39卷3期

• Link 政策論壇 Policy Forum
• 如何讓銀髮族吃得巧、吃得健康！Policy suggestions to promote eating healthy and eating smart in Taiwanese elderlies
• 潘文涵、吳思芸
  Wen-Harn Pan, Szu-Yun Wu
• 銀髮族、營養
  Taiwanese elderlies、nutrition
• 台灣在2018年初進入了高齡社會，超過14％以上的人口為65歲以上的老人[1]。隨著高齡人口族群的增加，高齡健康促進與疾病預防，已成為國家極重要的健康議題，特別是高齡人口常發生的老年症侯群，例如：肌少、衰弱、憂鬱、失智等問題，如未能有效預防，將成為國家社會嚴重的負擔。由於目前老年症候群在醫療上尚缺乏有效的藥物，一旦發生失智退化，往往無法逆轉。因此，「有效預防老年症候群的發生」是最重要的健康策略，目前的文獻上普遍認為：執行健康飲食、適量適性運動、社會參與為最有效的預防、管理、與改善方法。本篇將針對老年健康飲食促進政策做相關的討論與建議。
  Taiwan was an aging society at the beginning of 2018, and more than 14% of the population are elderly, over 65. As the elderly population increases, the health promotion and disease prevention of the elderly are important health issues that need to be addressed. Especially the syndromes often occur in the elderly, such as muscle loss, weakness, depression, dementia, etc. If it is not effectively prevented, it will become a serious burden on the country and society. As there are no effective medicines for the geriatric syndrome, once dementia degeneration occurs, it is often irreversible. Therefore, effectively preventing the occurrence of senile syndrome is the most critical health strategy. The current literature generally believes that implementing a healthy diet, appropriate exercise, and social participation are the most effective methods of prevention, management, and improvement. This article will make discussions and suggestions on policies related to promoting healthy eating for the elderly.
• 231 - 234
• 10.6288/TJPH.202006_39(3).PF03

• Link 公衛論壇 Public Health Forum
• 植入性醫材登錄監視制度與病人權益保障Patient rights perspective of medical implants registration and safety surveillance.
• 陳再晉、鐘珮純、 陳冠文、蕭允強
  Tzay-Jinn Chen, Pei-Chunn Chung, Kuan-Wen Chen, Yun-Chiang Hsiao
• 植入性醫材登錄、病人權益
  none
• 隨著醫療科技進步，植入性醫療器材（如：乳房植入物、人工關節、人工水晶體、血管內支架、心臟節律器、心內去顫器、腦內神經治療裝置、牙植體…等，以下稱植入性醫材）之使用日趨普遍。這些器材上市前，雖然都經過生物相容性、機械力學或電學等相關安全測試與審查，然而，植入物畢竟不是天然產品，長期置放於人體內，是否會有不良反應？是否會產生位移？是否因電子、機械性能逐漸耗損，致生健康危害？這些問題僅透過上市前有限期間及個案數之臨床試驗，很難完全得知。即令藥物主管機關附加要求製造商進行一定期間之上市後監視（post-marketing surveillance），倘於監視期滿後，特定型號或批號之產品發現瑕疵，如何及時獲悉使用者之資料，公告或通知召回（recall），以進行安檢、更換；或者在該器材之部分元件耗損時（如：牙植體之螺絲斷裂），如何確認其規格型號，以利迅速取得需要更換之元件，也是醫療消費者安全與權益保障不可或缺之一環。
  NONE
• 235 - 239
• 10.6288/TJPH.202006_39(3).109021

• Link 公衛論壇 Public Health Forum
• 逗陣鬥結核桌遊：綠絲帶卡牌創新設計Fighting tuberculosis board game: green ribbon card design.
• 蔡俊欽 、林云茜、吳芳妤、陳思柔、曾含妤、林函蓁、陳美芳 、何雪珍
  Han-Yu Tseng, Han-Zhen Lin, Mei-Fang Chen, Hsueh-Jen Ho
• 結核病、綠絲帶卡牌
  Tuberculosis, green ribbon card
• 結核病是國際間重視的嚴重傳染病[1]。世界衛生組織指出全球有1/3民眾感染潛伏結核病。被感染的民眾一生有10%會發病。若未經過妥善的結核治療，有2/3感染結核病的個案會死亡[2]。在台灣，一年四季都有結核病病例，目前結核病雖有下降的情況，但每年仍有約一萬名的新發病個案，要達到2035年終結結核，防治工作仍有更加努力精進之處[1,2]。肺結核防治的首要重點為及時診斷和正確治療傳染性肺結核病人，這需要全民對結核病有深度的認識才能共同對抗結核病。過去衛教方式採衛教單張、海報、影片宣導，這樣的方式過於嚴肅制式，民眾對於結核病知識吸收有限，創新衛教方式是值得發展的。
  NONE
• 240 - 242
• 10.6288/TJPH.202006_39(3).109012

• Link 原著 Original Article
• 燒傷醫療體系與大量燒傷事件應變計畫之國際比較International comparison of burn medical care systems and emergency response plans for burn mass casualty incidents
• 莊秀文、戴念梓、何慧燕
  Sheuwen Chuang, Niann-Tzyy Dai, Hui-Yan Ho
• 大量燒傷事件 ； 燒傷醫療體系 ； 國際比較 ； 緊急應變計畫
  burn mass casualty incidents ; burn care systems ; international comparison ; emergency response plan
• 目標：本研究目的是針對國際先進國家之燒傷照護體系與大量燒傷事件應變機制，進行比較，找出我國可借鏡之處。方法：以英文資料較完整的美國、澳洲、英國、瑞士與我國進行比較，分成兩個層次：各國對於燒傷治療的基本醫療體系，以及當大量燒傷傷患事件發生時，各國緊急應變的計畫或機制。結果：相對於美、澳、英、瑞四個國家皆有基本的燒傷醫療照護分級體系，以及地區性或全國性的大量燒傷事件的應變計畫而言，我國尚未在此方面有特別的建置，各國燒傷醫療體系的層級數不一。全國性的大量傷患事件應變層級從澳洲的兩層級、瑞士的三層級、美國的四層級、到英國的六層級，美國人口稠密的大都會，如紐約市，將醫療機構分為四個燒傷能力處置層級，來規劃區域性的大量燒傷事件應變計畫。結論：依據研究的結果與我國都會區人口、醫療體系特性，本文建議參考紐約市燒傷中心之大量燒傷事件應變計畫，研擬建立我國區域性、乃至全國性大量燒傷事件應變計畫，以及醫院燒傷醫療能力分級作法，做為我國燒傷醫療體系的短中期精進目標。
  Objectives: The purpose of this study is to compare and learn from the burn care systems and emergency response plans for burn mass casualty incidents (BMCI) across developed countries. Methods: Based on the availability of English information, the United States, United Kingdom, Switzerland, and Australia were selected for comparison with Taiwan. Two categories are compared across the 5 countries: the basic medical care systems for burn patients, and emergency response plans for BMCIs. Results: In contrast to Taiwan, the United States, Australia, United Kingdom, and Switzerland have established basic burn care systems and regional or national emergency response plans for BMCIs. The number of layers within both burn care systems and nation-wide emergency response plans for BMCIs varies from country to country. Emergency response plans for BMCIs in Australia was designed with two levels, and with three levels in Switzerland, four levels in the United States, and six levels in the United Kingdom. In densely-populated metropolitan areas such as New York City, hospitals are divided into four levels of burn care abilities as part of the regional emergency response plan for BMCIs. Conclusions: Based on the results of the study and the characteristics of Taiwan’s metropolitan population and medical care systems, the article recommends referring to the burn-center regional emergency response plans for BMCIs of New York City to develop a regional to national BMCI plans, and ranking method for burn care capabilities of hospitals as a short to medium-term improvement goal for Taiwan’s burn care system.
• 243 - 256
• 10.6288/TJPH.202006_39(3).109006

• Link 原著 Original Article
• 全民健保民眾就醫流程經驗與治療效果滿意度之相關：2012-2016年我國全民健保就醫權益調查為例Relationship between patient procedure experience and treatment outcome satisfaction by using 2012-2016 annual National Health Insurance survey data
• 邱尚志、李佩珍、李麗惠、林寬佳
  Shang-Jyh Chiou, Pei-Chen Lee, Li-Hui Lee, Kuan-Chia Lin
• 全民健康保險 ； 就醫流程經驗 ； 滿意度調查 ； 安德森架構
  National Health Insurance ; patient procedure experience ; satisfaction survey ; Andersen Behavioral Model
• 目標：探討以基層醫療或醫院的就醫流程經驗中哪些因素與治療效果滿意度有關。方法：資料來源為「101-105年全民健保民眾就醫權益長期監測系統之研究」，此研究以各年度橫斷面調查方式進行。問卷採用安德森架構，整合五年資料為同一樣本群體，依門診與醫院分成兩群進行後續分析，導入邏輯斯迴歸分析探討影響病人的就醫治療結果滿意度的相關因素。結果：民眾就醫經驗中與醫師之間的互動是相當重要影響治療結果滿意度的因素，有高達六或十倍以上的勝算比會比不滿意者表示滿意其治療效果，醫護人員如果有提供衛教指導也會有將近兩倍的勝算比，然不同求醫行為仍有其他影響因素。結論：影響滿意度核心因素仍然是民眾看診的經驗，醫病信任關係、醫療訊息傳遞與決策共享過程的品質皆是影響民眾總體感受的因子。台灣健保正邁向階段性成熟整合期，透過政策技術創新與倡議增加民眾互動的誘因，進而改善民眾就醫流程經驗與滿意度，逐步邁向醫病關係公平效率觀感及多方參與度的提升。
  Objectives: Identify factors influencing patients' satisfaction with outcomes of medical treatments of primary or hospital care. Methods: This study used data from the 2012-2016 annual National Health Insurance (NHI) surveys, which explored patient experiences related to receiving of medical services. The questionnaire was created on the basis of Andersen's model. We considered that data from every survey year in the multiyear survey database were independent and representative of the population. Logistic regression analysis was introduced into the research to explore relevant factors influencing patients' satisfaction with treatment outcomes. Results: Doctor-patient interaction with regard to outpatient services was a crucial factor influencing patients' satisfaction with treatment outcomes. Such an interaction was associated with a high likelihood of satisfaction with treatment outcomes (odds ratio = 6-10, p<0.001). Moreover, implementation of health education by medical staff was another factor concerning the likelihood of satisfaction with treatment outcomes (OR = 1.4-2.0; p<0.001). Nonetheless, influential factors may vary for different medical-seeking behaviors. Conclusions: Treatment-seeking experience is the key factor influencing patient satisfaction. Other factors influencing people's overall satisfaction include the doctor-patient trust, the quality of medical information delivery, and shared decision-making processes. Taiwan's NHI is entering a stage of maturity and integration, where innovative initiatives on policies and technologies serve as incentives to increase interaction with the public, thereby improving people's procedure experience and satisfaction with medical care, achieving positive perceptions of fairness and efficiency in a doctor-patient relationship as well as increased participation of various parties.
• 257 - 268
• 10.6288/TJPH.202006_39(3).108126

• Link 原著 Original Article
• 健保放寬降血脂藥物給付範圍對心血管疾病發生率及費用之影響The impact of expansion of dyslipidemia drug coverage on cardiovascular disease incidence and costs under the National Health Insurance scheme
• 郭蓓蓓、鄭守夏
  PEI-PEI KUO, Shou-Hsia Cheng
• 降血脂藥物 ； 心血管疾病 ； 高血脂 ； 醫療費用 ； 健保給付
  hypolipidemic drugs ; cardiovascular diseases ; hyperlipidemia ; health expenses ; National Health Insurance benefit package
• 目標：全民健保於2013年8月1日放寬高危險族群使用降血脂藥物的給付規定，本研究旨探討該政策對於心血管疾病發生率與醫療費用之影響。方法：使用全民健康保險全人口資料庫進行分析，針對用藥給付放寬的範圍去界定研究與對照組，選取無心血管疾病史的糖尿病患者118,912人為研究組；無心血管疾病史且無糖尿病史的高血壓患者150,930人為對照組。追蹤觀察期為2013年8月1日前後各3年。統計分析採用差異中的差異法，檢視政策實施前後，兩組病人在降血脂藥物開立、心血管疾病（急性心肌梗塞與缺血性腦中風）發生、及醫療花費的差異。結果：研究發現在政策實施後，研究組的病人比對照組較容易獲得降血脂藥物的開立（OR=1.095, p＜0.0001），其心血管疾病的發生機率也較低（OR=0.914, p=0.0046），且降血脂藥物費用較低（β=-0.016, p=0.0019），而心血管疾病的花費雖然有比較低，但未達統計上的顯著差異（β=-0.087, p=0.1504）。結論：2013年的放寬降血脂給付政策讓高風險族群的糖尿病患者的用藥人數上升、心血管疾病發生趨緩，但尚未見可以節省健保花費，建議未來可以做更長期的觀察評估。
  Objectives: Aiming to reduce the occurrence of cardiovascular disease (CVD), Taiwan's National Health Insurance (NHI) Administration expanded coverage for hypolipidemic drugs for high-risk patients, including patients with a history of CVD or diabetes in 2013. This study intended to evaluate the impact of this policy. Methods: Patients with diabetes but without a history of CVD (118,912 subjects) were selected as the study group, and patients with hypertension but without a history of CVD or diabetes (150,930 subjects) were the comparison group. Using August 1, 2013, as the cut-off point we defined 3 years each in the pre- and post-policy periods. Generalized estimation equation (GEE) models with a difference-in-differences analysis were used to estimate the effects of the new policy in 2010 and 2016. Outcome variables included the likelihood of receiving hypolipidemic drugs, occurrence of CVD (acute myocardial infarction and ischemic stroke), and expenses for drugs and CVD. Results: After introduction of the policy, subjects in the study group were more likely to receive hypolipidemic drugs (OR=1.095, p<0.001), and less likely to have CVD (OR=0.914, p=0.0046) than subjects in the comparison group. The subjects in the study group also had lower expenses for hypolipidemic drugs (ß=-0.016, p=0.0019), but the lower expenses for CVD did not reach the significance level (ß=-0.087, p=0.1504). Conclusions: The expanded coverage for hypolipidemic drugs significantly increased the use of medications for high-risk patients, and reduced the occurrence of CVD in Taiwan. Long-tern evaluation of this medication policy is recommended.
• 269 - 277
• 10.6288/TJPH.202006_39(3).108132

• Link 原著 Original Article
• 以系統性文獻回顧及統合分析法探討運動對於老人憂鬱的療效Effects of exercise on depression in older people: a systematic review and meta-analysis
• 方莉、方淑慧、方景林
  Li Fang, Shu-Hui Fang, Ching-Lin Fang
• 老人 ； 憂鬱 ； 運動
  elderly ; depression ; exercise
• 目標：以系統性文獻回顧與統合分析法，整合及探討運動對於老人憂鬱的療效。方法：搜尋的資料庫包含：2004年到2019年間發表於Pubmed、CINAHL、Cochrane Library、華藝線上圖書館、台灣期刊論文索引系統、台灣博碩士論文知識加值系統等電子資料庫。證據等級採用Melnyk和Fineout-Overholt提出介入性研究的證據等級。擷取後之資料採用RevMan 5.3軟體進行統合分析（Meta-Analysis），以檢視運動介入對老人憂鬱之療效。結果：納入結果分析的文章有13篇，共有1,477位受試者（實驗組720 & 對照組757人），95% CI [-0.45, -0.10]，Z=3.14，p=0.002，顯示綜合效果量為-0.27，表示運動介入可改善老人的憂鬱，但成效偏低。在次群體分析部份呈現：運動介入時間為「至少24週」、「每週運動兩次或三次」且對象為「社區老人」，可有效緩解憂鬱程度。結論：老人接受運動治療，可以改善其憂鬱。建議社區老人之運動設計，運動時間可設計為「至少24週」、且「每週運動兩次或三次」，以利緩解其憂鬱；未來希望納入更多實證研究，以針對介入運動種類、運動介入時間、每週介入的次數及受試者特質（種族、年齡、不同憂鬱程度個案）等因素，進行更明確的分析與討論。
  Objectives: To integrate and explore the effects of exercise on depression in older people by a systematic literature review and meta-analysis. Methods: The electronic databases PubMed, CINAHL, Cochrane Library, Index to Taiwan Periodical Literature System, and National Digital Library of Thesis and Dissertations were searched for articles published between 2004 and 2019 in Taiwan. This study used the level of evidence outlined in the article by Melnyk and Fineout- Overholt (2005) for the interventional study. A meta-analysis was applied using the RevMan 5.3 to examine the effects of the exercise interventions on depression in older people. Results: This study included 13 articles in the analysis. In total, 1477 participants (exercise: 720; control: 757, 95% confidence interval [-0.45, -0.10], Z = 3.14, p = 0.002) showed a combined effect of -0.27, indicating that exercise intervention could improve the degree of depression in older people. According to the subgroup analysis, the intervention time is "two or three times a week for at least 24 weeks", and the participant belongs to the "elderly community," which can effectively alleviate the degree of depression. Conclusions: Exercise can improve the degree of depression in older people. The recommended exercise protocol of older people in the community is that it should last for "at least 24 weeks", and include "exercise twice or three times a week" to alleviate their depression. More empirical studies are suggested in the future to provide a clearer analysis and discuss the factors of types of activity interventions, duration of exercise interventions, number of weekly interventions, and demographic characteristics (race, age, and degrees of depression).
• 278 - 291
• 10.6288/TJPH.202006_39(3).109030

• Link 原著 Original Article
• 運用德菲法建構醫師健康識能專業知能指標之研究Study of constructing indicators of physician's professional competence on health literacy by Delphi method
• 劉峻正、張家臻、賴香如、蔡兆勳、明金蓮、董貞吟
  Chun-Cheng Liu, Chia-Chen Chang, Hsiang-Ru Lai, Jaw-Shiun Tsai, Jin-Lain Ming, Chen-Yin Tung
• 健康識能 ； 德菲法 ； 醫師 ； 醫病關係 ； 醫療資源
  health literacy ; Delphi method ; physicians ; doctor-patient relations ; medical resources
• 目標：本研究旨在建構醫師健康識能專業知能指標，以促醫療提供者關注、掌握與因應病人健康識能、進行良好醫病溝通，並協助病人有效運用醫療資源。方法：本研究採德菲法，進行三回合調查，以凝聚13名專家之共識。根據文獻與焦點團體訪談結果，界定醫師健康識能專業知能之內涵與面向，並擬定指標初稿。在每回合調查歷程中，針對各項指標的適切性與一致性進行分析，依據專家意見修正與增刪指標。結果：建構「概念與評估」、「接納與尊重」、「溝通與互動」及「醫療資訊與決策」等四面向、13次面向、44項指標，以利醫師扮演健康識能評估者、接納者、規劃者及導引者之角色。結論：本研究建構之健康識能專業知能指標可作為未來規劃醫師健康識能專業知能相關職前與在職教育課程，以及研發相關測量工具之參考。
  Objectives: This study aims to construct indicators of physicians' professional competence on health literacy in order to motivate healthcare providers to pay attention to master, and respond to patients' health literacy; conduct good doctor-patient communication; and assist patients in effectively using medical resources. Methods: The Delphi method was applied, and three rounds of investigation were conducted to gather the consensus of 13 experts. According to the literature and results of focus group interviews, the connotations and dimensions of physicians' professional competence on health literacy were defined, and the first draft of indicators was drawn up. In the course of each round of investigation, the suitability and consistency of various indicators were analyzed, and indicators were revised, added, or deleted according to the experts' opinions. Results: Four dimensions, namely "concept and evaluation", "acceptance and respect", "communication and interaction", and "medical information and decision-making"; and 13 sub-dimensions and 44 indicators were constructed to help physicians play the roles of health literacy evaluators, receivers, planners, and guides. Conclusions: The indicators of physicians' professional competence on health literacy constructed in this study can be used as a reference for future planning of pre-service and on-the-job education courses related to physicians' professional competence on health literacy, as well as development of related measurement tools.
• 292 - 310
• 10.6288/TJPH.202006_39(3).108130

• Link 原著 Original Article
• 合併飲食、運動與心理介入對體重與飲食行為之成效The effects of combined diet, exercise, and psychological intervention on body weight and eating behaviors
• 柯佳宜、林宜美、李純瑩
  Chia-I Ko, I-Mei Lin, Chun-Ying Lee
• 身體質量指數 ； 體重管理 ； 心理介入 ； 情緒型飲食 ； 饞食型飲食
  body mass index ; weight management ; psychological intervention ; emotional eating ; grazing
• 目標：傳統減重以飲食和運動介入為主，本研究探討傳統減重合併心理介入對體重與飲食行為之成效。方法：採立意取樣招募體重管理中心體重過重與肥胖（身體質量指數大於等於24以上）的參與者，分為八週傳統減重組（以營養、有氧和肌力課程為主）與八週傳統合併心理組（包括傳統減重合併認知行為治療與正念飲食），分別於介入前、後測量參與者的體態、情緒飲食者量表（Emotional Eater Questionnaire, EEQ）和嘴饞量表（Grazing Questionnaire, GQ）。結果：二因子變異數分析發現「組別×時間」在腰圍和腰臀比有交互作用，事後檢定發現傳統合併心理組之後測腰圍與腰臀比低於前測，而傳統減重組僅後測腰圍低於前測。傳統合併心理組在腰圍和腰臀比的改變量高於傳統減重組。二因子變異數分析發現「組別×時間」在EEQ總分有交互作用，EEQ總分和GQ總分有顯著時間主效果，事後檢定發現傳統合併心理組在後測EEQ總分低於前測，後測時傳統合併心理組之EEQ總分低於傳統減重組，傳統合併心理組之EEQ總分改變量高於傳統減重組。結論：傳統減重合併心理課程在降低參與者腰圍、腰臀比、情緒型飲食與饞食型飲食之效果比傳統減重更佳。
  Objectives: Traditional weight control programs include diet and exercise. The present study explored the effects on body weight and eating behaviors of traditional weight management (TWM) combined with psychological intervention versus TWM only. Methods: Purposive sampling was used in this study. Participants with body mass index = 24 kg/m^2 were recruited from a weight management center and assigned to an eight-week traditional weight management program (TWM; diet, aerobic, and muscle strength exercise) or eight weeks of TWM with psychological intervention (PSY; cognitive behavior therapy and mindfulness eating). The indices of body weight, Emotional-Eater-Questionnaire (EEQ) score, and Grazing Questionnaire (GQ) score were measured at pre-test and post-test. Results: Two-way analysis of variance (ANOVA) revealed significant Group × Time interaction effects on waist circumference (WC) and waisthip ratio (WHR). Post-hoc comparison found lower WC and WHR at post-test than pre-test in the PSY group, and lower WC at post-test than pre-test in the TWM group. There was a larger change in WC and WHR in the PSY group than the TWM group. Two-way ANOVA showed a significant Group × Time interaction effect on EEQ and Time main effects on EEQ and GQ. Posthoc comparison showed lower EEQ of PSY at post-test than pre-test, and lower EEQ in PSY than TWM at post-test. Otherwise, the change scores of EEQ in the PSY group were better than the TWM group. Conclusions: This study indicated that TWM combined with psychological intervention had better effects on WC, WHR, EEQ, and GQ than TWM alone.
• 311 - 325
• 10.6288/TJPH.202006_39(3).108137

• Link 實務 Public Health Practice
• 檢視職業傷害的趨勢、分布與社會不平等：勞保現金給付之分析Trends, distribution, and social inequality of occupational injury: analysis of labor insurance compensation data
• 陳怡靜、鄭雅文
  Yi-Jing Chen, Yawen Cheng
• 職業傷害 ； 勞工保險 ； 健康不平等
  occupational injury ; labor insurance ; health inequality
• 目標：社會經濟地位可能影響職業傷害風險，然而台灣對此議題的探討仍不多。本研究旨在檢視職業傷害的近年趨勢、分布與社會不平等現象。方法：分析2016至2018年間勞保職業災害現金給付資料，比較不同性別、年齡、投保薪資、投保單位與產業之職業傷害發生率。結果：2016至2018年間有30,809,863投保人年，共發生1,617件致死性及150,026件非致死性職業傷害；平均致死性及非致死性職業傷害發生率分別為每十萬人年5.25及486.94件。非致死性職業傷害發生率有下降趨勢，但通勤事故佔比為36.3%且比例有上升趨勢。不論是致死性與非致死性職業傷害，男性均顯著高於女性，而60歲以上及20歲以下顯著高於其他年齡層。投保薪資最高的族群，職業傷害發生率最低，但投保薪資與職業傷害發生率之相關未呈現階層化分布。依產業類型分析，可發現營造業的致死性與非致死性職業傷害發生率最高，運輸倉儲、農林漁牧及土石礦業的致死性職業傷害發生亦顯著偏高。結論：勞動主管機關應檢視職業安全保護措施，並針對高風險族群加以改善，有關投保薪資與社會經濟地位之關聯則需進一步探究。
  Objectives: Workers' socioeconomic positions may influence the risk of occupational injury. However, in Taiwan, research on this issue remains limited. This study examined the recent trends, distribution, and social inequalities of occupational injury. Methods: We obtained data from the workers' compensation insurance during 2016-2018. Incidence rates of occupational injuries were compared by gender, age, level of insured salary, employment type, and industry. Results: From 2016 to 2018, 1617 fatal and 150,026 no nfatal occupational injury benefit claims were granted in 30,809,863 insured person-years. Incidence rates of fatal and nonfatal occupational injuries were 5.25 and 486.94 per 100,000 person-years, respectively. Although the incidence rates of fatal occupational injury were declining, the proportion of commute injury accounted for 36.3% of total occupational injury claims, and this proportion was increasing steadily. For both fatal and nonfatal occupational injuries, men and those aged >60 or <20 years had a significantly high risk. Those in the highest salary bracket had the lowest incidence of occupational injury, but no apparent pattern was observed between insured salary and occupational injury rate. However, construction workers showed significantly high incidences of both fatal and nonfatal occupational injuries. Workers in transport, logistics, and primary industrial sectors, including agriculture, fishery, forestry and mining were also observed to have high incidence rates of fatal occupational injuries. Conclusions: Labor authorities should examine and improve regulations and measures for occupational safety and health protection, particularly for high-risk groups. In addition, the relationship between insured salary and socioeconomic position deserves further research.
• 326 - 336
• 10.6288/TJPH.202006_39(3).109016

• Link 實務 Public Health Practice
• 醫院環境及設備消毒以預防COVID-19感染之探討Environmental disinfection at hospitals as a strategy for COVID-19 spread prevention
• 林增玉、洪靖慈、曾士誠、林俊祐
  Tseng-Yu Lin, Ching-Tzu Hung, Shih-Cheng Tseng, Chun-Yu Lin
• COVID-19（新冠病毒） ； 醫院環境清潔
  COVID-19 (New Crown Virus) ; clean hospital environment
• 目標：醫院公共環境設備或接觸面是最常被忽略預防感染重要點，藉由清潔頻率探討，達到COVID-19疫情期間預防感染及避免感染擴散的目的。方法：本研究採取ATP冷光反應檢測法，來量化醫院公共環境設備或接觸面環境污染的程度，以反應不同實際清潔頻率所達到的效果。結果：實證發現依照常規清潔及加強清潔頻率，如一般預測有不同檢測結果。常規清潔無法符合文獻建議較嚴格小於250RLU的標準。結論：於COVID-19疫情期間之上班時段對一般人頻繁接觸的物體表面清潔消毒頻率應提高至每2小時一次，並定時監測及將結果反應給清潔人員，同時支持嚴格遵守環境和手部衛生的要求，以達到COVID-19感染控制之目標。
  Objectives: Cleanliness of hospitals' public environmental equipment or contact surfaces are frequently overlooked in the prevention of COVID-19. This paper discusses the cleaning frequency, with the purpose of preventing COVID-19 infection and controlling its dissipation during the pandemic. Methods: Using the ATP cold light reaction detection method, we quantified the degree of pollution in hospitals' public environmental equipment or contact surfaces to reflect the effect of actual cleaning frequency. Results: Empirical findings indicated that according to the conventional cleaning and enhanced cleaning frequency, different test results are expected as generally predicted. Routine cleaning cannot meet the standard recommended in the literature (i.e., <250 RLU). Conclusions: During the COVID-19 pandemic, the frequency of cleaning and disinfecting surfaces of objects frequently contacted by general public should be increased to every 2 hours. Moreover, these results should be regularly monitored and reflected to the cleaning staff, so that they can support strict compliance with environmental and hand hygiene to meet infection control goals for COVID-19.
• 337 - 341
• 10.6288/TJPH.202006_39(3).109038

• Link 研究紀要 Research Brief
• 住院病患家屬對病人自主權利法的認知、態度及預立醫療決定的行為意向Knowledge and attitudes regarding the Patient Autonomy Act and behavioral intention regarding signing advance decision among in-patients' family members
• 吳佳穎、陳端容、黃心慈
  Chia-Ying Wu, Duan-Rung Chen, Shin-Tsyr Hung
• 病人自主權利法 ； 住院患者家屬 ； 疾病末期 ； 預立醫療決定行為意向
  Patient Autonomy Act ; in-patients' family members ; terminal illness ; behavioral intention of advance decision
• 目標：探討住院病患家屬對「病人自主權利法」（簡稱病主法）的認知、態度和預立醫療決定的行為意向。方法：以自擬結構式問卷為調查工具，於台北某國立醫學中心內外科病房及加護病房之住院病患家屬為訪問對象，共收案80人。結果：1）不到一半的受訪者（48.8%）知道己實施「病主法」，然而對病主法內容的答對率卻很高（71.88%），顯示多數受訪者肯定病人自決的理念。女性較男性有較高的填對率（35.00% vs. 13.75%, p＜0.001）。多數受訪者對「病主法」與安樂死（協助加工死亡）的差異並不清楚。2）90%以上受訪者願意進行「預立醫療照護諮商」（ACP），但卻只有一半（51.25%）願意簽署「預立醫療決定」（AD）。受訪者自覺生活品質良好會傾向簽定預立醫療決定。3）受訪者面對疾病末期時，治療選擇的考量因素首要為「治療後會不會造成未來家庭經濟負擔」，其次才是「治療後是否依舊行動自主」，第三是「治療後能不能恢復清醒」。4）受訪者對自己或是對父母、配偶在疾病末期情境下（以「重度失智症」為例）所做的治療選擇明顯不同。5）值得注意的是，多數受訪者不認為簽署「病主法」後，醫療人員即不再提供治療照護，也不認為簽署「病主法」就是等死。結論：住院病患家屬雖不完全知道「病主法」，但大多認同「病主法」能尊重「個人治療意願」，顯示多數民眾肯定個人自決的理念。民眾面對自己在疾病末期或是替父母、配偶在疾病末期做決定時，傾向採取不同的決策選擇，政府應強化宣導「預立醫療決定」，以避免疾病末期的決策困境。
  Objectives: To investigate the understanding of and attitude toward the "Patient Right to Autonomy Act" (hereafter, Patient Autonomy Act) among family members of hospitalized patients and their behavioral intention in advance decision (AD). Methods: A structured and specifically tailored questionnaire was used to conduct interviews with 80 family members of patients in the intensive care unit, medical, and surgical wards of a national university hospital in Taipei. Results: (1) Only 49.8% of the interviewees were aware of the Patient Autonomy Act; however, the understanding of its content was very high, with a correct rate of 71.88%. The results indicated that most interviewees were in favor of the concept of patient autonomy. However, most interviewees were also unclear regarding the difference between the Patient Autonomy Act and euthanasia (assisted death). Women had a better grasp of this distinction than did men (correct rate = 35.00% vs. 13.75%). Married individuals demonstrated a better understanding of the Patient Autonomy Act than unmarried individuals did. (2) More than 90% of the interviewees were willing to engage in advance care planning; however, only 51.25% of the interviewees were willing to sign an AD. Interviewees who judged that they had a good quality of health were more inclined to sign an AD. (3) In case of terminal illness, interviewees' medical decisions were primarily concerned with whether the patient recovers consciousness after treatment, whether they were still able to move autonomously, and whether treatment would incur a financial burden. However, interviewees' medical decisions varied depending on whether the decision was to be taken in connection with themselves, their parents, or their spouses. (4) Notably, most of the interviewees did not think that after signing the Patient Autonomy Act, the medical staff would stop providing treatment or care, nor did they think that signing it was equivalent to simply waiting for death. Conclusions: Although family members of hospitalized patients do not fully understand the Patient Autonomy Act, most of them comprehend that the legislation respects "the treatment wishes of individuals." Therefore, a large proportion of the population is in favor of the concept of individual autonomy. When confronted with their own terminal illness, Taiwanese people adopt different medical decisions than when faced with that of a parent or a spouse. This indicates that the government should strengthen awareness of AD, thereby avoiding decision-making quandaries in cases of terminal illness.
• 342 - 349
• 10.6288/TJPH.202006_39(3).109041

• Link 評論 Commentary
• 評論：實踐中的病人自主權利法評論：實踐中的病人自主權利法
• 楊秀儀
  Hsiu-I Yang
• 無
  none
• 無
  none
• 350 - 351
• 10.6288/TJPH.202006_39(3).10904101

• Link 作者回覆 Authors' response to commentary
• 作者回覆：生命末期治療決策代理的性別議題作者回覆：生命末期治療決策代理的性別議題
• 吳佳穎、陳端容、黃心慈
  Chia-Ying Wu, Duan-Rung Chen, Shin-Tsyr Hung
• 無
  none
• 無
  none
• 352 - 352
• 10.6288/TJPH.202006_39(3).10904102