36卷5期

• Link 公衛論壇 Public Health Forum
• 公共衛生與預防醫學的區別：歷史觀點The distinction between public health and preventive medicine: a historical perspect
• 江東亮
  Tung-Liang Chiang
• 無
  none
• 無
  none
• 423 - 426
• 10.6288/TJPH201736106072

• Link 綜論 Review Article
• 醫院整合醫學照護制度之國際經驗與對台灣的啟示International experience with a hospital medicine care system and lessons for Taiwan
• 黃俊哲、 譚家惠、楊銘欽
  CHUN-CHE HUANG, ELISE CHIA-HUI TAN, MING-CHIN YANG
• 醫院整合醫學 ； 醫院整合醫學科醫師 ； 照護制度
  hospital medicine ; hospitalist ; care system
• 醫院整合醫學（Hospital medicine）照護制度是由固定群組的主治醫師，採完整交接班的方式提供住院病人整合醫療照護，並與醫療團隊成員共同照護住院病人，以改善醫院和醫療照護體系執行成效，期藉此能達到促進住院病人安全、提升照護品質和妥善運用醫療資源之目標。美國是最早推行此制度的國家，隨後英國、加拿大、新加坡和日本等國家相繼仿效，並依各國健康照護體系的特色，發展照護模式及規劃專科醫師培育訓練，台灣亦在2015年6月起以試辦計畫方式於部分醫院推行。本文回顧與整理主要國家發展醫院整合醫學照護制度的沿革和實施經驗，期許對台灣發展醫院整合醫學照護制度的啟發。從國際經驗來看，本文建議加強醫院整合醫學科醫師招募、教育訓練和專業發展、提昇醫院高層管理者支持程度，以及提高病人對醫院整合醫學科醫師的認知與態度等因應措施，使台灣能朝發展在地化醫院整合醫學照護制度之目標邁進。
  A hospital medicine care system is a type of integrated care for inpatients provided by a fixed group of attending physicians with a complete handover system. They also work with other team members to take care of hospitalized patients in order to improve system performance. The objectives of this system are to promote the safety of inpatients, improve the quality of care, and utilize medical care resources more appropriately. The United States was the first country to implement this system, and was followed by the United Kingdom, Canada, Singapore, and Japan. Each country developed its care system and specialty training programs according to its own conditions. Taiwan also initiated a trial program in some hospitals in June, 2015. This paper reviews the development and practice experience of major countries with hospital medicine care systems, in hope of inspiring the development of hospital medicine in Taiwan. Based on international experience, the authors suggest strengthening the recruitment, training, and career development of hospital medicine specialists, elevating the degree of support from top management, and increasing the recognition by patients that hospital medicine specialists are key factors in helping Taiwan develop its own hospital medicine care system.
• 427 - 438
• 10.6288/TJPH201736106038

• Link 綜論 Review Article
• 癌症病人自殺流行病學綜合性論述癌症病人自殺流行病學綜合性論述
• 陳乃菁、廖佳怡、劉怡彣
  NAI-CHING CHEN, CHIA-YI LIAO, YI-WEN LIU
• 癌症 ； 癌症病人自殺 ； 流行病學 ； 自殺防治
  cancer ; suicide among cancer patients ; epidemiology ; suicide prevention
• 癌症多變性的衝擊以及死亡威脅所產生的心理壓力，促使癌症病人有相對較高的自殺風險，但其流行病學、危險因子、自殺的時間點、不同癌症與自殺間的關係、自殺防治並無統一整理論述，因此本文藉由分析整理國、內外癌症病人自殺相關之研究資料，歸納釐清並探討導致癌症病人自殺的可能原因和機制，期望進一步將防治工作推展至臨床工作，降低癌症自殺率。經文獻整理得知在癌症確診後、癌症診斷初期、癌症遠端轉移與預後差、影響生活品質或功能之癌症有較高的自殺風險，且當身體功能障礙、合併憂鬱症與物質濫用者、失去獨立性與自主權、中老年、男性、失業、低收入、未婚、離婚、鰥寡者亦是癌症病人高風險的自殺因子，此外，不安全的就醫環境、不當的醫療評估、未適當培訓管理照護人員，無法辨識潛在的自殺隱憂，因此如何有效評估高危險癌症自殺族群與進行防治工作是照護過程甚為重要的課題。本文結果有助於提高臨床照護過程癌症病人自殺防治的敏感度，於診治過程利用自殺風險篩選工具即早確診病人心理層面的問題，即時提供預防措施，創造安全就醫環境，促進醫護團隊與癌症病人有效溝通。
  Psychological stress as the result of the impact of varieties of cancer and death threat leads to a relatively higher risk of suicide completion among cancer patients. Nevertheless, unified and comprehensive interpretations concerning relevant epidemiology, risk factors, time point of suicidal behavior, the relationship between different cancers and suicidal behavior, and suicide prevention remain scarce. With the analysis of previous studies about cancer patients' suicidal behavior, the current study probed into potential reasons and mechanism leading to suicidal behavior among cancer patients, hoping to upgrade relevant preventions to clinical fields and lower the cancer-related suicide rate. The results revealed that upon confirmation of cancers, higher risks of suicide existed in conditions as getting close to the initial diagnosis, metastasis, poor prognosis, or suffering from cancers that affected quality of life and functions. High suicidal factors were also found among cancer patients with physical disabilities, comorbid depression and substance use, loss of independence and decision-making power, middle-aged people, male, unemployed, having low income, single, divorced, widower/widow. Moreover, unsafe medical environments, inappropriate medical assessment, insufficient training of caretakers, and inability to identify potential suicide problems were also major challenges. Therefore, effective assessment of cancer patients with high suicide risk and relevant prevention has been vital in the care process. The results of the current study help enhance the sensitivity to suicide prevention in the clinical process of taking care of cancer patients, with suicide risk screening employed to have a timely confirmation of the patients' psychological issues, to provide prompt prevention measures, to create safe medical environments, and to enhance effective communication between the medical team and cancer patients.
• 439 - 447
• 10.6288/TJPH201736106043

• Link 評論 Commentary
• 評論：防治癌症病人自殺：只有心理衛生篩檢足夠嗎？Commentary: suicide prevention among cancer patients: screening of mental health services is enough?
• 廖士程
  Shih-Cheng Liao
• 無
  none
• 無
  none
• 448 - 448
• 10.6288/TJPH20173610604301

• Link 原著 Original Article
• 運用C4.5決策樹分析失眠症狀Applying C4.5 decision tree to analyze insomnia symptoms
• 蔡崇煌、翁紹仁、周駿安、吳信宏、洪偉展
  CHUNG-HUANG TSAI, SHAO-JEN WENG, CHUN-AN CHOU, HSIN-HUNG WU, WEI-ZHAN HUNG
• 失眠；憂鬱症；健康管理；C4.5決策樹
  insomnia ; depression ; health management ; C4.5 decision tree
• 目標：失眠是常見的主觀症狀，會影響生活品質及身體健康，本研究目的為運用C4.5決策樹工具，以找出影響失眠問題關鍵重要因素，以供相關人員參考。方法：本研究收集2015年1月至12月間到台中市某區域醫院接受全身健康檢查之20歲以上之民眾為樣本個案，共收集有效樣本1,223人，其中，男性佔756人（61.8%）。研究使用結構性問卷，有人口統計基本資料、失眠症狀、生活型態、憂鬱及泛焦慮症狀等資訊。本研究以SPSS 20.0分析資料，憂鬱、焦慮量表及總量表之內在一致性（Cronbach's α）值分別為0.78、0.78及0.86。本研究進一步使用Weka 3.8.1之「C4.5決策樹」以產生規則以了解哪些因素的組合可能容易導致失眠症狀。結果：入睡困難、夜眠中斷、早醒、醒後疲倦、嚴重失眠問題等各種睡眠障礙因素之間的彼此相關性高；男性與入睡困難、夜眠中斷問題的相關性比女性高；睡前喝水、睡前喝酒、飲咖啡習慣、飲茶習慣皆與嚴重失眠問題正相關；安眠藥與各種睡眠障礙正相關；民眾擁有職業可能會改善入睡困難與夜眠中斷的問題；家庭壓力、工作壓力與其他壓力皆可能會產生睡眠障礙；運動習性的養成，不管是增加運動頻率或是增加運動量皆有助於部份民眾降低失眠障礙；睡前喝酒在短期內有助於克服睡眠問題；戒除飲咖啡習慣對部份民眾將有助於減緩失眠障礙；服用藥物對身體除了可能會產生各種副作用外，亦可能會對部分民眾造成失眠問題；抽煙習慣亦會對部分民眾產生睡眠障礙，擁有職業可降低部份民眾的失眠問題。結論：本研究使用決策樹針對不同類型的民眾進行統計分析以產生規則，發現養成運動習性、少抽煙、少飲咖啡、少服藥物、從事職業活動、睡前避免喝水等，有助於部份民眾改善失眠問題。
  Objectives: Insomnia is a common and subjective symptom that influences individuals' quality of life and health. The goal of this research is to apply C4.5 decision tree to identify the key factors for the reference of relevant personnel. Methods: Using a structured questionnaire, we collected physical examination data of 1223 individuals (756 [61.8%] males) older than 20 years attending a Taichung regional hospital. The questions were related to basic demographic information, insomnia symptoms, life style, and mood (depression, anxiety, etc.). This research used SPSS 20.0 to analyze the data. Cronbach's a for depression scores, anxiety scores, and total scores was 0.78, 0.78, and 0.86, respectively. The C4.5 decision tree in Weka 3.8.1 were applied to generate a rule of which combination of factors are most likely to generate insomnia symptoms. Results: ”Difficulty falling asleep,” ”Interrupted night sleep,” ”Wake up early,” ”Wake up tired,” and ”Serious insomnia problem” were highly correlated. Males were more likely to score high on ”Difficulty falling asleep” and ”Interrupted night sleep.” ”Drinking water before sleeping,” ”Drinking alcohol before sleeping,” ”Habit of drinking coffee,” and ”Habit of drinking tea” were positively correlated with ”Serious insomnia problem.” ”Sleeping pills” was positively correlated with each kind of insomnia symptom. ”Difficulty falling asleep” and ”Interrupted night sleep” were less likely in individuals who were employed. Family pressure, work pressure, and other pressure, may also generate insomnia symptoms. Exercise was associated with reduced insomnia symptoms, irrespective of the exercise frequency and exercise volume. ”Drinking alcohol before sleeping” could overcome insomnia problems over the short-term. ”Abstaining from drinking coffee” allowed some individuals to reduce insomnia symptoms. Using medicine not only generated various side effects, but may also have generated different insomnia symptoms in some individuals. Smoking can also lead to insomnia symptoms in some individuals, while employment can decrease insomnia symptoms. Conclusions: This study used a decision tree to generate rules on insomnia based on data obtained from a cohort of individuals. We found that taking part in exercise, stopping smoking, drinking coffee, taking medicine, and drinking before sleeping, as well as having employment are likely to improve insomnia symptoms in many individuals.
• 449 - 460
• 10.6288/TJPH201736106055

• Link 原著 Original Article
• 中老年人健康狀況、性別化家務工作與生活滿意度相關性之兩性差異Gender differences in the inter-relationships among health condition, gender-pattern housework, and life satisfaction in middle-aged and older adults
• 李青芬、 唐先梅
  CHING-FEN LEE, SHAIN-MAY TANG
• 健康狀況 ； 性別化家務工作 ； 生活滿意度 ； 中老年人
  health condition ; gender-pattern housework ; life satisfaction ; middle-aged and older adults
• 目標：瞭解不同性別的中老年人，健康狀況在「性別化家務工作」與「生活滿意度」關係中的調節效果。方法：資料來源為「台灣社會變遷基本調查第六期第二次家庭組問卷」，分析對象為當時55歲以上已婚有偶之中老年人計589人。使用多元迴歸分析，檢視健康狀況在「性別化家務工作」與「生活滿意度」間的關係。結果：(1)中老年人健康狀況越佳，生活滿意度也越高。(2)傳統男人家務與生活滿意度的關係，健康狀況具調節效果，且會因性別而不同。當中老年男性健康狀況較差，傳統男人家務參與愈多生活滿意度愈佳；但對身體較健康的男性，則傳統男人家務參與愈多生活滿意度愈低。對中老年女性來說，健康狀況愈好，傳統男人家務做越多生活滿意度愈佳；但對健康狀況較差的女性而言，做愈多傳統男人家務則生活滿意度愈差。結論：對未來家務工作與生活滿意關係的研究，除應考慮性別的議題，對中老年人更應加入身體健康的影響。此外，如何結合家務與健康使老年生活更為獨立與自主也是政策可考慮的方向。
  Objective: The aim of this study was to investigate how health status moderated the relationship between gender-pattern housework and life satisfaction from a sample of middle-aged and older adults living with a partner in Taiwan. Methods: The data source was the 6th issue of the ”Taiwan Social Change Survey”. The subjects (N=589) were restricted to people aged 55 or older. Multiple regression analysis was used to investigate how health status moderated the relationship between gender-pattern housework and life satisfaction. Results: (1) Health status was positively associated with life satisfaction for older adults. (2) The moderation of health status on the relationship between the performance of traditional masculine housework and life satisfaction varied by gender. Older male adults tended to have higher life satisfaction when they had poor health and did additional traditional masculine housework; however, they tended to have lower life satisfaction when they had good health, and did additional traditional masculine housework. Older female adults who were in good health and did additional traditional masculine housework, tended to have higher life satisfaction; however, when older women with poor health did additional traditional masculine housework, they tended to have lower life satisfaction. Conclusions: For future studies, the relationship between gender-pattern housework and life satisfaction should consider not only gender differences but also health status, especially for older adults. In terms of policy, housework and health status should be considered together as an important condition for the independent living of older adults.
• 461 - 472
• 10.6288/TJPH201736106070

• Link 原著 Original Article
• 初級照護品質與可避免急診之探討The association of quality of primary care and the potentially avoidable emergency department (ED) visit
• 張婷、 郭年真
  TING CHANG, RAYMOND N. KUO
• 初級照護品質 ； 門診敏感性病症 ； 可避免急診 ； 照護連續性
  primary care ; ambulatory care sensitive conditions (ACSC) ; avoidable emergency department visit ; continuity of care index (COCI)
• 目標：經由分析急診病患特性與其門診利用情形，瞭解發生「可避免急診」病患之特性，並探討可避免急診與初級照護品質的關係。方法：本研究以2010年至2013年發生「可避免急診」之病患為主要研究對象，與同年未發生可避免急診之門診患者進行配對。使用「照護連續性」作為測量初級照護品質的指標，分析「病患特性」、「照護連續性」、「門診主要就醫機構層級」對於發生可避免急診的影響。結果：研究結果發現，男性、投保金額低的病患，發生可避免急診的機率較高。多變量分析結果發現，在控制其他變項後，照護連續性越低的組別，發生可避免急診機率越高（OR=1.924～3.220）。相較於診所層級，區域醫院（OR=3.543）、醫學中心（OR=2.916）與地區醫院（OR=2.148）發生可避免急診機率較高。結論：本研究發現門診的照護連續性高則發生可避免急診之機率較低，因此建議應提昇民眾的照護連續性。此外建議可將「可避免急診」作為監控門診照護品質之指標。
  Objectives: This research aims to describe the characteristics and healthcare utilization of patients with avoidable emergency department (ED) visits and to explore the relationship between avoidable ED visits and the quality of primary care. Methods: Patients who had avoidable ED visit between 2010 and 2013 was selected as the case-group in this study and were matched to patients who had outpatient visits but without any avoidable ED visit in the same year. The continuity of care index (COCI) was used to measure the quality of primary care. Multivariate logistic regression analysis was applied to explore whether avoidable ED visits are associated with patients' characteristics, the continuity of care, and the type of providers as their usual source of primary care. Results: The study found that patient who was male or with lower income class were associated with higher probability of having avoidable ED visits. The result of multivariate analysis further revealed that the odds of avoidable ED visits were higher for patients with lower continuity of care (OR = 1.924 to 3.22), and for whom received primary care from regional hospitals (OR = 3.543) and medical centers (OR = 2.916). Conclusions: Higher continuity of care was found to significantly lower the risk of avoidable ED visits. Health policy stakeholders are therefore encouraged to improve continuity of care. We also suggest that avoidable ED visits should be used to monitor the quality of primary care routinely.
• 473 - 486
• 10.6288/TJPH201736106080

• Link 原著 Original Article
• 台灣留學生狂飲行為之研究The study of binge drinking behavior among international Taiwanese college students
• 李曉昀
  Hsiao-Yun Lee
• 狂飲行為 ； 大學生 ； 留學生 ； 文化涵化
  binge drinking ; college student ; international student ; acculturation
• 狂飲行為是最具危險性的飲酒行為，心理、環境、文化等因素皆可能影響狂飲行為產生。由於台灣留學生的狂飲行為長期受到忽略，本研究旨在探討上述各因子對於台灣留學生狂飲行為之影響。方法：本研究採自填式問卷於2012年收集資料，共522位在美國大學就讀的台灣留學生完成填答。研究以階層羅吉斯迴歸來分析影響狂飲行為的因子，迴歸分析輸入的順序為：(一)基本背景資料；(二)成癮物質使用習慣；(三)環境因素；(四)行為與心理因素；(五)文化涵化。結果：研究結果發現年齡較小、大學生（與研究生比）、與室友同住於校外、有吸菸習慣者較有可能出現狂飲行為。此外，同儕的飲酒態度、自己對飲酒的預期效果、飲酒導致負面事件與文化涵化等因子皆能預測台灣留學生的狂飲行為。性別、校園飲酒文化、與拒絕飲酒信心則未具有顯著預測力。結論：同儕態度、對飲酒的預期效果、飲酒導致負面事件以及美國文化的涵化程度為台灣留學生狂飲行為的重要危險因子。
  Objectives: Binge drinking is the most dangerous drinking behavior and could be influenced by psychological, environmental, and cultural factors. Due to limited studies of international Taiwanese college students' binge-drinking behavior, the aim of this study is to investigate the aforementioned factors influencing binge drinking behavior, focusing on international Taiwanese college students in the United States. Methods: A survey method was employed in 2012. In total, 522 valid responses were collected. A sequential logistic regression was applied to investigate determinants influencing binge-drinking behavior. Factors were entered by the following order: (1) demographics, (2) substance use, (3) environment, (4) behavioral and psychological factors, (5) acculturation. Results: The results showed factors of younger age, undergraduate status, living off campus with roommates, and being current smokers increased the likelihood of engaging in binge-drinking behavior. Moreover, peers' attitude toward drinking, drinking expectancy, negative consequences of drinking, and acculturation were significant factors predicting international Taiwanese college students' binge-drinking behavior. In contrast, gender, campus drinking culture, and confidence in refusing alcohol were not significant predictors. Conclusions: Peers' attitude toward drinking, drinking expectancy, negative consequences of drinking, and acculturation are risk factors of international Taiwanese college students' binge drinking behavior.
• 487 - 496
• 10.6288/TJPH201736106045

• Link 原著 Original Article
• 第二型糖尿病患者的睡眠品質與血糖控制之相關性探討The association of the sleep quality on glycemic control in patients with type II Diabetes
• 羅琦、 黃建寧、  郭青萍、 黃秀梨、 廖玟君
  Chyi L, Chien-Ning Huang, Ching-Pyng Kuo, Shiow-Li Hwang, Wen-Chun Liao
• 第二型糖尿病 ； 主客觀睡眠品質 ； 血糖控制
  type 2 diabetes ; subjective and objective sleep quality ; glycemic control
• 目標：第二型糖尿病與其所延伸健康問題威脅著台灣民眾的健康，本研究旨在探討第二型糖尿病病人之主客觀睡眠品質與血糖控制之間關係。方法：以立意取樣中部某醫學中心之第二型糖尿病患者共61位完成研究。主觀睡眠品質以匹茲堡睡眠品質指標量表（PSQI）測量，客觀睡眠品質以腕動計（wrist actigraphy）測量72小時（24小時*3天），並以病歷查閱方式追蹤病人收案後一年內的血糖控制生化值（HbA1c），資料以SPSS 17.0套裝軟體進行統計分析。結果：研究結果發現本研究族群血糖控制不佳，糖化血色素（HbA1c）平均為7.9±1.6%；飯前血糖值（AC sugar）平均為162.1±45.4 mg/dl，HbA1c＞7.0%佔72.2%。主觀睡眠品質之PSQI平均分數為6.6±4.1分，主觀睡眠品質不佳者（PSQI＞5分）佔57.4%；客觀睡眠時數平均為5.7小時，睡眠效率為75.3%，睡眠潛伏期為25.5分鐘、半夜醒來總時間為63.3分鐘。線性複迴歸分析結果發現，自覺睡眠效率（β=-0.040）、糖尿病罹病年數（β=0.07）、BMI（β=0.13）能預測糖化血色素值，解釋32.2%變異量。結論：主觀睡眠品質的好壞與第二型糖尿病患者的血糖控制具有相關性，本研究結果提供臨床照護者將睡眠品質評估納入糖尿病患者血糖控制的重要參考。
  Objectives: Type 2 diabetes and the health problems associated with type 2 diabetes threaten the health of the people in Taiwan. The purpose of this study was to determine the relationship between subjective and objective sleep quality on glycemic control of patients with type 2 diabetes. Methods: This study used a purpose sampling and cross-sectional study design to recruit type 2 diabetes patients from an outpatient endocrinology and metabolism clinic at a medical center in central Taiwan. A total of 61 patients completed questionnaires and were followed for 1 year. The Pittsburgh Sleep Quality Index (PSQI) measurements and wrist actigraphy (Somnowatch) measures for 72 h (24 h * 3 days) were collected. Glycemic control was followed for 1 year by reviewing the glycated hemoglobin (HbA1c) data in medical records. The SPSS 17.0 software package was used for statistical analysis. Results: The results showed poor glycemic control in patients with type 2 diabetes, with an average HbA1c of 7.9±1.6% and a fasting glucose value (AC sugar) of 162.1±45.4 mg/dl. The majority of patients (72.2%) had poor glycemic control (HbA1c> 7.0%). The subjective sleep quality was poor, with a global PSQI score of 6.6±4.1; 57.4% of patients had a PSQI score > 5. The objective sleep hours were inadequate, as follows: average total sleep time, 5.7 hours; sleep efficiency, 75.3%; sleep latency, 25.5 min; and awake time after sleep onset, 63.3 min. Linear multiple regression analysis showed that perceived sleep efficiency (ß=-0.040), duration of diabetes (ß=0.07), and BMI (ß=0.13) predicted the value of HbA1c with 32.2% of variance. Conclusions: Subjective sleep quality was shown to be associated with glycemic control in patients with type 2 diabetes. The results of this study suggest the importance of assessing patient sleep quality on managing glycemia in patients with type 2 diabetes.
• 497 - 510
• 10.6288/TJPH201736106048

• Link 研究紀要 Research Brief
• 長期照顧政策是照顧老人還是失能者？－以蔡英文臉書為例探勘民眾認知The subjectivity of long-term care policies in Taiwan: seniors or disabled? - an example from Tsai's Facebook page
• 管瓊瑛、謝寧、陳潔、 張桂萍、高翊瑋、謝邦昌、 張嘉芳、張耀懋
  Chiung-Ying Kuan, Ning Hsie, Chieh Chen, Kuei-Ping Chang, Yi-Wei Kao, Ben-Chang Shia, Chia-Fang Chang, Yao-Mao Chang
• 長期照顧政策 ； 老人 ； 失能 ； 文字探勘 ； 內容分析法
  long-term care policies ; seniors ; disabled ; text mining ; content analysis
• 目標：本研究分析蔡英文在社群媒體（臉書粉絲專頁）上所發有關長照的文章，以及民眾留言，對於長期照顧政策之照顧對象的理解，究竟為「老人」還是「失能者」。方法：資料來源為蔡英文臉書粉絲專頁於2011年7月1日至2016年9月14日所發布的內容。以內容分析與文字探勘兩種方法分析，內容分析法將照顧對象的測量尺標分為六種，包含：無提及失能者或老人、聚焦失能者、偏向失能者、失能及老人兩者皆提及、偏向老人、聚焦老人；文字探勘則以詞頻、集群分析以及相關性測量長照相關發文及留言回應。結果：在內容分析法上，蔡英文發文及民眾留言的照顧對象之眾數皆在「聚焦老人」族群；以文字探勘法分析同一批資料，蔡英文臉書的發文中，「長照」與「老化」字詞的相關性為0.61，具有中度相關；以集群分析網友的留言，「長照」及「老人」字詞被歸在同一類中。結論：不論是蔡英文的發文或留言回應長照政策認知上，多於專注在老人族群，值得注意的是，長期照顧服務法之照顧對象應為身心失能持續已達或預期達六個月以上者，卻不是主要高度關注的對象。
  Objectives: The aim of this study was to understand if people were able to discern the difference between ”seniors” and ”disabled” from Tsai's long-term care policies and the comments on Facebook by using content analysis and text mining. Methods: The data were retrieved from Facebook messages of Tsai Ing-wen from July 1^(st), 2011 to September 14^(th), 2016. We carried out content analysis by grouping the terms into six classifications: no mention, all disabled, some disabled, both disabled and seniors, some seniors, and all seniors. For text mining, we analyzed the frequency and relationship between keywords in the text. Results: Content analysis revealed that in most people's minds, ”long-term care” meant taking care of ”seniors”. Text-mining Tsai's Facebook posts revealed ”long-term care” and ”aging” to have a correlation coefficient of 0.61; analysis of comments on messages found that ”long-term care” and ”seniors” fell into one group. Conclusions: According to the Long-Term Care Services Act, long-term care means care in accordance with the needs of any individual whose mental or physical incapacity has lasted or is expected to last for six months or longer. Both research methods found ”long-term care” to be associated with seniors, while those with disabilities were neglected.
• 511 - 520
• 10.6288/TJPH201736106019

• Link 研究紀要 Research Brief
• 利用公開資源於藥物流行病學研究建立藥品檔案Drug list compilation for pharmacoepidemiology studies using available public resource in Taiwan
• 林卉敏、阮義蓁、 陳豈㠆、 陳建煒
  Hui-Min Lin, Yi-Chen Juan, Chi-Dan Chen, K Arnold Chan
• 藥品檔案建立 ； 台灣全民健康保險 ； ATC碼
  pharmacoepidemiology ; Taiwan National Health Insurance ; ATC code
• 目標：提供利用我國健康資料進行藥物流行病學研究時系統性整理出完整藥品檔案的方法，並探討WHO ATC碼於藥品檔案建立時之應用和注意事項。方法：利用衛生福利部食品藥物管理署（以下簡稱食藥署）和中央健康保險署（以下簡稱健保署）提供之公開網路資源，藉由藥物學名和WHO ATC碼分別搜尋，以建立阻塞性呼吸道疾病藥品（ATC碼R03類）在台灣的藥品品項檔案。此外，本研究除了比較食藥署和健保署對於同一成份藥品之ATC碼編輯情形之差異外，亦比較我國藥品ATC碼和WHO所建立的ATC碼是否相互對應。結果：有關ATC碼為R03藥品，食藥署網站共計958張許可證資料，於健保署網站和藥品壓縮總檔則共計1,071筆健保碼。健保署提供之R03藥品皆已編輯ATC碼，食藥署之公開提供資訊則有143張藥品許可證尚未編輯ATC碼，並有117張藥品許可證與健保署編輯的ATC碼不同。另健保署有18筆健保碼（為6張藥品許可證）之ATC碼未與WHO同步，而發現我國健保署藥品ATC編碼出現五種R03 ATC碼不存在於WHO分類中。結論：藥物流行病學研究中，以ATC碼可有效率的篩選藥品成分和劑型，然而食藥署和健保險署之編碼可能會有些許差異，且亦可能與WHO之編碼也有些許不同。因此建議除了以ATC碼取得特定成份和劑型藥品外，仍應以藥品學名再度檢查，以免造成藥品檔案之疏漏。
  Objectives: This technical report intends to share a process of compiling a comprehensive drug list for pharmacoepidemiology studies in Taiwan that utilize the National Health Insurance (NHI) data. In addition, it also explains the application of World Health Organization Anatomical Therapeutic Chemical (WHO ATC) codes in research settings. Methods: Publicly available (web-based) resources provided by Taiwan Food and Drug Administration (TFDA) and National Health Insurance Administration (NHIA) were utilized in a study that evaluated drugs for obstructive airway diseases (R03 ATC category). We searched ATC codes and generic names in order to compile a comprehensive drug list for the R03 drugs. ATC codes for drugs from TFDA and NHIA information was compared against the official ATC categorization by World Health Organization. Results: Within the R03 ATC category, 958 TFDA-approved drug entities and 1071 unique NHI drug codes from NHIA were identified. Drugs in the information provided by NHIA were all coded with ATC codes whereas 143 TFDA-approved drug entities did not have ATC code from the TFDA file. In addition, information from the TFDA file for 117 TFDA-approved drug entities had ATC codes that were different from the ATC codes provided by NHIA. Six TFDA-approved drug entities (corresponding to 18 NHI drug items) had ATC code that were different from the WHO ATC coding system. Finally, 5 R03 ATC codes provided by NHIA did not have corresponding code in the WHO ATC system. Conclusions: In pharmacoepidemiology studies utilizing Taiwan NHI data, compilation of drug list of interest could start with ATC code since ATC code represents not only a molecule but also specifies its formulation. However, there may be minor discrepancy between the ATC information provided by TFDA and NHIA, and they may also differ from the WHO ATC coding. When applying ATC code to drug list construction, cross-referencing generic names, especially for combination products, and ATC codes from TFDA and NHIA is highly recommended.
• 521 - 529
• 10.6288/TJPH201736105108