39卷4期

• Link 政策論壇 Policy Forum
• 我國需要發展全方位的「孕產婦心理健康政策」Developing a comprehensive maternal mental health policy
• 張珏、謝佳容
  Chueh Chang, Chia-Jung Hsieh
• 孕產婦、心理健康政策
  maternal mental health policy
• 近年孕產婦心理健康問題已被認為是全球一項重大的公共衛生挑戰,根據世界衛 生組織(WHO)的資料顯示,10%的孕婦和13%的產婦患有精神相關疾病,最常見的是憂鬱症,會導致孕產婦遭受巨大的痛苦和失能,影響母職工作和兒童的成長,甚至嚴重情況下會導致自殺或殺子後自殺的問題。我國孕產婦心理健康更理當融入所有相關方案與政策中,筆者在此建議以渥太華健康促進憲章的基本原則,訂定孕產婦心理健康政策,融入心理健康促進內容於所有相關健康政策、教育政策、勞動政策、文化政策等中。
  In recent years, the maternal mental health has been recognized as a major public health challenge in the world. According to data from the World Health Organization (WHO), 10% of pregnant women and 13% of lying-in women suffer from mental illnesses, the most common being depression, which can cause great pain and disability for pregnant women and affect maternal work and children's health. Growing up, or even in serious cases, can lead to suicide or suicide after homicide. The mental health of pregnant and lying-in women in China should be integrated into all relevant programs and policies. The author hereby suggests that the basic principles of the Ottawa Charter for Health Promotion should be used to formulate mental health policies for pregnant and lying-in women and integrate mental health promotion content into all relevant health policies, education policies, and Labor policy, cultural policy, etc.
• 353-355
• 10.6288/TJPH.202008_39(4).PF04

• Link 公衛論壇 Public Health Forum
• 由不同國家2019冠病毒疾病死亡率差異談死亡率可比性問題Explaining national differences in mortality from COVID-19: issues on comparability
• 呂宗學
  Tsung-Hsueh Lu
• 2019冠病毒、死亡率
  COVID-19, mortality
• 許多國際知名媒體都有專題報導不同國家2019冠病毒疾病死亡率差異,台灣許多新聞媒體也有翻譯部分內容。本文目的是要說明「死亡率」(mortality)這個名詞,在不同疾病專業與情境所使用的單位,分子分母定義與觀察時間不相同, 所以要進行比較前,一定要考量可比性(comparability)問題。本文包括五部分:首先介紹各國政府公告死亡率的分子分母,接著說明不同專業使用死亡率的分母差異,第三釐清率比例比與風險的概念與操作差異,第四解釋2019冠病毒致死率分子分母變動問題,第五考量不同嚴重度組成造成可比性問題,最後結論。
  Many well-known international media have special reports on the differences in the death rate of the COVID-19 in different countries, and many news media in Taiwan also have translated some content. The purpose of this article is to explain the term ``mortality''. In the units used in different professions and situations, the definition of the numerator and the denominator is different from the observation time. Therefore, before comparing, we must consider the issue of comparability. This article includes five parts: first introduce the numerator and denominator of the death rate announced by the governments of various countries, then explain the difference in the denominator of the death rate used by different professions, the third clarify the concept and operational differences of the rate ratio and risk, and the fourth explain the numerator of the death rate of COVID-19 denominator change problem. The fifth consideration is the comparability problem caused by the composition of different severity, and the final conclusion.
• 356-363
• 10.6288/TJPH.202008.39(4).109062

• Link 綜論 Review Article
• COVID-19大流行期間的身體活動建議Recommendations for physical activity during the COVID-19 pandemic
• 古博文、田甜、王湘、陳俐蓉
  Po-Wen Ku, Tian Tian, Hsiang Wong, Li-Jung Chen
• 冠狀病毒、肺炎、健身運動、檢疫、封城
  coronavirus, pneumonia, exercise, quarantine, lock down
• 新型冠狀病毒肺炎(以下簡稱COVID-19)的爆發不只對社會與經濟帶來了嚴重衝擊,同時也大幅影響了每人的生活方式。當COVID-19大流行肆虐全球之際,各國政府採取了系列措施如:外出戴口罩、保持社交距離、居家隔離、居家檢疫、集中檢疫,甚至封城等。這些做法不可避免的限制了身體活動以及產生更多靜態行為。如何在COVID-19大流行期間保持規律活動及健康顯然是一個重要的議題。本文彙整與COVID-19及身體活動有關之研究證據,並針對以下主題進行探討:(一)檢視近年美國、英國與世界衛生組織所發布最新身體活動指引,並針對當前全球身體活動不足的盛行率進行描述分析;(二)依據最新的研究證據,探討COVID-19爆發對身體活動不足與靜態行為的具體衝擊;(三)最後根據文獻探討結果,歸納在COVID-19流行期間如何進行身體活動的建議:(1)少勝於無:從事一些中強度身體活動比都沒有好。每日以步速(介於每分鐘100-130步)至少步行4,000-5,000步,能達到7,000-8,000步更佳,並搭配每周至少2天的中強度主要肌群強化運動。(2)減少久坐:每日靜態久坐不宜超過9小時,並應增加久坐中斷次數(如:每50分鐘站起來動一動),以輕度身體活動取代靜態行為,如走路或伸展5-10分鐘。(3)均衡選擇:儘可能從事多種身體活動如:有氧運動、阻力運動、伸展運動及平衡運動。(4)適性參與:視個人興趣與資源選擇適合的運動方式(如:徒手式運動、器械式運動、電子式運動或家務式勞動)。以上這些建議將有助於在COVID-19大流行期間或未來類似疫情爆發時,引導民眾如何透過身體活動強化身心健康。
  The coronavirus disease (COVID-19) outbreak has not only had severe social and economic effect but also has substantially affected the lifestyles of individuals. As the coronavirus pandemic rips through the world, many countries have implemented series of restrictions to control infection, such as the wearing of masks outside, social distancing, home isolation, home quarantine, group quarantine, and lockdowns, and these measures have inevitably limited physical activity and required more sedentary behavior. How a person can remain physically active and healthy during the COVID-19 pandemic is a crucial issue. The following procedure was implemented to review evidence regarding the COVID-19 outbreak and physical activity. First, the latest physical activity guidelines released by the United States, United Kingdom, and World Health Organization were reviewed, and the prevalence of insufficient physical activity was determined. Second, the effects of the COVID-19 outbreak on physical activity and amount of sedentary behavior were discussed using the obtained evidence. Finally, the current review suggests the following for individuals wishing to remain physically active and healthy: (1) Some physical activity is preferable to nothing. Engaging in some moderate-intensity physical activity, such as at least 4,000–5,000 steps per day (7,000–8,000 is better) at a pace of 100–130 steps per minute and resistance training twice a week to improve major muscle-group strength, is essential for everyone. (2) Daily sedentary time should be kept to less than 9 hours a day, and numerous breaks (e.g., every 50 minutes) in which sedentary time is replaced with light activity (e.g., 5- to 10-minute walking or stretch exercise) should be taken. (3) Ideally, people should engage in different types of physical activity, including aerobic exercise, resistance training, stretching, and balance training. (4) Finally, people should select types of exercise (e.g., freehand exercise, equipment-assisted exercise, electronic exercise, or household work) that fit their interests and resources. These suggestions provide guidance for strengthening individuals’ mental and physical well-being through physical activity in response to the COVID-19 pandemic or future similar outbreaks.
• 364-372
• 10.6288/TJPH.202008_39(4).109057

• Link 綜論 Review Article
• 高齡者財務濫用與專業人士的旁觀者介入模式：以失智症為中心的回顧Elder financial abuse and the professional bystander intervention model: a review centered on dementia
• 黃于玲、廖翊涵、古鯉榕
  Yu-Ling Huang, Yi-Han Liao, LI-Jung Elizabeth Ku
• 失智、高齡、財務濫用、金融機構
  dementia, elder, financial abuse, financial institutions
• 過往的高齡照護研究專注於長者身心狀態的維持,忽略了身心狀態與其財務安全的關聯。近年來不少研究團隊開始關注高齡者失智如何增加財務濫用的風險、財務濫用的型態以及降低此類風險的措施。本文針對此一主題進行重點式文獻回顧與評論,首先整理高齡者財務濫用的定義與類型,特別關注高齡失智者,並介紹「專業人士的旁觀者介入模式」與其降低財務濫用風險的效果。本文在第二部分整理並分析國內近十年與失智者財務濫用相關的新聞,資料來源 包含《中國時報》、《聯合報》、《自由時報》、《蘋果日報》四家報紙,分析的內容包含財務濫用類型、濫用者身分、財物損失的內容以及金融專業人員的角色。本文依照濫用者身分將新聞分為三類:家人侵占、外人詐欺、本人濫用,發現在後兩者情境中,銀行行員常扮演旁觀者介入的角色,防止財務濫用事件發生。後續研究方向建議:調查行員對於失智者財務濫用的辨識敏感度並強化其介入能力,與發展在地化的失智友善銀行培訓課程。
  Research on senior care has focused on both physical and mental health care, but the relationship between elders’ financial security and health has been overlooked. Recent studies have investigated how dementia increases the risk of elder financial abuse—focusing specifically on types of and measures against elder financial abuse. In the first part of this paper, we define and contextualize elder financial abuse, with specific respect to elders with dementia. We then introduce the professional bystander intervention model and discuss its potential to reduce the risk of financial abuse of elders with dementia. In the second part, we analyze news articles related to financial abuse of elders with dementia in Taiwan from 2009 to 2018. News articles published in four major newspapers (China Times, United Daily News, Liberty Times, and Apple Daily) are included. We analyze the types of financial abuse, identities of the abusers, types of property lost, and roles of bank staff. We categorize elders with dementia’s financial abuse into three ones based on the identity of the abuser: “family embezzlement,”“third-party fraud,” and “self-misuse.” In the cases of third-party fraud and self-misuse, bank staff were more likely to act as bystanders to prevent financial abuse. We propose two future research directions: first, to survey the bank staff’s awareness toward the financial abuse of people with dementia, and second, to develop training courses for banks to assist them become more dementia friendly.
• 373-385
• 10.6288/TJPH.202008_39(4).109050

• Link 綜論 Review Article
• 活躍老化之概念分析—以高齡者之賦權為主體A concept analysis of active aging: the subject of empowerment for the elderly
• 黎沛姍、謝佳容
  Pei-Shan Li, Chia-Jung Hsieh
• 高齡者、活躍老化、概念分析、賦權、實證
  elderly, active aging, concept analysis, empowerment, evidence
• 活躍老化為世界各國共同探索和追尋之目標與挑戰,有效建構高齡者的活躍老化已經是社會文化之歷程,並為高齡政策制定的重要基礎,所有以高齡者為核心,擴大至改善高齡者、家庭、社區和社會的活動都是活躍老化之元素。然而,活躍老化之概念不僅持續在發展,同時也具有多元特性,以多方面的視角詮釋活躍老化的概念,包含維持高齡者正常的日常生活活動功能及增加健康保障,以達到預期健康壽命的延續,並在此過程中達成獨立自主的態度發展生命歷程。因此,本文目的為運用Walker和Avant(2005)發展的概念分析步驟,針對活躍老化的概念發展與定義進行闡述,同時確認高齡者活躍老化之定義特徵包含健康壽命延續、賦權參與社會活動、工作意識及經濟安定、自立且安全的生活品質與擁有自信獲得尊重共五項,並列舉各項案例說明,最終提出國家層級概念活躍老化指標和個人層級活躍老化評估量表之實證測量工具的應用。期望借由多方面的視角來理解與詮釋活躍老化的概念,將有助於健康照護團隊人員能了解並應用此概念於高齡者的健康服務實務中,進而以高齡者之賦權為主體,達到貫徹「活躍老化」的整體目標之實踐作為。
  Active aging has been a challenging goal that is being explored and pursued by countries all over the world. Effectively establishing active aging for the elderly is a social and cultural process that requires policy framework and planning. The elderly are at the core of the active aging strategy, although families, communities, and society are also essential components in its utilization. However, the adoption and practice of active aging have continuously developed in different ways and with different characteristics all over the world. Some of the traditional aspects in the active aging policy framework are daily activities for the elderly, health protection, and life expectancy. However, the modern senior population has ability to take active part in social and political processes, so the rights to independent development must also be considered. Therefore,this study used the analysis steps of Walker and Avant (2005) to describe the definitional features of an intermediate period, case report, the results and their causes, and measurement tools for active aging. The definitional features of active aging including healthy life extension,empowerment to participate in social activities, work consciousness and economic stability, self-confidence and safe quality of life, and have self-confidence and respect. Finally, the directions of the evidence-basic measurement tools of the national level active aging index and the individual level active aging assessment scale. A multidimensional perspective was used to explain the concept of active aging. The results could help health care team members to understand and apply the concept in health care practice for the elderly, and empowerment of the elderly could help to achieve the overall goal of “active aging.”
• 386-396
• 10.6288/TJPH.202008_39(4).109037

• Link 原著 Original Article
• 嚴重急性呼吸道症候群（SARS）及新冠肺炎（COVID-19）投入資源比較暨推估疫情下可能投入之資源—以某醫學中心與區域醫院為例Comparison of resources investment for SARS and COVID-19 and the probable investment in epidemic resources - the case of a medical center& regional hospital
• 林育瑄、戴天亮、羅銀秀、陳惠貞、鍾靜江、邱淑芳
  Yu-Xuan Lin, Tien-Liang Tai, Yin-Hsiu Lo, Hui-Chen Chen, Ching-Chiang Chung, Shu-Fang Chiu
• SARS、COVID-19、投入資源、超前部屬、推估疫情
  SARS, COVID-19, investment of resources, advance deployment, epidemic prediction
• 目標:本研究旨在比較SARS及COVID-19兩疫情資源投入、醫學中心與區域醫院在SARS期間資源投入差異比較分析,及在疫情不同發展階段,推估醫院可能之資源投入(含支出及成本)。方法:採回溯性資料統計,進行不同疫情及不同層級醫院比較及投入資源推估。結果:某醫學中心SARS期間總資源投入為7,034萬元,以設置負壓隔離病房及發燒篩檢站為主要投入資源(約佔總投資50%),而COVID-19期間以防疫物資、醫護人員特別津貼投入較多。而醫學中心與區域醫院投入防疫資源與醫院規模相關性高。另某醫學中心推估新冠肺炎(COVID-19)如發展到最嚴重時期,紫色2階時不含成本分攤會投入約4,304萬元支出,約SARS期間支出61%,如含成本分攤,約投入5,334萬元,約為SARS期間之76%。SARS時期因無類似經驗,突發疫情讓醫院措手不及、且無負壓隔離病房等設施,須大量投入此項資源以收治確診病患,而COVID-19疫情雖嚴峻,因已設置負壓隔離病房等設施,且政府與某醫學中心均採超前部署,至目前為止疫情尚在掌控當中。結論:疫情具有不可預測性,疫情何時結束無法預測,對醫院防疫資源投入的預估有侷限。疫情在某階段時間長短、疫情嚴重度、政府的防疫政策及醫院防疫措施效果均會影響資源投入的金額。而在防疫期間醫院收入減少,如無政府經費挹注,會造成醫院資金周轉問題,政府應作為醫院防疫後盾,適時予以醫院財務支持,以共度難關。
  Objectives: This study aims to compare the resources invested during the SARS and COVID-19 epidemics, analyze and compare resources invested by a medical center and a regional hospital during SARS, and estimate the possible investment of resources (including expenses and costs) by the hospitals in different stages of epidemic development. Methods: Compare the different epidemics and hospitals at different levels based on retrospective data, and estimate the investment of resources. Results: A medical center invested NT$ 70.34 million worth of resources during SARS, mainly for setting up negative-pressure isolation rooms and a fever clinic (accounting for about 50% of the total investment), whereas the investment during COVID-19 is mainly on anti-epidemic supplies and special allowances for healthcare workers. There is a high level of correlation between investment in anti-epidemic resources by a medical center/regional hospital and the scale of a hospital. Moreover, a medical center estimates that when COVID-19 develops to the most severe stage, the investment will be around NT$ 43.04 million (excluding cost allocation), that is about 61% of the expenditure during SARS, and around NT$ 53.34 million (including cost allocation), about 76% of the SARS expenditure, at Purple Level 2 status. At the time of SARS, with no similar experience before, hospitals were caught unprepared upon the sudden outbreak, with no negative-pressure isolation facilities. Immense investment had to be made in this resource to accommodate confirmed cases. Although the COVID-19 epidemic is severe, with the negative-pressure isolation facilities already established and the advance deployment already adopted by both the government and the medical center, the epidemic has been kept in control to date. Conclusions: Due to the unpredictability of the epidemic, the time when the epidemic will end is unpredictable, and this will constrain the hospitals’ ability to estimate the investment in anti-epidemic resources. The length of a certain stage of epidemic, the severity of the epidemic, the government’s anti-epidemic policy, and the result of the hospitals’ implementation of anti-epidemic measures all affect the amount of investment in resources. When combating the epidemic, hospitals will have reduced income, and hospitals may face cash flow problem if no government funding is provided. To give back up for the hospitals’ anti-epidemic efforts, the government should provide timely financial support for the hospitals to help them overcome the challenge.
• 397-410
• 10.6288/TJPH.202008_39(4).109069

• Link 評論 Commentary
• 評論：嚴重急性呼吸道症候群（SARS）及新冠肺炎（COVID-19）投入資源比較暨推估疫情下可能投入之資源—以某醫學中心與區域醫院為例Commentary: comparison of resources investment for SARS and COVID-19 and the probable investment in epidemic resources - the case of a medical center& regional hospital
• 邱政元
  Jeng-Yuan Chiou
• 無
  none
• 無
  none
• 411
• 10.6288/TJPH.202008_39(4).10906901

• Link 原著 Original Article
• 12週漸增式肌力訓練對老年人不同體能表現之成效Effect of a 12-week incremental muscle strength training regimen on different physical performance in elderly people
• 胡巧欣、吳一德
  Chiao-Hsin Hu, I-Te Wu
• 老年人、肌力、運動訓練、社區環境
  elderly, muscle strength, exercise training, community environment
• 目標:12週漸增式肌力訓練對老年人不同體能表現之成效。方法:招募65歲以上無規律運動習慣60位老年人,依上、下肢肌力(muscle strength)與走路速度檢測結果,分成體能良好組18位、體能普通組16位、體能衰弱組(physical weakness)11位和控制組15位等4組。運動訓練組三組老年人均參與每週兩次、每次約90鐘運動訓練共12週;控制組則正常作息。分別於運動介入前、後評估上、下肢肌力(muscle strength)、單腳站(one leg stance)、10公尺走路速度(10-meter walk speed),與簡易身體功能量表(short physical performance battery, SPPB)。結果:共56位受試者完成本研究,除慢性病罹患率,各組基本資料並無統計差異。經12週漸增式肌力訓練介入後,體能良好組及體能普通組在上、下肢肌力、單腳站立、10m走路速度四項表現達顯著成效;體能衰弱組則在上、下肢肌力、10公尺走路速度三項表現達顯著成效。進一步分析發現在上肢肌力之改變量體能良好及體能普通組顯著高於對照組;在下肢肌力與單腳站立之改變量體能良好及體能普通組顯著高於體能衰弱組及對照組;其餘10公尺走路速度及簡易體能活動組間皆未達顯著差異(p>.05)。結論:12週漸增式肌力訓練對不同體能程度的老年人在各項體能表現皆有促進效果,可提供國內各社區關懷據點,應用於不同體能程度的老年人介入及效益評估之參考。
  Objectives: The effect of 12 weeks of muscle strength training on the physical performance of elderly people was investigated. Methods: This study recruited 60 people older than 65 years and without a regular exercise habit. On the basis of their upper and lower limb muscle strength and walking speed, they were divided into a control group (15 participants) and three training groups, namely high physical fitness (18 participants), general fitness (16 participants), and physical weakness (11 participants) groups. The training groups trained twice weekly for 90 min for 12 weeks, whereas the control group kept their normal routine. Upper and lower limb muscle strength, one-leg stance, 10-m walking speed, and short physical performance battery (SPPB) score were assessed before and after the exercise intervention. Results: A total of 56 subjects completed this research. Except for the prevalence of chronic diseases, no significant differences were discovered in the basic data of the groups. After 12 weeks of incremental muscle training, the high physical fitness and general fitness groups achieved significant improvements in upper and lower limb muscle strength, one-leg stance, and 10-m walking speed. By contrast, the poor physical fitness group significantly improved their upper and lower limb muscle strength and 10-m walking speed. Upon further analysis, we discovered that the improvements in upper limb muscle strength in the high physical fitness and general fitness groups were significantly greater than those in the control group. Moreover, the improvements in lower limb muscle strength and one-leg stance in the high physical fitness and general fitness groups were significantly greater than those in the poor physical weakness and control groups. No clear differences in 10-m walking speed and SPPB score were found (p > .05). Conclusions: The 12-week incremental muscle training benefitted the elderly participants with different physical fitness levels in every aspect of physical performance. This research can be provided as a reference to every community care center in Taiwan to demonstrate an effective exercise intervention and the benefits for elderly people with varying levels of physical fitness.
• 412-426
• 10.6288/TJPH.202008_39(4).109036

• Link 原著 Original Article
• 醫學中心高齡門診病患其睡眠品質及各項構面之性別差異研究Sex differences in sleep quality and various dimensions among elderly outpatients at a medical hospital
• 許惠玲、陳伊伶、蕭思美、周雨青、楊燦
  Hui-Lin Hsu, Yi-Ling Chen, Szu-Mei Hsiao, Yu-Ching Chou, Tsan Yang
• 老年人、睡眠品質、性別差異、呼吸障礙
  older adults, sleep quality, sex differences, sleep-disordered breathing
• 目標:本研究以醫學中心門診老年人為研究對象,探討及分析影響老年人睡眠品質及各項構面之性別差異及修飾作用。方法:本研究採橫斷式研究設計。於台灣南部某醫學中心之高齡醫學科、神經內科與精神科之門診個案,進行人口學特質、生活型態、代謝症候群臨床檢驗值、匹茲堡睡眠品質問卷、愛普沃斯嗜睡量表、老年憂鬱量表、睡眠呼吸障礙與日常生活活動功能等量表進行資料收集。結果:結果顯示女性有較多睡眠品質不佳的問題。而女性無規律運動、BMI≧27、憂鬱評估異常、有代謝性症候群及睡眠呼吸障礙中/高風險者有較差的睡眠品質;男性中憂鬱評估異常及睡眠呼吸障礙中/高風險者有較差的睡眠品質。以睡眠品質的各構面分析中發現,女性在主觀性睡眠品質、睡眠潛伏期時間、睡眠效率、服用藥物幫助入睡及日間功能上都較男性差。以邏輯斯迴歸分析睡眠品質各項構面之性別修飾作用,結果顯示男性女性老年憂鬱評估異常者在主觀式睡眠品質、服用安眠藥物與日間功能失調構面上較憂鬱評估正常者有較高風險。男女性在睡眠呼吸障礙中/高風險者的睡眠困擾與日間功能障礙構面上較低風險者有較高風險,女性更多了睡眠潛伏期及睡眠總時間兩構面。結論:男性當中有較多睡眠困擾的問題及睡眠潛伏期較長,女性為睡眠潛伏期較長及使用睡眠藥物,男女皆有較多的主觀睡眠品質不佳。憂鬱評估異常為男性及女性的主觀睡眠品質、使用睡眠相關藥物及日間功能障礙之影響因素;睡眠呼吸障礙為男性睡眠困擾及日間功能及女性睡眠潛伏期長、睡眠時間短、睡眠困擾及日間功能的影響因素。
  Objectives: This study takes the elderly outpatients of a medical hospital as subjects, analyzes the effects of various dimensions on their sleep quality, and examines how such effects differ by sex and modification. Methods: By employing a cross-sectional design, this study collected data by obtaining clinical measurements related to metabolic syndrome in patients attending outpatient geriatrics, neurology, and psychiatry departments at a medical center in Southern Taiwan. Data were collected using a questionnaire containing a demographic scale, a lifestyle scale, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Geriatric Depression Scale, a sleep-disordered breathing scale, and an activities of daily living functional assessment scale. Results: Women had more problems with low sleep quality. Women with irregular exercise, BMI ≥ 27 kg/m2, an abnormal depression evaluation, metabolic syndrome, and moderate-to-high risk of sleep-disordered breathing had low sleep quality, as were men with an abnormal depression assessment and moderate-to-high risk of sleep-disordered breathing. In the analysis of all dimensions of sleep quality, women had significantly poorer scores than did men in subjective sleep quality, sleep latency, habitual sleep efficiency, sleeping medication use, and daytime dysfunction. In a logistic regression analysis on sex modification in various aspects of sleep quality, men and women with abnormal geriatric depression results had higher risks of poor subjective sleep quality, sleeping medication use, and daytime dysfunction than did those with normal depression results. Men and women with moderate-to-high risks of sleep-disordered breathing and daytime dysfunction, respectively, had higher risks of sleep disturbance than did their counterparts with low risks. Conclusions: The most common sleep problems in men were sleep disturbance and longer sleep latency, whereas those in women were longer sleep latency and sleeping medication use. Both men and women frequently experienced low subjective sleep quality. Abnormal depression assessment was the major factor influencing the subjective sleep quality of men and women, as indicated by their use of sleeping medication and daytime dysfunction. Sleep-disordered breathing among men and long sleep latency and short sleep time among women were the major factors affecting sleep distress and daytime functioning.
• 427-440
• 10.6288/TJPH.202008_39(4).109011

• Link 原著 Original Article
• 刨路作業人員結晶型游離二氧化矽暴露特性調查The investigation on exposure characteristics of crystalline free silica of pavement milling operator
• 楊心豪、陳昆皇、黃小林、洪粕宸、黃筱茜、徐櫻芳、莊啓佑
  Shin-Hao Yang, Kun-Huang Chen, Hsiao-Lin Huang, Po-Chen Hung, Hsiao-Chien Huang, Ying-Fang Hsu, Chi-Yu Chuang
• 刨路、作業環境、總粉塵、可呼吸性粉塵、可呼吸性結晶游離二氧化矽
  pavement milling, operating environment, total dust, respirable dust, crystalline free silica
• 目標:刨路作業中作業人員會暴露於高粉塵與結晶型游離二氧化矽的環境中,本研究主要針對刨路作業環境中總粉塵、可呼吸性粉塵以及可呼吸性粉塵結晶型游離二氧化矽進行採樣分析,以瞭解刨路作業作業人員中粉塵與可呼吸性結晶型游離二氧化矽之暴露情形。方法:選取10條平面道路作為銑刨作業之採樣標的,採樣分為區域採樣與個人採樣,個人採樣是由作業人員配戴個人採樣器,並依行政院勞動部公告之採樣分析建議方法進行採樣,總粉塵與可呼吸性粉塵為建議方法CLA4002與CLA4001,可呼吸性結晶游離二氧化矽則以CLA4003進行之;區域採樣則是利用腳架配載採樣器,並以相同建議方法於刨路前一日作業進行背景濃度採樣。結果:在10條刨路作業道路中,刨刀確認員、駕駛員、人孔確認員總粉塵平均濃度為2.77±1.71mg/m3、3.74±2.54 mg/m3、0.76±0.59 mg/m3;可呼吸性粉塵平均濃度為1.20±0.80 mg/m3、1.60±0.93 mg/m3、0.33±0.25 mg/m3;刨刀確認員與駕駛員之可呼吸性結晶型游離二氧化矽平均濃度為0.53±0.29 mg/m3與0.73±0.44 mg/m3,人孔確認員由於暴露時間較短,僅一條道路檢出0.10 mg/m3外,其餘均為未檢出。在檢出之結果中,三種粉塵中個人暴露均顯著高於背景值。以我國之第一種粉塵容許標準來看,刨刀確認員與駕駛員超過容許值之比例為75%及90%;另以美國NIOSH針對可呼吸性結晶游離二氧化矽暴露濃度建議值0.05 mg/m3為基準,本研究調查之刨刀確認員與駕駛員暴露濃度超過建議值之比例為89%及100%。結論:刨路作業產生高量之可呼吸性結晶游離二氧化矽,使得作業人員確實暴露危害中,因此實應加強作業人員個人防護以及開發粉塵防護裝置等職業衛生措施,方能保障作業人員健康。
  Objectives: Pavement milling process produces high concentrations of dust and free crystalline silica during. This study aimed to explore the exposure of total dust, respirable dust and respirable free crystalline silica for workers during the pavement milling operation. Methods: Ten roads were selected as the sampling sites. Both milling-site samples and personal samples were collected and analyzed according to methods CLA4002, CLA4001, and CLA 4003 recommended by the Ministry of Labor, the Executive Yuan. Results: During the pavement milling process on the 10 roads, the average total dust concentrations in samples collected by cutter confirmers, drivers, and manhole confirmers were 2.77±1.71 mg/m3, 3.74±2.54 mg/m3, and 0.76±0.59 mg/m3, respectively. The corresponding average exposed respirable dust concentrations were 1.20±0.80 mg/m3, 1.60±0.93 mg/m3, and 0.33±0.25 mg/m3, respectively. The respirable crystalline free silica exposure concentrations of cutter confirmers and drivers were 0.53±0.29 mg/m3 and 0.73±0.44 mg/m3, respectively. Due to the short exposure time, only one sample of respirable free crystalline silica was collected for the manhole confirmer, with a concentration of 0.10 mg/m3. The results also showed that these three kinds of dust concentrations of personal exposure were significantly higher than the background concentrations. The cutter confirmer and the driver with exposure of respiratory dust exceeding the Taiwan’s permissible exposure limit accounted for 75% and 90%, respectively, or exceeding the US NIOSH recommended value of 0.05 mg/m3 accounted for 89% and 100%, respectively. Conclusions: Workers are exposed to the hazardous respirable free crystalline silica during the process of milling roads. Personal protective equipment and dust protection devices should be strengthened to ensure the health of workers.
• 441-452
• 10.6288/TJPH.202008_39(4).109032

• Link 原著 Original Article
• Prevalence and related factors of musculoskeletal disorders among dentists in Taiwan: a cross-sectional study using the National Health Insurance Research Database台灣牙醫師肌肉骨骼疾病的盛行率與相關因素：以全民健保資料庫進行橫斷性研究
• 李淑芬、洪錦墩、吳啟明、李美文
  Shu-Fen Li, Chin-Tun Hung, Chi-Ming Wu, Mei-Wen Lee
• dentist, musculoskeletal disorders, risk factors, comorbidity
  牙醫師、肌肉骨骼疾病、危險因素、共病症
• Objectives: Musculoskeletal disorders (MSDs) are common occupational diseases that consume medical resources and reduce productivity and work quality. When treating patients, dentists often must maintain a fixed posture. Thus, dentists have a higher chance of MSDs. This study examined the prevalence and frequency distribution of MSDs among dentists and the related factors for MSDs. Methods: A cross-sectional study design was used, and 8,303 dentists with 12 consecutive months of practice in 2011 from the Taiwan National Health Insurance Research Database were selected as study subjects. The study variables included sex, age, mean number of consultations per month per dentist, level of medical institution, and comorbidity. The logistic regression model was used to analyze related factors for MSDs in dentists. Results: In 2011, the prevalence of MSDs in dentists was 15.8% (Overall, 84.2% of the dentists had no record of visiting a doctor; in addition, 2.1%, 0.6%, 0.2%, and 12.9% of the dentists had visited a doctor once, twice, three times , and four times or more frequently, respectively). Male dentists had a marginally significant lower risk of MSDs than did female dentists (odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.74–1.01). Compared with dentists in the age group of 26–35 years, dentists in the age groups of 36–45, 46–55, and 56–65 years had a higher risk of MSDs (OR: 1.28; 95% CI: 1.07–1.54; OR: 1.70; 95% CI: 1.43–2.02; OR: 1.69; 95% CI: 1.38–2.06, respectively).Compared with dentists without comorbidities, dentists with insomnia, depression, or anxiety had a higher risk of MSDs (OR: 1.44; 95% CI: 1.09–1.90; OR: 1.67; 95% CI: 1.10–2.53; OR: 1.70; 95% CI: 1.25–2.31). Conclusions: In total, 15.8% of the dentists had MSDs. For dentists with MSDs with records of visiting a doctor, those who visited once accounted for 13%, and those with over two visits accounted for 87%. MSDs of the back accounted for most MSD cases. Female sex; older age; and comorbidities of insomnia, depression, and anxiety were factors associated with MSDs in dentists.
  目標:肌肉骨骼疾病是工作場所中常見的職業病,罹病者除耗用醫療資源外,也會影響生產力與工作品質。牙醫師在治療病患時經常需長時間維持固定姿勢,使其有較高機會發生肌肉骨骼疾病。本研究目的主要是調查牙醫師肌肉骨骼疾病的盛行率、次數分布與肌肉骨骼疾病的相關因素。方法:使用橫斷式研究設計,從台灣全民健保研究資料庫中擷取2011年連續執業12個月之牙醫師共8,303位作為研究對象。研究變項包括性別、年齡、每月平均門診次數、執業醫院層級、共病症等。使用邏輯式迴歸模型分析牙醫師肌肉骨骼疾病之相關因素。結果:2011年台灣牙醫師肌肉骨骼疾病盛行率是15.8%(無就醫記錄者佔84.2%,1次佔2.1%、2次佔0.6%、3次佔0.2%、4次以上佔12.9%)。男性牙醫師罹患肌肉骨骼疾病的風險邊際顯著低於女牙醫師(odds ratio [OR]:0.86; 95% confidence interval [CI]:0.74–1.01);相較於26–35歲之牙醫師,牙醫師36–45歲、46–55歲56–65歲有較高的肌肉骨骼疾病的風險(OR: 1.28; 95% CI: 1.07–1.54;OR: 1.70; 95% CI: 1.43–2.02; OR:1.69; 95% CI:1.38–2.06);相較於無共病者,共病失眠、憂鬱、焦慮症的牙醫師有較高的肌肉骨骼疾病風險(OR: 1.44; 95% CI: 1.09–1.90, OR: 1.67; 95% CI:1.10–2.53, OR: 1.70; 95% CI: 1.25–2.31)。結論:牙醫師實際上有肌肉骨骼疾病醫療利用的盛行率是15.8%。有肌肉骨骼疾病就診記錄的牙醫師,就醫次數僅為單次者只佔13%,2次以上者佔了87%。背部是最容易發生肌肉骨骼疾病的部位。女性、年齡增加與共病失眠、憂鬱或焦慮皆是牙醫師罹患肌肉骨骼疾病的相關因素。
• 453-463
• 10.6288/TJPH.202008_39(4).109018