45卷2期

• Link 政策論壇 Policy Forum
• 認識台灣失智照護資源 An introduction to dementia care resources in Taiwan
• 洪煒斌、白明奇
  Wei-Pin Hong, Ming-Chyi Pai
• 無none
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• 097-102
• 10.6288/TJPH.202604_45(2).PF02

• Link 公衛今與昔 Public Health Now and Then
• 戰後衛生所保健員的工作圖像速寫：以林丁伍先生為案例的分析Sketches of health assistants at the public health center after World War II: a case study analysis of Ding-Wu Lin
• 陳柏勳
  Po-Hsun Chen
• 無none
  無none
• 無none
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• 103-106
• 10.6288/TJPH.202604_45(2).114013

• Link 原著 Original Article
• COVID-19疫情對醫學生臨床訓練的影響：對Disease X準備的啟示Impact of the COVID-19 pandemic on medical students' clinical training: lessons for preparing for Disease X
• 吳政誠、吳建志、郭鐘隆、侯文萱
  Jeng‐Cheng Wu, Chien‐Chih Wu, Jong-Long Guo, Wen-Hsuan Hou
• OSCE臨床能力、COVID-19、疾病X、醫學教育、醫學生
  OSCE clinical competence, COVID-19, Disease X, medical education, undergraduate
• 目標：本研究旨在探討新興傳染疾病（Disease X）即COVID-19疫情對醫學生臨床訓練的影響，特別針對OSCE(Objective Structured Clinical Examination, OSCE)臨床能力表現與對學習環境的感知。方法：採橫斷式研究設計，納入疫情前（2019世代）與疫情中（2020世代）兩組醫學生的臨床訓練資料進行分析比較。研究工具包含Dundee醫學教育環境量表（Dundee Ready Education Environment Measure, DREEM）及客觀結構式臨床技能測驗（OSCE），使用描述性統計、t檢定、皮爾森相關及多元線性迴歸分析。結果：本研究共納入322名醫學生（2019世代167人；2020世代155人），其中男性（187人）約占全體研究對象之六成（58.1%）。兩組之DREEM分數無顯著差異，且與OSCE分數無顯著相關。然而，2020世代在OSCE標準化病人模擬情境測驗的總分，顯著低於2019世代。性別分析顯示，2020世代女性學生在DREEM與OSCE表現均顯著下降，男性則僅在OSCE分數降低。迴歸分析亦確認疫情中世代OSCE成績顯著下滑。結論：新興傳染疾病疫情期間，醫學生OSCE臨床能力普遍下降，女性學生對臨床學習環境的正向感受亦低於疫情前世代。研究結果可為公共衛生體系在未來疫情中參與制定精準醫學教育策略提供依據，並凸顯維持臨床訓練韌性對新興傳染病疫情的必要性。
  Objectives: The coronavirus disease 2019 (COVID-19) pandemic disrupted medical education worldwide, especially limiting real-word clinical experiences and direct patient interactions which are crucial to medical skill development. This study examined how this disease X pandemic affected clinical training for medical undergraduates. Methods: This cross-sectional study included participants from a prepandemic (Cohort 2019) and a midpandemic (Cohort 2020) cohort. Descriptive statistics, t-tests, Pearson correlation, and multiple linear regressions were conducted to examined the condition differences between the cohorts. Results: A total of 322 students were recruited, including 167 from Cohort 2019 and 155 from Cohort 2020; 187 participants (58.1%) were male. Subjective perceptions of the clinical learning environment were assessed using the Dundee Ready Educational Environment Measure (DREEM), while objective clinical competencies were evaluated using the Objective Structured Clinical Examination (OSCE). Our results showed neither significant differences in DREEM scores between the cohorts, nor significant correlation between DREEM and OSCE scores. OSCE scores were significantly lower in Cohort 2020 than in Cohort 2019. Female students in Cohort 2020 reported lower DREEM perceptions and OSCE performance, while male students mainly showed decreased OSCE scores only. Multiple linear regression analyses also confirmed significant reductions in OSCE scores in Cohort 2020. Conclusions: During the disease X pandemic, female students reported lower positive perceptions of the clinical learning environment, and all students trained during the pandemic period demonstrated lower OSCE clinical competencies compared with the pre-pandemic cohort. Our evidence could not only provide public health systems to prepare targeted strategies for future disease X, but also highlight the need to ensure resilience in clinical training.
• 107-121
• 10.6288/TJPH.202604_45(2).114089

• Link 原著 Original Article
• 線上點餐平台手搖飲品減糖措施：助推(Nudge)策略是否有效? Reducing sugar intake from hand-shaken beverages provided on online food ordering platforms: are nudges effective?
• 賴逸琳、吳舜文
  Yi-Lin Lai, Shun-Wen Wu
• 助推、手搖飲料、心理偏誤、焦點團體、調查實驗
  nudge, hand-shaken beverages, cognitive bias, focus group, survey experiment
• 目標：本研究探討以實施成本低、保有民眾選擇自由的助推工具，減少大學生從手搖飲料攝取的糖量之可行性。方法：採混合方法，以18歲至24歲的北部大學生為研究對象。透過焦點團體確認大學生的重要心理偏誤，據以設計未來健康風險以及預設選項助推政策工具，並以採四臂隨機分配設計之網路問卷實驗，以及利用部分等比例勝算模型分析助推工具的有效性，最後再次辦理焦點團體以解析實驗結果。結果：接受預設無糖助推工具之大學生，比起控制組選擇無糖的機率增加約0.13，選擇低甜度以及中高甜度的機率分別減少0.04及0.09；預設半糖及未來健康風險助推工具對於甜度選擇則無顯著影響。另拒絕含糖手搖飲料自我效能以及對含糖手搖飲料態度與手搖飲料甜度選擇有關。實驗後的焦點團體訪談結果顯示，大學生們認為助推工具保有甜度選擇自由，故支持實施減糖助推工具。結論：預設無糖可以提高大學生選擇無糖手搖飲料之機率，且本研究受訪者支持推動減糖助推工具，故政府可以考慮善用助推工具作為減糖政策的優先選項，以達減糖目標。
  Objectives: This study examined the feasibility of using low-cost, choice-preserving nudge tools to reduce sugar intake from hand-shaken beverages among university students. Methods: A mixed-methods approach targeting university students aged 18–24 years in northern Taiwan was adopted. Focus groups were conducted to identify key cognitive biases influencing the students’ sweetness choices. On the basis of these focus groups’ findings, two nudge tools were designed: (1) future health risk messaging and (2) sugar level defaulting. A four-arm randomized online experiment was then conducted, and a partial proportional odds model was used to assess the effectiveness of these interventions, followed by focus groups to interpret the experimental findings. Results: The sugar-free defaulting nudge significantly increased the probability of selecting sugar-free beverages by approximately 0.13 and decreased the probabilities of selecting low-sugar and high-sugar beverages by approximately 0.04 and 0.09, respectively. However, neither the medium-sugar defaulting nudge nor the future health risk messaging nudge had a significant effect on the students’ sweetness choices. Post experiment focus groups revealed that the students perceived the nudges as preserving their freedom of choice and expressed support for implementing such sugar-reduction interventions. Furthermore, self-efficacy in rejecting hand- shaken beverages and attitudes toward hand-shaken beverages were associated with sweetness choices. Conclusions: Because of their effectiveness and acceptance by university students, nudge tools are recommended to be included in governmental sugar reduction policies to reduce sugar consumption among university students.
• 122-135
• 10.6288/TJPH.202604_45(2).114070

• Link 評論 Commentary
• 評論：線上點餐平台手搖飲品減糖措施：助推(Nudge)策略是否有效？ Commentary: reducing sugar intake from hand-shaken beverages provided on online food ordering platforms: are nudges effective?
• 陳秋瑩
  Chiu-Ying Chen
• 無none
  無none
• 無none
  無none
• 136-137
• 10.6288/TJPH.202604_45(2).11407001

• Link 原著 Original Article
• 學齡前幼兒24小時活動問卷之信度及效度Reliability and validity of the 24-hour movement questionnaire for preschool children
• 薛名淳、廖　邕、黃婉綺、林倩宇
  Ming-Chun Hsueh, Yung Liao, Wan-Chi Huang, Chien-Yu Lin
• 兒童、運動、久坐行為、睡眠品質、加速度計
  children, physical activity, sedentary behavior, sleep quality, accelerometer
• 目標：本研究旨在發展具信度與效度之學齡前幼兒24小時活動問卷。方法：225位（女孩=107位）3至7歲幼兒配戴三軸加速規連續7天，家長於第1天（前測）及第7天（後測）填寫問卷。再測信度以組內相關係數（Intraclass correlation coefficient, ICC）及斯皮爾曼等級相關檢驗前後測問卷之相關程度，同時效度則透過斯皮爾曼等級相關評估問卷後測與三軸加速規測量24小時活動之相關性。結果：問卷的一週再測信度顯示身體活動及靜態行為均呈現中等至良好相關程度，包括：每日平均中高強度活動（ICC=0.84；ρ=0.84）、輕度活動（ICC=0.85；ρ=0.79）；靜態行為之螢幕時間（ICC=0.83；ρ=0.88）、活動受限（ICC=0.84；ρ=0.84）及非螢幕時間（ICC=0.77；ρ=0.75）；夜晚睡眠時間（ICC=0.44；ρ=0.75）、午睡（ICC=0.56； ρ=0.81）及睡眠中斷（ICC=0.68~0.82）。同時效度部分，問卷與客觀測量在不同行為呈現低至中度相關（ρ=0.13~0.49），但不同行為相關程度略有差異，其中以夜間睡眠相關程度最高，中高強度身體活動最低。結論：本研究發展的問卷較過往其他分別測量幼兒活動行為問卷具備較良好的一週再測信度與三軸加速規測量比較的同時效度，有助於大規模的針對學齡前幼兒24小時活動行為進行監測與例行性測量，作為未來發展幼兒24小時活動指引及健康政策擬定之參考基礎。
  Objectives: To develop and validate a reliable and valid 24-hour movement questionnaire for use in preschool children. Methods: A total of 225 preschool children (107 girls), aged 3 to 7 years, wore a triaxial accelerometer on their waist for 7 consecutive days. Their parents completed the 24-hour movement questionnaire on Day 1 (test) and Day 7 (retest). The test–retest reliability of the questionnaire was assessed by calculating intraclass correlation coefficients (ICCs) and Spearman’s rank correlation coefficients. The questionnaire’s concurrent validity was evaluated by examining the associations between the retest questionnaire scores and accelerometer-derived measures of the participants’ 24-hour movement behaviors. Results: Regarding 1-week test–retest reliability, moderate to good agreement was noted in the test and retest scores for most physical activity (PA) and sedentary behavior measures, including daily average moderate to vigorous PA (ICC = 0.84; ρ = 0.84) and light PA (ICC = 0.85; ρ = 0.79). Regarding sedentary behavior, moderate to good reliability was observed in the test–retest scores for screen time (ICC = 0.83; ρ = 0.88), restrained activity (ICC = 0.84; ρ = 0.84), and nonscreen sedentary time (ICC = 0.77; ρ = 0.75). Furthermore, the questionnaire exhibited fair to good reliability for sleep-related measures such as nighttime sleep duration (ICC = 0.44; ρ = 0.75), daytime napping (ICC = 0.56; ρ = 0.81), and sleep interruptions (ICC = 0.68-0.82). Regarding the questionnaire’s concurrent validity, the correlations between the questionnaire scores and accelerometer-derived measures for various health behaviors were weak to moderate (ρ = 0.13–0.49), with the strongest and weakest correlations noted for nighttime sleep duration and moderate to vigorous PA, respectively. Conclusions: Our questionnaire exhibits higher 1-week test–retest reliability and concurrent validity with accelerometer-derived measures than do instruments that separately assess preschool children’s 24-hour activity behaviors. The questionnaire can facilitate large-scale surveillance and routine assessment of preschool children’s 24-hour movement behaviors and may inform future 24-hour movement guidelines for this population and related health policy formulation.
• 138-153
• 10.6288/TJPH.202604_45(2).114097

• Link 原著 Original Article
• 不同肥胖程度下台灣第二型糖尿病死亡率之當前與未來趨勢 Trends and projections of type 2 diabetes mortality under various obesity scenarios in Taiwan
• 羅苡晅、劉柏辰、趙臨梅、林先和
  Yi-Hsuan Lo, Po-Chen Liu, April Meirie Hill, Hsien-Ho Lin
• 第二型糖尿病、身體質量指數、族群可歸因分率、比較風險評估、死亡率預測
  type 2 diabetes mellitus, body mass index, population attributable fraction, comparative risk assessment, mortality projection
• 目標：第二型糖尿病（T2DM）為全球主要健康威脅，高身體質量指數（BMI）為其關鍵危險因子。本研究旨在探討不同過重及肥胖情境下，台灣T2DM死亡率之未來趨勢與政策應對建議。方法：本研究採用全球疾病負擔研究（GBD）之比較風險評估法（CRA），分析2001-2020年BMI與死亡資料，估算2021-2035年間T2DM死亡中BMI之可歸因分率（PAF）與不可歸因死亡率，並參考NAHSIT模擬四種過重與肥胖情境。資料來源包括衛生福利部死因登錄檔（T2DM死亡資料）、國民健康訪問調查（NHIS）五次調查之BMI盛行率，以及內政部人口統計資料。相對風險（RR）與理論最小風險暴露水準（TMREL）取自GBD 2021。分析納入三種非歸因死亡率模型進行敏感性分析，並以蒙地卡羅模擬進行不確定性評估。結果：2021年起T2DM粗死亡率上升，年齡標準化率持續下降。歷史資料顯示，男性與女性BMI歸因分率分別為26-30%與25-28%。若未來過重及肥胖率降至32.7%，可避免約15,821人死亡；降至43.3%則約8,787人；若穩定於50%，可避免4,130人。男性與年長者死亡率均相對較高。結論：控制過重與肥胖為減少未來T2DM死亡之關鍵。為有效降低總體死亡負擔，應搭配涵蓋非肥胖相關因素之多元公共衛生策略。本研究可作為未來肥胖管理與糖尿病政策規劃之依據。
  Objectives: Type 2 diabetes mellitus (T2DM) is a major global health concern, with high body mass index (BMI) as a key mortality risk factor. This study aimed to estimate current and projected future T2DM mortality trends in Taiwan under various overweight and obesity scenarios. Methods: This study applied the Comparative Risk Assessment (CRA) methodology developed by the Global Burden of Disease Study (GBD). Data from 2001 to 2020 were used to estimate population attributable fractions (PAFs) and non-attributable T2DM mortality burden for 2021-2035. Projections incorporated national mortality records from Taiwan’s National Death Registry, BMI prevalence from five waves of the National Health Interview Survey (NHIS), population data from the Ministry of the Interior, and relative risks and theoretical minimum risk exposure levels (TMRELs) from GBD 2021. Mortality projections incorporated four overweight and obesity scenarios (Current Trend, Stop Rise, Aggressive Intervention 1, and Aggressive Intervention 2, adapted from the Nutrition and Health Survey in Taiwan) and three non-attributable death rate models, with sensitivity and uncertainty analyses conducted using Monte Carlo simulations. Results: Crude T2DM mortality is projected to rise after 2021, while age-standardized rates continue to decline, highlighting the impact of population aging. Between 2001 and 2020, high BMI contributed to 26-30% of T2DM deaths in males and 25-28% in females. Reducing overweight and obesity prevalence to 32.7% could prevent an estimated 15,821 deaths from 2021 to 2035; reducing it to 43.3% could prevent 8,787 deaths; stabilizing it at 50% could prevent 4,130 deaths. Mortality was consistently higher among older adults and males. Conclusions: Aggressive and sustained obesity reduction is essential for curbing future T2DM mortality in Taiwan. However, broader public health strategies addressing both obesity-related and non-obesity-related factors are necessary to substantially reduce the mortality burden.
• 154-169
• 10.6288/TJPH.202604_45(2).114076

• Link 原著 Original Article
• 台灣市售檳榔嚼塊中多重農藥殘留與重金屬之合規性分析：專法施行前的全國基線調查Compliance analysis of multiple pesticide residues and heavy metal testing in commercial betel quid products in Taiwan: a nationwide baseline survey prior to the implementation of specific regulations
• 王亮懿、林泉成、陳嘉惠、殷子晴、陳政綱、莊麗真
  Liang-Yi Wang, Chuan-Cheng Lin, Chia-Hui Chen. Zih-Ching Yin. Stanley Chen. Li-Chen Chuang
• 檳榔嚼塊、農藥殘留、重金屬、口腔癌、檳榔健康危害防制法
  betel quid, pesticide residues, heavy metals, oral cancer, Betel Quid Health Hazard Prevention Act
• 目標：檳榔嚼食為台灣口腔癌重要危險因子，但相關研究多聚焦於檳榔子本身致癌性，較少探討檳榔嚼塊中可能存在的外源性污染物。本研究檢測台灣市售檳榔嚼塊之農藥殘留與重金屬含量，評估其合規性，作為《檳榔健康危害防制法》施行前之全國基線資料。方法：於2023與2025年自台灣19縣市抽樣市售檳榔嚼塊樣本，包含檳榔子、白灰檳榔與紅灰檳榔。以FaPEx前處理結合LC–MS/MS質譜快速篩檢技術對200種農藥殘留進行定性定量分析，以判定農藥殘留的合規性。2025年的部分檳榔嚼塊樣本以ICP-MS分析砷、鎘、鉛與汞的重金屬檢出情形。結果：農藥殘留檢測樣本共211件，整體農藥殘留不合格率為84.8%，多數樣本檢出多重農藥殘留，又以含荖葉之白灰檳榔最為嚴重，其不合格農藥數為檳榔子的3.23倍（p<0.001），以2025年為例，檢出11種以上不合格農藥的比例為53.2%。除了多重農藥，亦檢出多種禁用農藥。2025年另送驗重金屬共19件，雖未檢出汞，但砷、鎘與鉛之檢出率皆逾八成，又以紅灰檳榔全部檢出最為嚴重。結論：台灣市售檳榔嚼塊普遍存在多重農藥殘留與重金屬暴露風險。本研究提供專法施行前之全國基線資料，可作為未來監測與政策管理之參考。
  Objectives: Betel quid chewing is a major risk factor for oral cancer. Most studies on this topic have focused on the carcinogenicity of the areca nut, and limited attention has been given to exogenous contaminants that may be present in betel quid products. In consideration of this gap, the present study investigated pesticide residues and heavy metal content in commercial betel quid products in Taiwan, evaluated regulatory compliance, and established nationwide baseline data prior to the implementation of the Betel Quid Health Hazard Prevention Act. Methods: Betel quid samples, including areca nuts and both white-lime and red-lime betel quids, were collected from 19 counties and cities in Taiwan in 2023 and 2025. Pesticide residues were extracted and analyzed using liquid chromatography tandem mass spectrometry. In total, 200 pesticides were targeted. A subset of the 2025 betel quid samples was analyzed for heavy metals using Inductively Coupled Plasma Mass Spectrometry (ICP-MS), including arsenic, cadmium, lead, and mercury. Results: Among 211 samples analyzed for pesticides, the overall noncompliance rate was 84.8%. Multiple pesticides were detected in most samples, with the most severe contamination occurring in white-lime betel quids wrapped in betel leaves. The number of noncompliant pesticides in white-lime betel quid samples was 3.23 times that in areca nuts (p < .001). In 2025, 53.2% of white-lime betel quid samples contained more than 11 noncompliant pesticides. Several banned pesticides were also detected. In 2025, 19 samples were analyzed for heavy metals. Although mercury was not detected, arsenic, cadmium, and lead were detected in more than 80% of the samples, with red-lime betel quid exhibiting the highest level of contamination. Conclusions: Commercial betel quid products in Taiwan commonly contain multiple pesticide residues and heavy metals. These findings provide crucial nationwide baseline data and may serve as a reference for future monitoring and policy management.
• 170-183
• 10.6288/TJPH.202604_45(2).114110

• Link 原著 Original Article
• 2020–2021年台灣COVID-19預防行為遵從情形：全國性追蹤調查Adherence to preventive behaviors related to COVID-19 in Taiwan in 2020-2021: a population-based follow-up survey
• 伍倢瑩、藍之辰、簡淑婉、楊芷其、許雯棋、陳保中、張書森、林先和、台灣COVID-19防疫行為調查計畫團隊
  Chieh-Yin Wu, Chih-Chan Lan, Shu-Wan Jian, Chih-Chi Yang, Wen-Chi Hsu, Pau-Chung Chen, Shu-Sen Chang, Hsien-Ho Lin, Taiwan COVID-19 Prevention Behaviors Survey Team
• 預防行為、監測、調查、COVID-19
  preventive behaviors, surveillance, survey, COVID-19
• 目標：COVID-19大流行在全球造成預防行為的顯著改變。本研究透過追蹤調查，以了解台灣民眾於2020年及2021年間的預防行為變化。方法：此對20歲以上成人之以全人口為基礎的調查研究包含後續三次追蹤，內容包括民眾對COVID-19風險的認知，以及其對台灣疾病管制署「防疫新生活運動」所倡議的各項預防行為之遵從情形。結果：在2020年7月至9月間（台灣無本土疫情期間），維持室內社交距離與室外社交距離的遵從比例分別為51.5%與63.5%；且有81.5%的受訪者表示，若無法維持社交距離，將會配戴口罩。分層分析顯示，女性與年長者在大部分預防行為上具有顯著較高的遵從度。整體而言，從2020年至2021年中期，民眾對預防行為的遵從度呈現上升趨勢，並未出現防疫疲乏的跡象。結論：本調查為了解台灣在疫情前兩年期間一般民眾的預防行為提供了重要的實證資料。由於非藥物介入措施（NPI）在疫情初期具有關鍵作用，我們認為定期監測民眾預防行為應作為疫情準備的重要基礎工作。此外，仍需投入更多努力，以尋找最可行且具成本效益的預防行為監測方法。
  Objectives: The COVID-19 pandemic was associated with significant changes in preventive behaviors worldwide. We conducted a population-based longitudinal follow-up survey to understand these behavioral changes in Taiwan during 2020 and 2021. Methods: A population-based survey with three follow-up rounds was implemented among individuals aged 20 and older. The survey included questions about perceptions of COVID-19 risk and adherence to preventive behaviors promoted by the Taiwan Centers for Disease Control in its New Life Strategies. Results: Between July and September 2020, a period with no local COVID-19 cases, adherence to indoor and outdoor social distancing was 51.5% and 63.5%, respectively, while 81.5% of people indicated they would wear facial masks if social distancing could not be practiced. In stratified analysis, females and the elderly exhibited significantly higher adherence to most of the preventive measures. We observed an increase in adherence to preventive behaviors from 2020 to the middle of 2021, with no signs of fatigue. Conclusions: The survey provides empirical evidence on adherence to preventive behaviors in the general population in Taiwan during the first two years of the pandemic. Given the importance of non-pharmaceutical interventions (NPIs) in the early stage of a pandemic, our findings suggest that monitoring preventive behaviors may offer useful insights for pandemic preparedness. However, such monitoring is not routinely implemented and may face practical challenges related to resources and logistics. Further efforts are needed to identify feasible and cost-effective approaches for the monitoring of preventive behaviors.
• 184-196
• 10.6288/TJPH.202604_45(2).114107

• Link 其他 Others
• 作者勘誤：初發缺血性腦中風之風險分級：動態危險因子之健保資料庫分析Corrigendum: risk stratification for new-onset ischemic stroke: dynamic risk factor analysis using the National Health Insurance Research Database
• 李佩儒、陳東藝、史麗珠
  Pei-Ru Li, Dong-Yi Chen, Lai-Chu See
• 無none
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• 197-198
• 10.6288/TJPH.202602_45(1).114074_Corrigendum