36卷4期

• Link 公衛論壇 Public Health Forum
• 全球疾病負擔研究中的健康照護品質排名－以慢性腎臟病為例Ranking of healthcare access and quality in the Global Burden of Disease Study -- a closer look at the situation of chronic kidney disease in Taiwan
• 吳昀麇、呂宗學、林先和
  Yun-Chun Wu, Tsung-Hsueh Lu, Hsien-Ho Lin
• 無
  none
• 無
  none
• 315 - 318
• 10.6288/TJPH201736106064

• Link 公衛論壇 Public Health Forum
• 「健康台灣」的最後場域－以「健康」結合「健保」促成「健康監獄」The last setting for healthy Taiwan -toward healthy prisons through health promotion
• 李佳綺、 鍾志宏、陳孝平
  Chiachi Bonnie Lee, Chih-Hung Chung, Michael S. Chen
• 無
  none
• 無
  none
• 319 - 323
• 10.6288/TJPH201736106039

• Link 綜論 Review Article
• 照護連續性議題的省思與未來發展方向Re-thinking continuity of care and future directions
• 陳啟禎、陳麗光、 鄭守夏
  CHI-CHEN CHEN, LIKWANG CHEN, SHOU-HSIA CHENG
• 照護連續性 ； 測量指標 ； 行政資料為基礎的測量 ； 病患觀點 ； 回顧
  continuity of care ; measurement ; claim-based measurement ; patient perspective ; review
• 近年來，許多研究者利用行政資料建構照護連續性的測量指標，且多數研究發現照護連續性可改善照護結果。然而，這種量性測量能否代表照護連續性的概念，值得深思。本文以「照護連續性的概念與測量指標之發展脈絡」、「應用量化照護連續性指標的限制」，以及「病人觀點的照護連續性測量工具的發展」三部份為主軸進行文獻回顧。結果發現，研究者普遍認為照護連續性為多範疇的概念，而以行政資料為基礎的量化照護連續性指標係測量一段時間內患者看診次數集中或分散於不同看診醫師間的程度，我們認為這無法反應照護連續性多範疇的概念。此外，量化指標亦無法反應在不同照護場域與醫療環境中照護連續性的本質。最後，以病患為觀點的照護連續性測量逐漸受到重視，建議研究者可以發展病患觀點的照護連續性測量工具，並探究量化指標與各範疇病患觀點指標間的相關性，與各類照護連續性測量指標對照護結果的影響。
  Along with the availability of administrative claim data in recent years, researchers have constructed claim-based continuity of care (COC) measurements and found that better COC was associated with favorable health outcomes. Can these claim-based COC measures, however, represent the concept of COC? This issue deserves investigation. This article reviews the following: (1) the evolution and implication of the concept and measurement of COC; (2) the limitation of application of claim-based quantitative measures of COC; and (3) COC measurement from the patient perspective. We found that COC was a multi-dimensional concept in previous studies; however, the claim-based COC measures describe the concentration or dispersion of physician visits among healthcare providers, and we consider that these quantitative measures might not reflect the multi-dimensional concept of COC. In addition, claim-based COC measures may not reflect the essence of care continuity in different care contexts and the medical care environment. Finally, COC measures from the patient perspective has gradually become more important. We suggest that researchers may develop measurement tools for COC from the patient perspective. Furthermore, researchers should examine the relationship between claim-based COC measures and COC measures from the patient perspective in various dimensions, and examine the effects of various COC measures on health outcomes.
• 324 - 336
• 10.6288/TJPH201736106052

• Link 綜論 Review Article
• 高齡者久坐行為與健康之文獻回顧A review of sedentary behavior and health in older adults
• 薛名淳、 廖邕、黃品瑄、張少熙
  MING-CHUN HSUEH, YUNG LIAO, PIN-HSUAN HUANG, SHAO-HSI CHANG
• 靜態時間 ； 坐式生活 ； 流行病學 ； 老年人 ； 文獻回顧
  sedentary time ; sedentary lifestyle ; epidemiology ; elderly ; literature review
• 久坐行為已經成為影響健康的重要危險因子。高齡者經常花費過量的時間在久坐行為活動上。國外已經有許多研究證實久坐行為會提升高齡者罹患疾病與死亡的風險，但有關久坐行為與健康結果的關係仍未被完整探討。本研究旨在透過有關高齡者久坐行為與各種疾病的流行病學研究證據，提出一敘述性的綜論供國內久坐行為臨床研究與實務之參考。本文採用文獻回顧方法搜尋PUBMED資料庫2007年1月至2016年12月的相關文獻，經搜尋與排除條件檢核後，共19篇文章符合篩選標準。結果發現高齡者長時間久坐行為會提高全死因死亡率之風險；久坐行為與糖尿病、代謝症候群和過重肥胖之關係有一致性的結果；久坐行為與腎臟惡性腫瘤之關係仍未被發現。本研究之文獻回顧結果支持久坐行為與高齡者健康之間的關係。未來相關研究宜採用大樣本調查與縱貫性研究設計，並應考量納入本研究所提之干擾因素較有研究證據力。此外，未來宜持續探討不同久坐行為類型（休閒、通勤、工作及家庭層面）對高齡者健康的影響，並建議同時採用主觀及客觀方式測量久坐行為。
  Sedentary behavior has emerged as a new risk factor for health. The elderly spend most of their waking time in sedentary activities. Despite the fact that several studies have demonstrated the impact of sedentary behavior on the health of older adults, few studies have been done with an older Taiwanese population. We systematically reviewed epidemiologic evidence for associations between sedentary behavior and multiple health outcomes in older adults in order to provide crucial information for clinical research and practice. We searched the PUBMED database for observational studies published from January 2007 to December 2016, and found 19 eligible articles. The results showed that greater sedentary time was related to an increased risk of mortality from all causes in older adults. Some studies showed consistent results and indicated a relationship between sedentary behavior and metabolic syndrome, overweight/obesity, and diabetes; the findings relative to cancer remain insufficient to draw conclusions. This systematic review supported the relationship between sedentary behavior and mortality in older adults. Further research on this topic should utilize a nationally representative sample, a large-scale prospective cohort study, and adjustment for multiple confounders. Furthermore, investigations of an ecologic model with different domains of sedentary behavior and data collection with a combination of subjective and objective measures of sedentary behavior are recommended.
• 337 - 349
• 10.6288/TJPH201736106024

• Link 原著 Original Article
• 台灣年輕群體之裂孔性視網膜剝離發生率與眼球共病Incidence and ocular comorbidities of rhegmatogenous retinal detachment among younger people in Taiwan
• 白麗雯、楊素珍、林美玲、鍾月琴、李宏謨、郭疆和、 邱淑卿
  LEE-WEN PAI, SHU-CHEN YANG, MEI-LING LIN, YUEH-CHIN CHUNG, HORNG-MO LEE, CHIANG-HO KUO, SHU-CHING CHIU
• 共病 ； 近視 ； 周邊網膜變性（格子狀變性） ； 健康保險資料庫 ； 危險因子
  comorbidities ; high myopia ; lattice degeneration ; health insurance research database ; risk factor
• 目標：分析年輕群體眼球之裂孔性視網膜剝離發生率與共病。方法：本研究以全民健保資料庫為基礎，將健保之百萬人資料抽樣檔回溯追蹤十年2001-2010年資料，透過健保門診明細檔及醫令檔，分析0-44歲之裂孔性視網膜剝離個案每年新發生個案之發生率，並用勝算比及95%信賴區間統計共病資料。結果：臺灣2001-2010年45歲以下群體之裂孔性視網膜剝離發生率為每十萬人口16.4位，其中年輕女性高峰在25-29歲每十萬人口中有23位，年輕男性持續增加在40-44歲達到每十萬人口28.3位。再者，將已發生裂孔性視網膜剝離與未發生裂孔性視網膜剝離年輕群體相較，發現前者前一年的統計顯著疾病有高度近視（OR 7.38, 95% CI 3.97-13.72），其他病理性疾病有玻璃體出血（OR 72.57, 95% CI 9.93-530.55）、周邊網膜變性（格子狀變性）（OR 5.11, 95% CI 2.44-10.67）。結論：台灣年輕群體之裂孔性視網膜剝離人數居高不下，平均男性多於女性。統計發現高度近視和視網膜病理變化之共病結果，可以提供未來預防裂孔性視網膜剝離之參考。
  Objectives: The ocular incidence rate and comorbidities of rhegmatogenous retinal detachment (RRD) in young groups were analyzed. Methods: This retrospective study was population-based and data were analyzed using the Taiwan Longitudinal Health Insurance Database 2000. The ages of the subjects included in the young RRD group ranged from 0 years to 44 years. The annual incidence rate was calculated by dividing the number of new cases by the population size of individuals with health insurance coverage. Odds ratio (OR) with 95% confidence interval (CI) was used to analyze the comorbidities. Results: From 2001 to 2010, the incidence rate of RRD for individuals under 45 years of age in Taiwan was 16.4 per 100,000. The young female group, aged 25-29 years, peaked first at 23.0 per 100,000, whereas the young male group, aged 40-44 years, increased continually and peaked at 28.3 per 100,000. The young RRD group was highly comorbid with some diseases and statistically more associated with high myopia (OR 7.38, 95% CI 3.97-13.72) than the young non-RRD group. Other pathological changes in the young RRD group were vitreous hemorrhage (OR 72.57, 95% CI: 9.93-530.55) and lattice degeneration (OR 5.11, 95% CI: 2.44-10.67) as compared with young non-RRD subjects. Conclusions: The young population of Taiwan shows high number of RRD cases dominated by males. The co-morbid analysis of high myopia and pathological changes of retinal degeneration can provide references for RRD prevention in young residents.
• 350 - 360
• 10.6288/TJPH201736106036

• Link 原著 Original Article
• 台灣社區老人手部握力相關因素的探討－台灣南部社區民眾複合式健檢資料的分析研究Study on related factors of grip strength: integrated physical examination analysis of community-dwelling adults in southern Taiwan
• 秦秀蘭、林裕珍、 蕭玉芬、 莊華盈
  HSIU-LAN CHIN, YU-CHEN LIN, YU-FEN HSIAO, HUA-YING CHUANG
• 手部握力 ； 日常生活習慣 ； 衰弱症狀 ； 健康體能 ； 複合式健檢
  grip strength ; lifestyle ; frailty syndrome ; physical condition ; integrated physical examination
• 目標：本研究為南部某縣2015-2016年複合式健檢資料的分析，以了解社區老人的健康體能與衰老情形，以及影響手部握力的相關因子。方法：本次共收錄了1,002位65歲以上老年人（74.19±6.02歲）的資料，包括435位男性（74.97±6.28歲）、567位女性（73.56±5.74歲）。分析資料包括日常生活習慣，一般健檢的身高、體重、身體質量指數、骨密度、基礎代謝率、手部握力、身體靜態平衡力與動態平衡力。結果：男女和不同年齡層受試者在許多體能上都有顯著差異；性別、基礎代謝率和年齡是影響手部握力的三個關鍵因素，三個因素可決定受試者手部握力的49.2%（Adj R^2=.492）。其他影響因子依序為：身體靜態平衡力、身體質量指數、舒張壓、體重、就寢時間。結論：身體靜態平衡力、舒張壓對手部握力的預測力，是本次研究的重要發現。其中，身體平衡力與老化的關係是目前許多老化研究的重點；然而，舒張壓與手部握力表現的關係卻極少被討論到。本研究顯示，舒張壓對手部握力的預測力比體重、骨密度都高。此外，這些老年男性受試者的舒張壓明顯高於女性受試者；女性受試者的收縮壓與舒張壓的差異值明顯大於男性受試者，值得進一步追蹤與後續更大量的資料分析。
  Objectives: This study is about the Integrated Physical Examination of one county in Taiwan during 2015-2016. This study aims at understanding the physical health condition of community-dwelling adults in southern Taiwan and the related factors of grip strength. Methods: Participants incorporate 435 males (M=74.97±6.28 years old) and 567 females (M=73.56±5.74 years old) in southern Taiwan. The testing items include: lifestyle, body weight, blood pressure, body mass index, bone density, basal metabolic rate, grip strength and body balance. Results: The study shows significant difference between male and female and among age-groups in many variables as well. The main factors affecting grip strength performance are gender, basal metabolic rate and age, with the 49.2% of explanatory power (Adj R^2=.492). The other related factors are static body balance, body mass index, diastolic blood pressure, body weight, habit of bedtime. Conclusions: The study indicates high correlation between static body balance and grip strength, which is corroborated in the other research. The analysis also identifies a positive correlation between diastolic blood pressure and grip strength, and the explanatory power is even higher than body weight and bone density. Therefore, extended study and sampling should be carried out.
• 361 - 374
• 10.6288/TJPH201736106051

• Link 原著 Original Article
• 失智症家庭使用長期照顧服務的情形與不使用的原因Long-term care services use and reasons for non-use by elders with dementia and their families
• 施姵宇、古鯉榕、 白明奇、劉立凡
  PEI-YU SHIH, LI-JUNG ELIZABETH KU, MING-CHYI PAI, LI-FAN LIU
• 失智症 ； 長期照顧 ； 外籍看護工 ； 服務使用
  dementia ; long-term care ; foreign care worker ; service use
• 目標：分析失智症家庭使用長期照顧服務的情形與影響使用的因素，並探討家庭照顧者不使用長照服務的原因。方法：收案對象為台南某醫學中心失智症門診之病人及家庭照顧者共231組；以結構式的問卷與照顧者進行電話訪談。結果：失智者使用長照服務的比率僅8%，遠低於使用看護工的35%，或未使用任何服務的57%。失智者未使用服務的主因是照顧者不覺得失智者有需要使用服務（64%）、其次是照顧者表示服務項目不適合患者（20%）。至於未曾使用家庭照顧者支持服務的主因，是照顧者缺少相關服務的資訊（56%）。邏輯斯迴歸分析顯示使用服務的照顧者的長照資源相關資訊顯著高於未使用者（OR=1.76, 95% CI=1.19-2.61），但失智者特性包括認知功能和身體功能嚴重度皆與使用看護工顯著相關。結論：本研究的失智者和其家庭照顧者使用長照服務的比率皆偏低，由於照顧者缺少相關服務的資訊，建議政府應加強宣導，並提供更多給家庭照顧者的支持服務，才能在雇用看護工的方式之外，以多元的服務來滿足失智症全家照護的需求。
  Objectives: The goals of this study were to describe the pattern and predictors of long-term care (LTC) services utilization elders with dementia and their families, and to determine reasons for non-use of LTC services. Methods: The study sample included 231 elders with dementia and caregiver dyads recruited from a dementia clinic at a medical center in Tainan. Caregivers were interviewed via telephone using a structured questionnaire. Results: The LTC services use rate was 8% among the sample, 35% hired foreign care workers, and 57% did not use any LTC services. The main reasons given for families not using LTC services were the perceived lack of need (64%), followed by the service not meeting the patient’s needs (20%). The main reason for not using caregiver support services was caregivers being unaware of the availability of services (56%). Logistic regression results showed that knowledge about LTC resources (OR=1.76, 95% CI=1.19-2.61) was the only significant predictor of LTC services use, while the patient’s level of cognitive impairment and physical disability were significant predictors of hiring a foreign care worker. Conclusions: Because the utilization rates of LTC services by elders with dementia and their caregivers were low, and the main reason for non-use was due to caregivers being unaware of services, we recommend that the government strengthen educational campaigns for family caregivers and provide caregiver support services. There should be more choices regarding LTC services available to families caring for an elder with dementia in addition to hiring a foreign care worker.
• 375 - 385
• 10.6288/TJPH201736106026

• Link 原著 Original Article
• 兒童風濕疾病及其醫療利用與罹癌風險之探討A population-based cohort study of the risk of cancer in children with rheumatic disease and their precancerous medical utilization
• 馬震中、蘇有村、林佟威、 鄭怡婷
  CHEN-CHUNG MA, YU-TSUN SU, TUNG-WEI LIN, I-TING CHENG
• 兒童 ； 風濕疾病 ； 癌症 ； 醫療利用
  children ; pediatric rheumatic disease ; cancer ; medical utilization
• 目標：風濕疾病為一種慢性的炎症，可能會增加罹癌風險，因此本研究目的在探討台灣地區兒童風濕病人罹癌之風險及其罹癌前醫療利用之情形。方法：本研究採回溯性研究設計，運用次級資料分析，資料來源為全民健保資料庫，選取2000年至2012年診斷為風濕疾病之兒童，以紅斑性狼瘡及幼年特發性關節炎等八種風濕疾病進行觀察；使用Cox models分析罹癌症風險，並以Mann-Whitney U Test檢定病人罹癌前醫療利用之變化。結果：整體兒童風濕病人相較於兒童非風濕病人高出3.71倍罹癌風險，其中紅斑性狼瘡、幼年特發性關節炎與修格連氏症候群的罹癌風險分別為3.94倍、5.93倍與5.29倍；藥物中，曾使用免疫調節劑者罹癌風險約增加5.65倍，曾使用生物製劑罹癌風險高出約26.01倍；另外，兒童風濕病人在罹癌前的醫療利用變化呈現門診利用增加、住院利用減少，經Mann-Whitney U Test檢定均未達顯著差異。結論：綜合研究結果，兒童罹患風濕疾病會增加其罹癌風險，因此本研究建議衛生主管機關應加強重視兒童風濕病人的醫療照護，避免將來支出更多的社會成本。
  Objectives: A clinical manifestation of rheumatic disease is chronic inflammation that may increase the risk of cancer. The purpose of this study was to explore the risk of cancer and the precancerous medical utilization by children with rheumatism in Taiwan. Methods: This was a retrospective study with secondary data analysis. The data were drawn from the National Health Insurance Research Database from 2000 to 2012. Patients under the age of 18 with a diagnosis of pediatric rheumatic disease, including systemic lupus erythematosus, juvenile idiopathic arthritis, Sjogren’s syndrome, scleroderma, polymyositis, dermatomyositis, vasculitis and Behcet’s disease. A total of 1,741 cases were identified. The Cox proportional hazards model was used to analyze the risk of cancer, and the Mann-Whitney U Test was used to assess whether the patient’s medical use was different from that in the year prior to the diagnosis of cancer. Results: The overall risk for children with rheumatism compared with non-rheumatic patients was 3.71 times the risk for cancer; for systemic lupus erythematosus, juvenile idiopathic arthritis and Sjogren's syndrome, the cancer risk was 3.94 times, 5.93 times and 5.29 times, respectively. The risk for cancer was increased by 5.65 times in those who had used immunoregulatory drugs, and this was 26.01 times more than that of those who had used biological agents. For children with rheumatism, in the year before the diagnosis of cancer and in terms of overall medical use before cancer, the number of outpatient visits and expenses increased, but the number of hospitalizations, hospital days, and cost reduction were not significantly different. Conclusions: Based on the results of this study, we suggest that the health authorities pay more attention to the medical care of children with rheumatism in order to avoid future social costs.
• 386 - 396
• 10.6288/TJPH201736106027

• Link 原著 Original Article
• 經濟弱勢兒童之多重飲食行為軌跡：以早餐、蔬果及零食飲料為例Multiple dietary behavior trajectories among economically disadvantaged children: an example of breakfast, fruits and vegetables, and snacks and beverages
• 蕭怡真、陳俊元
  YI-CHEN HSIAO, CHUN-YUAN CHEN
• 多重飲食行為 ； 兒童 ； 經濟弱勢 ； 群體基礎軌跡模型
  multiple dietary behaviors ; children ; economic disadvantage ; group-based trajectory modeling
• 目標：兒童時期的飲食行為對未來健康有著深遠影響。目前多數證據侷限於一般兒童與單一種飲食行為，本研究旨在探討經濟弱勢兒童由吃早餐、蔬果及零食飲料構成的多重飲食行為軌跡及其相關因素。方法：使用「台灣貧窮兒少資料庫：弱勢兒少生活趨勢調查」2009年、2011年與2013年部分資料，樣本共計1,001位國小學童（女生佔50.25%；初始平均年齡為9.07歲）。群體基礎多重軌跡模型和多類別邏輯斯迴歸為主要分析方法。結果：辨識出三種多重飲食行為軌跡，包含「飲食長期規律組」（21.28%），近乎每日吃早餐與蔬果但吃蔬果的頻率從第一時點至第三時點明顯減少；「早餐蔬果長期不規律組」（77.62%），吃早餐的頻率在所有時點皆為最低且有不規律吃蔬果的情況；以及「蔬果長期缺乏組」（1.10%），吃蔬果的頻率在所有時點皆為每週一天或以下。所有組別的零食飲料行為軌跡相似。年齡越大與雙親教育程度越低，不健康飲食行為的可能性越高。結論：吃早餐、蔬果及零食飲料行為之間的關係並非簡單的線性關係，且其發展具有異質性。此次發現的相關因素有限，未來研究應持續探討並剖析不同軌跡之影響機制。
  Objectives: Dietary behaviors in childhood have a great influence on future health. Currently, most of the evidence has been focused on non-economically disadvantaged children and single dietary behaviors. The aim of this study was to explore multiple dietary behavior trajectories of breakfast, fruits and vegetables, and snacks and beverages, and associated factors. Methods: The partial data for this study were obtained from the Taiwan Database of Children and Youth in Poverty in 2009, 2011, and 2013, with a total sample size of 1001 elementary school children (50.25% girls and 49.75% boys; mean age at baseline = 9.07 [standard deviation = 1.24] years). Group-based multi-trajectory modeling and multinomial logistic regression were the main analytic methods. Results: Three multiple dietary behavior trajectories were identified, as follows: (1) the ”regular eating” group (21.28%) with most children eating breakfast and fruits and vegetables daily, but the frequency of eating fruits and vegetables decreased significantly from time 1 to time 3; (2) the ”irregular breakfast and fruits and vegetables eating” group (77.62%) with the lowest frequencies of eating breakfast at all time points and having an irregular pattern of eating fruits and vegetables; and (3) the ”lack of fruits and vegetables” group (1.10%), in which children ate fruits and vegetables 1 day or less per week at all time points. There were similar trajectories of eating snacks and consuming beverages in all groups. Older age and parents with lower levels of education were associated with higher probabilities of unhealthy eating behaviors. Conclusions: The associations between eating breakfast, fruit and vegetable intake, and snack and beverage consumption were not as simple as linear relationships, with heterogeneity in the development of these dietary behaviors. Other potential factors were only minimally noted in our study. Future research should explore associated factors and mechanisms of different multiple dietary behavior trajectories.
• 397 - 411
• 10.6288/TJPH201736106041

• Link 實務 Public Health Practice
• 2015年中東呼吸症候群冠狀病毒（MERS-CoV）感染症疫情之旅遊衝擊與健康管理The impact on tourism and health management of the MERS-CoV outbreak in 2015
• 饒珍年、王穎筠、吳智文
  CHEN-NIEN JAO, YING-YUN WANG, JHY-WEN WU
• 中東呼吸症候群 ； 冠狀病毒感染 ； 旅遊衝擊 ； 健康管理
  Middle East respiratory syndrome ; coronavirus infections ; tourism impact ; health management
• 目標：2015年5月至7月間南韓爆發中東呼吸症候群冠狀病毒感染症（Middle East respiratory syndrome coronavirus infections）流行疫情，病例及死亡人數快速累積，嚴重的疫情重挫南韓經濟及旅遊業。本研究檢視南韓疫情期間，台灣出入境旅遊人數的衝擊相關影響，闡述國內防治作為及衛教民眾自我健康管理的重要性。方法：利用搜尋引擎以關鍵字「中東呼吸症候群冠狀病毒感染症」相關字串蒐集事件報導及文獻，分析南韓MERS-CoV疫情衝擊我國旅遊產業。結果：MERS-CoV疫情影響包含旅遊、航空運輸、經濟貿易、衛生政策及防疫機制等。我國防治策略包括：成立應變小組，加強疫情監視與風險評估等策略，確保國內防疫與國人健康。結論：疫情影響觀光旅遊產業，凸顯國際疫病藉由運輸傳播的危機，引發國際間旅遊秩序的改變。經由正確的疫情評估、實施有效策略及加強民眾健康管理策略，建立自我健康管理的共識，共同對抗傳染病帶來的考驗與挑戰。
  Objectives: An epidemic of Middle East Respiratory Syndrome Coronavirus (MERSCoV) erupted in South Korea from May to July 2015. This research focused on the impact of the number of inbound and outbound tourists in Taiwan, elaboration of strategies for domestic prevention and control, and the importance of self-health management during the serious epidemic in South Korea. Methods: We used the search engine with keywords “Middle East Respiratory Syndrome Coronavirus Infection “and related words to identify events, reports, and the relevant literature. We analyzed the impact of theMERS-CoV epidemic in South Korea on the domestic tourism industry. Results: The MERS-CoV epidemic influenced t travel, air transportation, economics, trade, health policy and mechanisms for the prevention of epidemics. In response to the MERS-CoV epidemic, the government set up an emergency task force and strengthened surveillance and risk assessment strategies in order to ensure domestic safety and public health. Conclusions: The epidemic affected the tourism industry which magnified the crisis as the international epidemic spread through the transportation system and triggered changes in international tourism. With an accurate assessment of the epidemic, effective strategies and the strengthening of people’s health management strategies, the government can ensure the health management of the public and fight the challenge of epidemic diseases.
• 412 - 422
• 10.6288/TJPH201736106053