45卷3期

• Link 政策論壇 Policy Forum
• 台灣代謝症候群防治計畫的現況與建議 Current status and policy recommendations for Taiwan’s Metabolic Syndrome Prevention Program
• 王澤強、盧佳文
  Tse-Chyang Wang, Chia-Wen Lu
• 代謝症候群防治計畫
  Metabolic Syndrome Prevention Program
• 防治代謝症候群對預防非傳染性疾病及相關共病、重症而言極為重要，台灣代謝症候群防治計畫已推行三年餘，作者統整出實務觀察，包含：已用藥控制但尚未有診斷的群體面臨制度空白、介入頻率未能滿足行為改變的支持需求、缺乏目標設定到執行間的行動支持工具等，並從各國作法提出相關政策建議。
  無none
• 199-203
• 10.6288/TJPH.202606_45(3).PF03

• Link 公衛今與昔 Public Health Now and Then
• 蘭安生 (John B. Grant) 1950年對台灣公共衛生的建議與影響：以台灣血清疫苗製造所設立為例 John B. Grant's 1950 recommendation and impact on public health in Taiwan: establishment of the Taiwan serum and vaccine laboratory as an example
• 容世明
  Shih-Ming Jung
• 蘭安生、台灣血清疫苗製造所
  John B. Grant, Taiwan Serum and Vaccine Laboratory
• 由冷戰視角回顧1950年代「台灣血清疫苗製造所」從倡議到設立的過程，及其對台灣公共衛生體系的影響：始於農復會邀請美國專家蘭安生來台考察提出之建議，在台大校長傅斯年與錢思亮接續推動，以及農復會、美援經費與美國專家陶立曼的技術協助下，製造所由台大與省政府共同設立。
  無none
• 204-214
• 10.6288/TJPH.202606_45(3).115011

• Link 原著 Original Article
• 自願性指引與強制性法規對試管嬰兒胚胎植入的影響：以台灣為例 Impact of voluntary guidelines versus mandatory regulations on embryo transfer in IVF: evidence from Taiwan
• 郭貞蘭、賴國瑛、吳嘉苓
  Janet Chen-Lan Kuo, Zoe Kuo-Ing Lai, Chia-Ling Wu
• 植入胚胎數、體外受精、法規、專業指引、妊娠結果
  embryo transfer, In Vitro Fertilization (IVF), legislation, guidelines, pregnancy outcomes
• 目標：本研究檢視台灣體外受精胚胎移植數限制之雙軌監管模式，比較具有法律強制力的《人工生殖法》與專業自律指引，分析其對臨床實務的影響及母嬰健康後果。方法：利用「人工生殖資料庫」（1998-2017），依據台灣生殖醫學會指引及2007年《人工生殖法》規範，分析胚胎植入數、臨床懷孕率與活產率（每植入週期），以及不良母嬰健康指標之時間趨勢。結果：平均胚胎植入數由4.19降至2.36。然《人工生殖法》採用缺乏「年齡分層」的上限設計，違背最佳「單胚胎植入」實務與「愈年輕，愈少胚胎」的國際共識。此寬鬆的法規設計致使多胚胎植入仍持續存在，尤集中於年輕女性（<35），進而增加母嬰健康風險。結論：缺乏細緻年齡層分的強制性法規，恐引發醫源性負面效果並削弱專業指引影響力。未來應優先推動年輕女性（<35歲）的單胚胎植入；同時，在確立嚴格法定基準以保障群體母嬰安全之際，必須保留具實證基礎的臨床例外彈性，以確保個體化醫療的靈活度。
  Objectives: This study examined Taiwan’s dual regulatory approach to embryo transfer limits in in vitro fertilization (IVF), focusing on the effects of legally mandated restrictions and voluntary guidelines. This study addressed two questions: (1) How does this dual system affect IVF practices? and (2) What reproductive, maternal, and neonatal health outcomes are associated with adherence to these regulations? Methods: Data were obtained from Taiwan’s National Registry of Assisted Reproduction and included 178,933 embryo transfer cycles performed between January 1998 and May 2017. Key metrics, including the number of embryos transferred (NET), clinical pregnancy rates, live birth rates, and maternal and neonatal health outcomes, were evaluated across periods defined by the implementation of three NET restriction policies. Results: NET decreased from 4.19 to 2.36 over the study period, indicating a shift toward single-embryo transfer (SET). However, the Assisted Reproduction Act imposed age-insensitive restrictions that conflicted with optimal SET practices and the principle of transferring fewer embryos to younger women, leading to persistently high multiple-embryo transfer (MET) rates, especially among younger women, who experienced increased maternal and neonatal health risks. Conclusions: Mandatory regulations based on uniform transfer limits may inadvertently produce adverse outcomes and weaken the effectiveness of voluntary guidelines. Future policies should prioritize SET to reduce the cascading risks associated with MET, especially among women aged <35 years. The optimal regulatory framework should establish strict statutory standards to protect population-level health and preserve clinical exemptions that enable individualized medical care.
• 215-235
• 10.6288/TJPH.202606_45(3).114108

• Link 原著 Original Article
• 邁向整合照護：台灣居家與社區式服務（HCBS）組合型態與醫療費用之分析——以全國性資料世代研究為基礎 Association between approved home- and community-based service patterns and changes in health-care costs: a national data-based cohort study in Taiwan
• 鐘雅慧、吳世權、鍾國彪、陳雅美
  Ya-Hui Chung, Shih-Cyuan Wu, Kuo-Piao Chung, Ya-Mei Chen
• 居家與社區式服務（HCBS）、核定服務組合型態、醫療費用、潛在類別分析、整合式服務
  home- and community-based services (HCBS), approved service patterns, health-care costs, latent class analysis, integrated services
• 目標：本研究旨在探討不同居家與社區式服務（home- and community-based services, HCBS）核定服務組合型態與高齡照顧接受者醫療費用變化之關聯。方法：使用台灣長期照顧十年計畫1.0資料庫與全民健康保險申報資料，分析2009–2014年之世代資料。研究樣本為106,578名首次申請HCBS，且於接受服務核定時年齡≥65歲者。採用潛在類別分析辨識相似HCBS核定服務組合型態，並以多元線性迴歸分析其與醫療費用變化之關聯；醫療費用變化係以核定後第4至第15個月減核定前12個月計算。結果：辨識出四種HCBS核定服務組合型態：居家服務照顧（home-based personal care, PC）、居家專業照顧（home-based medical care, MC）、PC/MC，以及社區式照顧。與PC/MC組相比，MC組在總醫療費用（β = −42,842.00，p < .0001）、急診費用（β = −699.14，p < .0001）及住院費用（β = −43,091.00，p < .0001）呈現顯著較大降幅；而PC組與社區式照顧組的醫療費用之變化，多數未達統計顯著差異。結論：以專業照護服務為主的HCBS核定服務組合型態，與醫療費用支出下降幅度較大相關，可作為未來推動HCBS專業照護整合與服務協調之參考。
  Objectives: This study examined the association between approved home- and community-based service (HCBS) patterns and changes in health-care costs among older adults receiving care services. Methods: We analyzed cohort data from two national databases in Taiwan: the Ten-Year Long-Term Care Plan 1.0 database and the National Health Insurance Program claims data collected between 2009 and 2014. The sample included 106,578 care recipients who were first-time HCBS applicants and aged ≥65 years at service approval. Latent class analysis was performed to identify similar approved HCBS service patterns, and multiple linear regression was used to examine their associations with changes in health-care costs. Changes in health-care costs were calculated by subtracting costs incurred during the 12 months before service approval from costs incurred during months 4–15 after service approval. Results: Four approved HCBS service patterns were identified: home-based personal care (PC), home-based medical care (MC), combined PC/MC, and community-based care. Compared with the combined PC/MC group, the MC group exhibited significantly greater reductions in total health-care costs (β = −42,842.00, p < .0001), emergency department costs (β = −699.14, p < .0001), and hospitalization costs (β = −43,091.00, p < .0001). Most changes in health-care costs in the PC and community-based care groups did not significantly differ from those in the PC/MC group. Conclusions: Approved HCBS service patterns primarily characterized by professional care services were associated with greater reductions in health-care expenditures. These findings may inform future efforts to integrate professional care services within HCBS and strengthen service coordination.
• 236-250
• 10.6288/TJPH.202606_45(3).115018

• Link 原著 Original Article
• 垃圾暫置場挖掘作業人員之粉塵、重金屬、硫醇類氣體與生物氣膠暴露特性 Exposure characteristics of dust, heavy metals, thiols, and bioaerosols among excavator operators in municipal solid waste temporary storage sites
• 楊心豪、洪粕宸、黃筱茜、徐櫻芳、莊啓佑
  Shinhao Yang, Po-Chen Hung, Hsiao-Chien Huang, Ying-Fang Hsu, Chi-Yu Chuang
• 垃圾暫置場、挖掘機駕駛、總粉塵、硫醇類、生物氣膠
  municipal solid waste temporary storage site, excavator operator, total dust, thiols, bioaerosols
• 目標：國內垃圾處理受限於焚化爐歲修或量能不足，導致「垃圾暫置場」成為常態性運作場所。挖掘機駕駛為此類場所主要作業人員，面臨粉塵、生物氣膠與有機腐敗氣體之複合暴露風險。本研究旨在調查不同型態垃圾暫置場中，挖掘作業人員於總粉塵、可呼吸性粉塵、重金屬、生物氣膠及異味來源（硫醇類）之暴露特性。方法：選取國內5處具代表性之垃圾暫置場（代號A-E），涵蓋長期堆置型與短期轉運型場域。針對所有場域進行作業環境及駕駛艙內之「總粉塵」、「可呼吸性粉塵」、「硫醇類」及「生物氣膠」採樣，並分析粉塵中8種重金屬成分。利用Mann-Whitney U檢定比較不同操作型態之暴露差異。結果：粉塵與重金屬部分，駕駛艙內總粉塵（0.33-0.62 mg/m³）與可呼吸性粉塵濃度均低於我國勞工作業場所容許暴露標準，重金屬以鐵（Fe）為主，鎘（Cd）多數未檢出。然而，生物氣膠在駕駛艙內濃度仍達103 CFU/m³ 數量級，且細菌與真菌濃度皆高於室內空氣品質標準建議值。統計檢定證實，關窗作業之粉塵室內/室外濃度比值（I/O Ratio, 0.74 ± 0.08）顯著低於開窗作業（0.89 ± 0.04, p < 0.05），顯示具阻絕效果；但在氣體部分，關窗之A場域駕駛艙內檢出硫化氫（0.0035 ppmv），開窗之B場域則未檢出。結論：垃圾暫置場之粒狀污染物雖合規，但高濃度生物氣膠為潛在危害。現行標準駕駛艙雖能有效阻絕粉塵（關窗I/O顯著較低），但因濾網缺乏濾除氣態有機物的功能，導致關窗時硫化氫氣體於艙內累積。建議未來應將空調濾網升級為具化學吸附功能之複合濾材，以解決氣態與粉塵問題。
  Objectives: Because of the need for ongoing maintenance for incineration facilities and insufficient processing capacity in Taiwan, municipal solid waste (MSW) temporary storage sites have become widespread in the region. Excavator operators at these sites are exposed to a complex mix of dust, bioaerosols, and volatile organic compounds. The present study investigated these operators’ exposure to total dust, respirable dust, heavy metals, bioaerosols, and odorous thiols. Methods: Five representative MSW temporary storage sites were selected. Air samples were collected from inside excavator cabins and from fixed locations around the storage sites. Concentrations of total dust, respirable dust, and bioaerosols were measured, and dust samples were analyzed for eight heavy metals. Additionally, concentrations of thiols, such as hydrogen sulfide, were measured at sites with reported odor complaints. The Mann–Whitney U test was used to compare exposure levels between open-window and closed-window operation modes. Results: The concentrations of total dust (0.33–0.62 mg/m³), respirable dust, and heavy metals inside the cabins were all within the permissible exposure limits specified by the Taiwanese government. However, bioaerosol concentrations were high (103 CFU/m³), with bacteria and fungi levels exceeding indoor air quality recommendations. Statistical analysis confirmed that closed-window operations had significantly lower indoor/outdoor dust ratios (0.74 ± 0.08) than open-window operations did (0.89 ± 0.04, p < .05), indicating effective isolation. Conversely, for gaseous pollutants, hydrogen sulfide was detected only inside closed cabins (0.0035 ppmv). Conclusions: Although concentrations of total dust, respirable dust, and heavy metals were within Taiwan’s permissible exposure limits, bioaerosols were not, indicating a potential hazard. The cabins effectively blocked dust (as evidenced by lower indoor/outdoor ratios); however, air filters lack the capability to remove gaseous organic compounds, leading to the accumulation of hydrogen sulfide when windows are closed. Combined particulate and gas filters capable of absorbing chemicals should be employed to simultaneously address dust isolation and gas removal.
• 251-263
• 10.6288/TJPH.202606_45(3).115006

• Link 研究紀要 Research Brief
• 鏡檢與阿米巴物種分子鑑別診斷之差異及其對臨床實務與公共衛生監測意涵：以一例 Entamoeba dispar 感染者為例 Microscopy versus molecular identification of Entamoeba species and their implications for clinical practice and public health surveillance: a case of Entamoeba dispar infection
• 張皓婷、商弘昇、潘品靜
  Hao-Ting Chang, Hung-Sheng Shang, Pin-Ching Pan
• 阿米巴、Entamoeba dispar、qPCR、物種鑑別、公共衛生監測
  amoebiasis, Entamoeba dispar, qPCR, species differentiation, public health surveillance
• 目標：本研究報告一例健康檢查中發現 Entamoeba dispar 感染個案，並探討其臨床與監測意涵。由於 Entamoeba histolytica 與 Entamoeba dispar、Entamoeba hartmanni 在鏡檢下形態相似，糞便鏡檢難以準確鑑別，可能導致誤分類與不必要治療。方法：回溯分析一名糞便鏡檢疑似阿米巴囊體但無症狀之個案，並以qPCR確認物種；另回顧本院近五年寄生蟲檢體資料，以及台灣CDC 2011至2025年年報病例數。結果：該個案為33歲女性，經qPCR確認為 E. dispar。臨床僅給予衛教與追蹤。院內2020至2025年寄生蟲檢體陽性率介於0.16%至0.49%，多為非致病性原蟲。全國資料顯示，2011至2025年痢疾阿米巴病例數呈年度波動，通報數普遍高於確定病例數。結論：本案例凸顯鏡檢在阿米巴物種鑑別上的限制，以及分子檢測對臨床決策與監測資料判讀之重要性。結合鏡檢與qPCR之分層檢測策略，有助於提升診斷準確性、避免不必要治療，並增進監測資料之可信度。
  Objectives: This study aimed to report a case of Entamoeba dispar infection detected during a routine health check and to discuss its implications for clinical practice and public health surveillance. Because Entamoeba histolytica, Entamoeba dispar, and Entamoeba hartmanni are morphologically similar under microscopy, stool microscopy alone is insufficient to distinguish these species. This may lead to misclassification and unnecessary treatment. Methods: We reviewed an asymptomatic patient with suspected amoebic cysts on stool microscopy and used quantitative polymerase chain reaction (qPCR) to confirm the species. We also reviewed 5 years of laboratory parasitology data and Taiwan Centers for Disease Control case data from 2011 to 2025. Results: The patient was a 33-year-old woman, and qPCR confirmed E. dispar. She received health education and clinical follow-up without antiparasitic treatment. In our laboratory, parasite positivity rates ranged from 0.16% to 0.49% during 2020 to 2025, and most positive findings were non-pathogenic protozoa. National data revealed annual fluctuations in confirmed amoebiasis cases from 2011 to 2025, and reported cases were generally higher than confirmed cases. Conclusions: This case highlights the limitation of microscopy in identifying Entamoeba species and the importance of molecular testing for clinical decision-making and interpretation of surveillance data. A stepwise strategy combining microscopy and qPCR may improve diagnostic accuracy, avoid unnecessary treatment, and improve the reliability of surveillance data.
• 264-271
• 10.6288/TJPH.202606_45(3).115110