the influence of job stress on turnover intention is contingent upon emotional norms and team climate. Conclusions: A dual-path intervention strategy involving enhancing positive psychological resources and fostering an emotionally safe team culture can contribute to greater workforce stability and sustainability in the nursing profession.
• 516-530
• 10.6288/TJPH.202510_44(5).114046