38卷3期

• Link 政策論壇 Policy Forum
• 限制致命工具以減少自殺死亡：原理與應用Restricting high-lethality means to reduce suicide deaths: principles and applications
• 張書森
  Shu-Sen Chang
• 無
  none
• 無
  none
• 223 - 227
• 10.6288/TJPH.201906_38(3).PF03

• Link 綜論 Review Article
• 成人每日靜態行為時間上限之建議Recommended limit for time spent in daily sedentary behaviors among adults
• 古博文、陳上迪、鄭聖儒、陳俐蓉
  Po-Wen Ku, Shang-Ti Chen, Rutherford Ru, Li-Jung Chen
• 久坐；加速規；客觀測量；切分點
  prolonged sitting?;?accelerometer?;?objective measure?;?cut-off point
• 久坐已逐漸被視為公共衛生的重要課題，並建議所有成人均應設法減少每日靜態行為。本篇綜論在於檢視靜態行為與健康之相關議題，並討論發展每日靜態行為時間上限的可能性。透過回顧每日靜態時間的相關研究證實，本文針對以下與靜態時間及健康有關之議題進行評析與討論：（1）探討各國成年人每日從事靜態行為的現況；（2）彙整與分析世界衛生組織以及各國針對靜態時間所發布的指導原則；（3）透過系統性文獻探討與統合分析的研究證據，探究每日靜態行為時間上限的建議；（4）靜態行為的測量方法可能會調節靜態時間與死亡率間的關係。最後歸結本文的結論與提出未來建議。整體而論，花費過多時間在靜態行為會提高成年人的罹病率及死亡風險。自陳式問卷相較於儀器測量，較容易低估每日靜態時間。儘管近來已有統合分析建議成年人每日超過9小時靜態時間會增加死亡風險。但基於使用客觀測量靜態時間的研究有限，目前仍未足以訂立有關每日靜態時間的建議上限。未來仍需持續累積採用大型樣本且使用客觀儀器測量靜態時間的前瞻性世代以檢驗這些發現。
  Prolonged sitting is increasingly being considered a severe concern in public health recommendations, which suggests that all adults should reduce the amount of daily sedentary time. This review examines several crucial aspects of sedentary behaviors and health and discusses the possibilities of developing public health guidelines on daily sedentary time. The following issues were observed and analyzed to review the evidence regarding sedentary time and health: First, the profile of the daily sedentary time of adults across different countries was described. Second, the physical activity guidelines provided by the World Health Organization or government authorities of various countries were reviewed. Third, evidence was obtained on systematic reviews and meta-analyses to explore the recommended limit of daily sedentary time; spending a higher amount of time on sedentary activities than the recommended threshold may damage adult health. Fourth, measurement methods of sedentary behaviors may moderate the associations between sedentary time and mortality across studies. Finally, conclusions and suggestions for future research were proposed. In summary, an increased sedentary time is associated with high morbidity and mortality risks in adults. Self-reported questionnaires typically underestimate the total sedentary time compared with that obtained using device-based measures. Recent meta-analyses revealed that sedentary time of >9 h/day may increase the all-cause mortality risk. However, based on few studies conducted with objectively-assessed sedentary time, the current evidence is insufficient to form guidelines. More large-scale and long-term prospective studies with objective measures of sedentary time are required to validate these findings.
• 228 - 235
• 10.6288/TJPH.201906_38(3).108009

• Link 綜論 Review Article
• 從英國發展早期感知與預警系統的經驗為例，看台灣健康照護體系之應用Appling early awareness and alert (EAA) systems to Taiwan healthcare system - an example learned from UK
• 楊雯雯、蒲若芳
  Wen-Wen Yang, Raoh-Fang Pwu
• 前瞻性評估；早期感知與預警系統；醫療科技評估；歐洲科技偵測國際網絡中心；英國國家衛生研究院創新觀測中心
  horizon scanning?;?early awareness and alert (EAA) system?;?health technology assessment?;?International Information Network on New and Emerging Health Technologies (EuroScan)?;?National Institute for Health Research Innovation Observatory (NIHR IO)
• 新醫療科技日新月異，售價與日俱增，前瞻性評估已被用來做為感知和預警健康照護系統決策單位的方法學，以利於對未來可能造成照護體系影響的新醫療科技能盡早就所需的法規、財務衝擊、環境建置、人力培訓、倫理考量等事宜預做安排與規劃。英國有多年執行早期感知與預警系統的經驗，辨識對國民健康服務有影響的新醫療科技是其範疇之一，借鏡英國篩選出新醫療科技清單的經驗可做為健保總額匡列年度新醫療科技預算之參考。惟政策制定者應先決定納入分析科技的類型、時機點、篩選條件和選題機制、產品價格和健保收載價格落差的處理、產品上市延期影響總額執行的因應措施，以及給付優先順序設定的條件。
  Due to the rapid development of health technologies and the ever-rising healthcare costs, horizon scanning, also known as early awareness and alert (EAA) activities, is the method aiming at identifying new and emerging health technologies that may have impact on health system and early alerting and informing policy-makers to arrange and plan following issues, such as regulatory environment, financial management, workplace preparedness, training and education, and ethics. The Horizon Scanning Research and Intelligence Centre in UK has several years of experience in EAA activities. Identifying new and emerging health technologies influencing the National Health Service is one activity within their remit. We could learn the experience of EAA's processing to produce their final lists of health technologies as the guidance when planning our own fiscal budget for new health technologies under the scheme of global budget. However, policy-makers should first decide the scope, the timing within reasonable frame, filtration criteria, who and how to process the topic selection, how to manage the gap between manufacturer's suggested price and National Health Insurance price, the strategies to cope with the impact, resulted from the unpredictable delayed approval of health technologies, on the executing fiscal budget, and the setting of the criteria to prioritize the health technologies within the fixed amount under the fiscal budget.
• 236 - 251
• 10.6288/TJPH.201906_38(3).107135

• Link 原著 Original Article
• 台灣各縣市高齡者密度及公車資源之空間分析Relationship of regional elderly density and bus resource based on geographical analysis
• 蔡怡萱、邱靜如、朱宏杰
  Yi-Hsuan Tsai, Ching-Ju Chiu, Hone-Jay Chu
• 公車資源；使用率；高齡者
  bus resource?;?usage rate?;?elderly
• 目標：公車為高齡者外出最倚賴之公共運輸載具，然公車資源分佈與高齡人口分布區域是否相符並不清楚。本研究分析各台灣縣市高齡者比例與公車資源之地理分佈相關性，以及資源分布是否影響高齡者使用行為，提供高齡者公車需求與供應之實證數據分析。方法：縣市高齡人口根據內政部2016年人口年齡分布統計取得，縣市公車站牌由交通部GIS-t地理倉儲系統以及PTX公共運輸整合資訊流通平台公開資料取得，各縣市高齡者公車使用率由2016年民眾日常使用運具狀況調查取得。以相關係數分析公車站牌密度與高齡者公車使用率之相關性，再以GIS分析呈現縣市公車資源配置與人口需求、老化狀況、及公車使用率之間的關係。結果：各縣市高齡者公車使用率和縣市公車站牌密度（每平方公里公車站牌數）相比，成正相關（R：0.74，p＜.001），可及距離與高齡者使用率雖無顯著意義，但趨勢上可看出距離越長，使用意願越低（R：-0.44，p＝0.051），公車站牌密度最低站牌間距最長的五個縣市為苗栗縣，彰化縣，南投縣，台東縣以及花蓮縣，主要分布於中部與東部。單一路線站牌服務人口數和各縣市高齡人口呈顯著正相關（R：0.48，p＝0.025），單一路線站牌服務人口數最多的四個縣市是雲林縣，苗栗縣，嘉義縣，台東縣。結論：公車資源較足夠的縣市，高齡者公車使用率相對較高。然而，高度高齡化的縣市，公車使用率卻嚴重偏低，公車可及性差；站牌密度低距離遠，公車的服務量低：單一路線站牌服務人口數高，公車資源相對不足。公車資源分布城鄉差距明顯，雲林縣，南投縣，彰化縣，苗栗縣，嘉義縣和東部最缺乏，極需政府重視與加速建置。
  Objectives: Bus is the most used mode of transportation for the elderly, yet it is not clear about the relationship between bus resource and the elderly population distribution. This study compared the regional elderly density and the bus resource distribution to investigate whether the bus resource meets the needs of the elderly. Methods: Data on regional elderly population was retrieved from the Ministry of the Interior at Executive Yuanin 2016. The number of bus stops was obtained from GIS-t, a geographic information system and Public transport data exchange managed by the Ministry of Transportation and Communications. The bus usage rate of the regional public transportation resource came from the survey of people's daily use of transportation vehicles, in 2016. Correlation analyses and the Quantum-GIS was used to present the relationship among the distribution of bus resource, the regional population demand, the aged condition, and the bus usage rate. Results: The regional elderly public transport usage rate was positively related to bus stops density (Bus stops per Square kilometer) (r= 0.74, p< .001). The distance between bus stops had a trend of negative association with the elderly bus usage rate (r: -0.44, p= 0.051). Inside the last five list of bus stops density were Miaoli County, Changhua County, Nantou County, Taitung County and Hualien County which were located in the central and eastern Taiwan. The number of the elderly was serviced by per bus route stop which was positively related to the regional aging ratio (R: 0.48, p= 0.025). The top four numbers of the elderly serviced by per route bus stop were Yunlin County, Miaoli County, Chiayi County and Taitung County. Conclusions: The richer the bus resource a regional area has, the higher usage rate of public transportation there is. However, it was found that the regional areas with more elderly people have fewer bus resources, and there is a gap between urban and rural areas in terms of the bus resource distribution. Yunlin County, Miaoli County, Chiayi County, Changhua County, Nantou County and the eastern Taiwan have fewer bus resources. It is vital for the government to give more concern to this issue and facilitate the construction of public transportation.
• 252 - 264
• 10.6288/TJPH.201906_38(3).107109

• Link 原著 Original Article
• 臺灣園藝類型援外計畫對民眾蔬果攝食量之影響－以吉里巴斯為例The effectiveness of Taiwan's Horticulture Aid Project and its impact on people's fruit and vegetable intake in Kiribati
• 鄭晏宗、曾筠凊、楊文山
  Yan-Tzong Cheng, Yun-Ching Tseng, Wen-Shan Yang
• 國合會；計畫評核；援外計畫；反事實分析法；傾向分數配對法
  TaiwanICDF?;?evaluation?;?aid project?;?counterfactual analysis?;?propensity score matching
• 目標：本文旨在探討臺灣的政府開發援助藉由園藝類型計畫介入之成效，亦以實證方式說明臺灣的援外計畫之具體效果。方法：本研究為橫斷式研究，採準實驗設計，並選取計畫參與家戶與非計畫參與家戶以符合實驗組與控制組之實驗設計。資料收集主要係以自編結構式問卷蒐集受訪者資料，資料分析則以受訪家戶之蔬果攝取量探討計畫介入成效，並運用反事實分析法控制受訪者社經背景，降低選樣誤差，以確認研究變項之因果關係。結果：本研究共計回收171份有效問卷，其中包括63計畫參與家戶與108非計畫參與家戶。受訪家戶平均每戶每日蔬果攝取量為2.42份（SD＝5.07、Median＝2），計畫參與家戶之「每戶每日蔬果攝取量」較非計畫參與家戶高出0.89份（p＜.05）。迴歸分析的結果亦顯示，「是否參與計畫」為每戶每日蔬果量之影響因素（p＜.05）。本研究以傾向分數配對法（Propensity Score Matching，PSM）執行反事實分析，結果顯示，即使控制了樣本的背景因素，是否參與計畫仍然對蔬果攝取存在積極作用。結論：受評計畫符合計畫改變理論，且確實影響吉國蔬果飲食行為。
  Objectives: To explore the Taiwanese government's development aid and aid effectiveness of the horticulture project's intervention and use evidence-based approach to prove the effects of the Taiwanese aid project. Methods: This study is a cross-sectional study with a quasi-experimental design and mixed methods. In order to comply with the framework of quasi-experimental design, we selected and assigned participants (using household as a unit) of the projects to the experimental group and non-participants to the control group. As for data collection in the field, we collected data through a structured questionnaire. We used the vegetable and fruit intake of the interviewees to explore the effectiveness of the project's intervention. Also, we used counterfactual analysis to reduce the selection bias to confirm the causal relationship. Results: A total of 117 valid questionnaires were collected, including 63 participants and 108 nonparticipants. The average household consumption of vegetables and fruits is 2.42 units (SD=5.07, Median=2). Comparing project participants with non-participants, consumption of vegetables and fruits of the participants is 0.89 units higher than non-participants (p<. 05). Results from regression analysis indicate that participation in the project significantly affects consumption of vegetables and fruits (p<. 05). The counterfactual analysis shows that even when controlling the background factors, participation in the project still affects vegetable and fruit intake. Conclusions: The project is in line with the theory of change and there are statistically significant intervention effects on fruit and vegetable intake.
• 265 - 279
• 10.6288/TJPH.201906_38(3).107130

• Link 原著 Original Article
• 兩岸三地青少年約會暴力盛行率及其與憂鬱情緒關係之探討The prevalence rate and depression underlying adolescent dating violence among Taiwan, Hong Kong, and Shanghai
• 沈瓊桃、趙雨龍、高建秀
  Apr il Chiung-Tao Shen, Marc us Yu-Lung Chiu, Jianxiu Gao
• 親密關係暴力；約會暴力；青少年；憂鬱；兩岸三地
  ?intimate partner violence?;?dating violence?;?adolescent?;?depression?;?Taiwan?;?Hong Kong?;?Shanghai
• 目標：本文旨在探討不同的華人社會中，青少年經歷約會暴力的盛行率及其與憂鬱情緒之關係。方法：本研究對象是在兩岸三地（台灣、香港、上海）就讀國、高中的青少年共3,138位（來自42個學校）。抽樣方法採用兩階段式的分層隨機抽樣。測量工具是自我報告式的問卷調查，其中包括「約會暴力量表」與「青少年憂鬱情緒自我檢視表」。結果：共有31.7%（N＝994）的研究參與者表示曾有交往的經驗；平均開始交往的年齡為13.7歲。台灣青少年的施暴盛行率為22.5%；受暴盛行率為29.9%。香港青少年的施暴盛行率為32.2%；受暴盛行率為42.7%。上海青少年的施暴盛行率為22.5%；受暴盛行率為49.2%。兩岸三地在施暴與受暴的盛行率上有顯著差異。香港青少年有較高的施暴盛行率；上海的青少年有較高的受暴盛行率。此外，t檢定結果顯示約會暴力受害者的憂鬱程度顯著地高於沒有受暴經驗者。結論：兩岸三地青少年施暴與受暴的盛行率高，亟需情感教育以及約會暴力防治方案。
  Objectives: This study aims to examine the prevalence rates and depression underlying adolescent dating violence in three different Chinese societies: Taiwan, Hong Kong, and Shanghai. Methods: Data were collected via self-report measurements from a probability sample of 3,138 students in 42 middle and senior high schools. The measures included Dating Violence Scale and Adolescent Depression Inventory. Results: The research results show that 31.7% of the participants had dating experiences and that they started dating at the age of 13.7 on average. Among those who dated in Taiwan, the prevalence rate for dating violence perpetration is 22.5%, and the prevalence rate for dating violence victimization is 29.9%. Among those who dated in Hong Kong, the prevalence rate for dating violence perpetration is 32.2%, and the prevalence rate for dating violence victimization is 42.7%. Among those who dated in Shanghai, the prevalence rate for dating violence perpetration is 22.5%, and the prevalence rate for dating violence victimization is 49.2%. A comparison of the three above-mentioned Chinese societies shows that the prevalence rates are significantly different: Hong Kong has highest prevalence rate for dating violence perpetration, and Shanghai has highest prevalence rate for dating violence victimization. Moreover, t-test shows that the depressive degrees are significantly higher among dating violence victims than those who do not have dating violence experiences. Conclusions: The present findings of the high prevalence rates in dating violence underscore the importance of relationship education and dating violence prevention and intervention programs for adolescents.
• 280 - 288
• 10.6288/TJPH.201906_38(3).108011

• Link 原著 Original Article
• 台灣AMI品質報告卡住院過程指標的效度驗證Validity of acute myocardial infarction inpatient process measures on the report card in Taiwan
• 陳宗泰、薛亞聖、陳芸華、郎慧珠、范傑閔、魏中仁、王宗倫
  Tsung-Tai Chen, Ya-Seng (Arthur) Hsueh, Yun-Hua Chen, Hui-Chu Lang, Chieh-Min Fan, Chung-Jen Wei, Tzong-Luen Wang
• 心肌梗塞；品質公開；死亡率；再住院率；病人和醫院層級
  AMI?;?public disclosure?;?mortality?;?readmission?;?patient and hospital levels?
• 目標：檢視台灣心肌梗塞品質報告卡過程指標的效度。若報告卡的品質指標具有高效度，則可以增加民眾使用品質報告卡的信心，醫師也較願意根據成效結果做出改善。方法：本研究主要分析2011到2012年，5個公開的過程指標與負向結果指標的關係，選取對象為前述期間健保資料庫住院資料有急性心肌梗塞主診斷（ICD-9-CM 410）的病人。主要的結果指標分別為病人和醫院層級的3天內重返急診、14天內非預期性再住院，以及出院30天死亡率。結果：除了低密度脂蛋白檢查指標外，4個過程指標皆與醫院層級的結果指標有顯著負相關。結論：因應報告卡效度透明化的要求，我們的研究指出，立基於報告卡使用的過程指標與負向結果有相關，現行台灣AMI品質報告卡上的過程指標具有效度。換句話說，在過程指標獲得高分的醫院，可能也具有較佳的結果品質。
  Objectives: To investigate the validity of acute myocardial infarction (AMI) process measures on the public report card in Taiwan. If the quality measure of report card is highly valid, then it can enhance confidence over the use of report cards by citizens, and physicians would be more willing to make improvements based on the results of performance. Methods: The study analyzes the associations between the 5 process measures reported and the negative outcome measures from 2011 to 2012. Subjects were selected from the National Health Insurance Association (NHIA) admission files and had a principal diagnosis of acute AMI (ICD-9-CM 410) during the study period. The main outcome measures include return to the emergency department (ED) within 3 days, unscheduled readmission within 14 days, and 30-day mortality at the patient and hospital levels. Results: Four process measures are all negatively associated with the outcomes at hospital level, except for the LDL examination. Conclusions: Regarding the requirement for validity transparency of a report card, our research suggests that these process measures currently used on the AMI report card in Taiwan are valid based on their associations with negative outcomes. In other words, a hospital that achieves high scores on process measures probably also realizes better outcome quality.
• 289 - 300
• 10.6288/TJPH.201906_38(3).107115

• Link 評論 Commentary
• 評論：醫療品質指標風險校正模型，是否應納入病患社經特性？Commentary: should patient's socio-economic status be incorporated into risk adjustment models for outcome measures
• 郭年真
  Raymond N. Kuo
• 無
  none
• 無
  none
• 301 - 302
• 10.6288/TJPH.201906_38(3).10711501

• Link 評論 Commentary
• 作者回覆：醫療品質指標風險校正模型，是否應納入病患社經特性？Authors' response to commentary: should patient's socioeconomic status be incorporated into risk adjustment models for outcome measures
• 陳宗泰、薛亞聖、陳芸華、郎慧珠、范傑閔、魏中仁、王宗倫
  Tsung-Tai Chen, Ya-Seng (Arthur) Hsueh, Yun-Hua Chen, Hui-Chu Lang, Chieh-Min Fan, Chung-Jen Wei, Tzong-Luen Wang
• 無
  none
• 無
  none
• 303 - 304
• 10.6288/TJPH.201906_38(3).10711502

• Link 原著 Original Article
• 職場健康資產管理－潛在健康生產力損失推估模型之建立Workplace health asset management: establishment of a potential health-related productivity loss estimation model
• 葉婉榆、陳叡瑜、李昕亮
  Wan-Yu Yeh, Ruey-Yu Chen, Hsin-Liang Lee
• 職場健康促進；減效出席；工作壓力；健康生產力；健康行銷
  workplace health promotion?;?presenteeism?;?work stress?;?health-related productivity?;?health marketing
• 目標：工作者的身心健康問題除了影響工作表現，還可能導致病假、抱病上班等「健康生產力減損」的後果，影響企業的營運效能。本研究運用職場員工「減效出席」（presenteeism）現象（指身心負荷過重或有症狀／疾病，卻仍勉強上班）和病假天數，建立「潛在健康生產力損失模型」（potential health-related productivity loss model），估算企業因員工健康問題所損失的人力成本，並分析影響因素。方法：資料來源為某健診機構企業健檢客戶在2017年2月至9月間收集的326份問卷，另納入政府勞動統計數據估算潛在健康生產力損失經濟價值。結果：在各種身心症狀中，感冒、頭痛、肌肉骨骼、消化、皮膚、情緒、睡眠問題和減效出席關聯性較高，有無這些症狀者健康生產力損失也有顯著差異。在納入主計處報告的薪資和工時參數後，換算調查對象之潛在健康生產力損失平均為2,038.84元／月。多元線性迴歸分析顯示，職場員工的年齡、工作個人生活衝突、疾病和身心不適症狀數量，和潛在健康生產力損失經濟價值有正向關係。結論：藉由本研究建立的推估模型，可成為健康促進介入方案投入／成效的評估指標，另對於因健康和壓力問題造成的減效出席風險因素，也提供企業做為提供職業健康服務的實證依據，作為職場健康問題改善優先次序的參考。
  Objectives: Workers' physical and mental health problems negatively affect their work performance as well as their employers' daily business operations; coming to work sick lowers productivity and sick leave increases labor costs. In this article, we establish a ”potential health-related productivity loss model” that uses the concept of ”presenteeism” (the psychological tendency to feel obligated to be present at work despite experiencing physical or psychological stress overload or suffering from symptoms of an illness) and days of sick leave to estimate labor costs incurred by a company because of employee health conditions and analyze influencing factors. Methods: Data were obtained from 326 questionnaires collected by corporate health check clients of a health management institution between February and September 2017. Government labor statistics were also included in the model and were used together with questionnaire data to estimate potential health productivity losses. Results: Close correlations were identified between sickness presenteeism and symptoms of physical/psychological discomfort related to common colds; headaches; musculoskeletal conditions; digestive disorders; and skin, mood, and sleep problems. Potential health productivity loss was significant among workers with these symptoms compared with the productivity of workers without these health conditions. After including the salary and working hour parameters reported by the Taiwan Directorate General of Budget, Accounting and Statistics, the mean potential health productivity loss of the survey respondents was calculated to be NT$2,038.84 per month. The results of the multiple linear regression analysis indicated that employees' age, degree of work and life conflict, and number of illnesses and physical/mental symptoms were positively related to the monetary value of potential health productivity loss. Conclusions: The estimation model established in this study can be used as an indicator to evaluate the cost/benefit of workplace health promotion intervention programs, and empirical evidence concerning presenteeism-related risk factors can encourage companies to provide occupational health services and prioritize health promotion.
• 305 - 315
• 10.6288/TJPH.201906_38(3).108004