39卷5期

• Link 政策論壇 Policy Forum
• 要提升生育先落實適齡結婚To boost birth, marriage first
• 薛承泰
  Cherng-Tay Hsueh
• 生育、結婚
  fertility, marriage
• 今年的結婚對數1至8月共 77,252對，和去年同期相比，少了7,188對，和2016年同期相比，少了13,738對，四年間減幅達15%。今年結婚對數持續下滑，意味著明年生育狀況可能比今年更差，而後年（2022）是虎年，情況難變好！簡言之，未來三年很可能會連續創生育的新低。 所謂的適齡結婚， 廣義指的應該是20-34歲，由於國人普遍接受高等教育，25 歲之前結婚機會不大，若能在25-29歲結婚，35歲（女性）之前生育的機會就會較高。然而，在人口高齡化少子化趨勢下，帶來社會經濟廣泛的衝擊，年輕人的負擔很可能攀升；如果年輕人薪資偏低（相對於房價），失業風險高，經濟基礎脆弱又如何能來落實「適齡結婚」呢?這是一個現實問題。換言之，結婚除了要有意願，還要有經濟能力來維持一個家庭，至於要改變年輕人的觀念，則更需要調整社會的價值觀。
  The number of married couples was 77,252 from January to August, which was 7,188 less than the same period last year, and 13,738 less than the same period in 2016, representing a decrease of 15% in four years. The continued decline in the number of marriage pairs this year means that the fertility status next year may be worse than this year, and 2022 is the year of the tiger, and the situation will hardly get better! In short, the next three years are likely to continue to hit new lows in fertility. The so-called age-appropriate marriage should broadly refer to the age of 20-34. As people generally receive higher education, there is little chance of getting married before 25. If they can get married at the age of 25-29, the chance of giving birth before the age of 35 (female) will be Higher. However, under the trend of aging population and declining birthrate, it brings about a wide range of socio-economic impacts, and the burden on young people is likely to rise. If young people’s salary is low (relative to housing prices), the risk of unemployment is high, and the economic foundation is weak, how can "age-appropriate marriage" be implemented? This is a practical problem. To sum up, in addition to the willingness to get married, the financial ability is necessary to maintain a family. As for changing the mindset of young people, it is even more essential to adjust social values.
• 465-468
• 10.6288/TJPH.202010_39(5).PF05

• Link 公衛今與昔 Public Health Now and Then
• 原死因選擇準則改變對死因別死亡率趨勢分析的影響Effects of changes in underlying cause of death selection rules on the analysis of cause-specific mortality trends
• 呂宗學
  Tsung-Hsueh Lu.
• 國際疾病分類、自動化編碼、原死因選擇準則、死因別死亡率
  International Statistical Classification of Diseases and Health Related Problem (ICD), automated coding, selection rules, cause-specific mortality
• 為了反映醫學與公共衛生知識與觀念的更新，國際疾病分類（International Statistical Classification of Diseases and Health Related Problem, ICD）會定期改版。本文回顧第二次世界大戰以後世界衛生組織成立，開始強力要求會員國遵守ICD-6的選擇準則來選則原死因，所造成美國腎炎腎病與糖尿病死亡率影響。接著看到英國1980年代針對選擇準則的修改，造成對肺炎與一些神經退化性疾病死亡率的影響。到了2000年代許多先進國家開始採用自動化編碼系統的經驗，台灣也跟上這個進步潮流在 2008年開始採用。最後再以六個死因為例，說明如何使用可比較性比值進行調整，可以更清楚看到選擇準則變動的影響。本文對於死因統計產出過程的關鍵步驟進行相當詳細的介紹，相信會有助於對死因別死亡率趨勢做出更適當的解釋。
  To reflect the updating of medical and public health knowledge and concepts, the International Statistical Classification of Diseases and Health Related Problem (ICD) will be revised regularly. This article reviews the establishment of the World Health Organization after World War II, and it began to force member states to abide by the ICD-6 selection criteria to select the original cause of death, which has caused the mortality of nephritis and diabetes in the United States. Then I saw the revision of the selection rules in the UK in the 1980s, which impacted the mortality of pneumonia and some neurodegenerative diseases. By the 2000s, many advanced countries began to adopt the experience of automated coding systems, and Taiwan also kept up with this trend of advancement and adopted it in 2008. At the Final of this article, six examples of death causes were used to illustrate how to use the comparability ratio to adjust selection rules. You can more clearly see the impact of changes in the selection criteria. This article gives a reasonably detailed introduction to the critical steps of the death cause statistical output process, which is believed to help make a more appropriate explanation of the trend of death rate by cause.
• 469-477
• 10.6288/TJPH.202010_39(5).109040

• Link 綜論 Review Article
• 青少年每日靜態行為的時間分布、測量與類型：範域文獻回顧Prevalence, measures, and types of daily sedentary behavior among adolescents: a scoping review
• 陳上迪、陳俐蓉、王宗進、古博文
  Shang-Ti Chen, Li-Jung Chen, Tsung-Chinn Wang, Po-Wen Ku
• 久坐、螢幕行為、加速規、每日時間
  prolonged sitting, screen-based behavior, accelerometers, daily time
• 本研究旨在以範域文獻回顧探討國際間青少年每日靜態時間的分布、測量方法，以及分析常見的青少年靜態行為類型。本研究以Bauman等人(2008)研究靜態行為盛行率搜尋檢索方式與搜尋後結果，並延續其檢索策略搜尋PubMed與華藝線上圖書館在2012-2020年期間的期刊論文，篩選納入43篇。研究發現如下：(一)青少年每日客觀測量靜態時間平均為8.83小時/日（中位數為9.05 小時/日），不同研究間的異質性高；(二)靜態行為測量包含自陳式問卷測量及客觀儀器測量，二者各有其優缺點並具功能互補性；(三)青少年靜態行為類型相當多元，可歸納出兩種類型：螢幕使用(包含：看電視／影片、使用電腦/瀏覽網頁、打電動/遊戲、使用手機/傳訊息/聊天)與非螢幕使用(包含：完成學校課業、從事休閒、騎乘交通工具、閱讀)。尤其是看電視／影片、使用電腦 /上網、玩電動/遊戲等螢幕式靜態行為，以及完成學校課業等非螢幕式行為等，不僅是最常被納入問卷測量題項中，也是花費靜態時間最高的幾種行為。本研究發現可供未來政府及學術機構研發適合測量台灣青少年靜態行為的工具以及進行青少年族群靜態行為調查、監測與分析之參考。建議未來針對青少年靜態行為的研究應採用具人口代表性的大型樣本，採取多次測量的前瞻性世代研究設計，並兼採自陳式問卷及客觀儀器測量，以進一步了解青少年靜態時間與其各種健康狀態的關係。
  This scoping review (a) explored the prevalence of sedentary time among adolescents worldwide, (b) discussed issues of assessment regarding sedentary time, and (c) analyzed different modes of adolescent sedentary behavior. We used the search strategies and results of Bauman et al. (2018), who reviewed the prevalence of sedentary time. We extended their results and searched two databases (PubMed and Airiti Library) to identify published studies. Forty-three studies were eligible for the scoping review and were analyzed. The average of sedentary time using objective measures was 8.83 h/day per adolescent (median: 9.05 h/day). High interstudy heterogeneity was observed. The studies assessed sedentary time by using objective and subjective measures, which had advantages and disadvantages and were sometimes complementary to each other. Furthermore, adolescents engaged in diverse types of sedentary behavior. In general, two types of sedentary behavior were observed: screen-based behavior (i.e., watching TV/videos, using the computer/ surfing websites, playing video games, and using cell phones/sending text messages/chatting) and nonscreen-based behavior (i.e., doing homework, engaging in recreational activities, traveling, and reading). Among them, the screen-based behaviors of watching TV/videos, using the computer/ surfing websites, and playing video games and the nonscreen-based behavior of doing homework were the most common sedentary behaviors for adolescents. Our findings provide evidence for developing an indigenizing scale for future researchers to investigate, monitor, and analyze the prevalence of sedentary time among adolescents. To elucidate the associations between adolescent sedentary behavior and various health outcomes, future large-scale prospective studies are warranted that include multiple waves of representative samples and employ a combination of objective and subjective measures of sedentary behavior.
• 493-508
• 10.6288/TJPH.202010_39(5).109080

• Link 原著 Original Article
• 大學生蔬果攝取行為及其影響因素之探討—以新竹縣某科技大學為例Fruit and vegetable consumption behavior and its influencing factors among college students: a survey at a University of Technology in Hsinchu County
• 趙丹平、蘇聖珠
  Dan-Ping Chao, Sheng-Chu Su
• 大學生、天天5蔬果、健康自覺、蔬果攝取、健康行為
  college student, five a day, perceived health, fruit and vegetable intake, health behavior
• 目標：蔬果為健康飲食中重要的一環，而大學為行為發展定型的關鍵時刻，大學生之健康自覺可能影響其健康促進行為。故本研究期望了解大學生的蔬果攝取及自覺健康現況，進而探討可預測蔬果攝取行為之影響因素。方法：本研究以新竹縣某科技大學日間部大學生為研究對象，採分層隨機抽樣和自填問卷蒐集資料，共發出403份問卷，回收有效問卷375份，有效回收率93.1%。結果：本研究發現研究對象每日蔬菜和水果達建議量者分別僅有1.6%和8%，每週蔬果達建議量超過三天者不到半數；而自覺健康狀況在中等程度之上，以人際互動得分最高，情緒狀態最低。其中男性、低收入、自覺健康狀況之生活適應高分者的每週蔬果達建議量天數較少；收入低和自覺健康狀況之人際互動高分者的每日蔬菜份數較少；而低年級、校外租屋、自覺健康狀況之人際互動高分、情緒狀態低分者的每日水果份數較少。結論：建議針對上述蔬果攝取亟需改善的族群優先規劃衛教課程，並運用同儕的力量引起興趣及相互支持。
  Objectives: Fruit and vegetables are essential for a healthy diet. College age is a crucial period of development and formalization in personal behavior, and the perceived health status (PHS) of college students may influence their health-promoting behavior. Therefore, this study aimed to explore the factors of fruit and vegetable consumption behavior of college students by understanding their fruit and vegetable consumption profile and PHS. Methods: We enrolled 403 students from a university of technology in Hsinchu county by using stratified sampling and a self-administered questionnaire. We received 375 valid questionnaires with an effective rate of 93.1%. Results: The daily vegetable and fruit consumption of participants which met the recommendation were only 1.6% and 8%, respectively. Les than half the participants meet the fruit and vegetables consumption recommendation for more than three days per week. The PHS of the participants was relatively positive. They had the highest PHS score for interpersonal interaction and the lowest score for emotional status. Male participants and those with low income and high score for life adjustment of PHS had fewer weekly recommendation-meeting days of fruit and vegetable consumption. The participants with low income and high score for interpersonal interaction of PHS had inadequate daily servings of vegetables. Underclassman, those in off-campus housing, and those scoring high in interpersonal interaction and low in emotional status of PHS had inadequate daily servings of fruit. Conclusions: We suggest that the health education for the students who are require improvement in their fruit and vegetable consumption behavior should be planned preferentially and be supported by their social group.
• 493-508
• 10.6288/TJPH.202010_39(5).109043

• Link 原著 Original Article
• 自評健康與社會資本：以國際社會調查計畫資料為本的跨國分析Self-rated health and social capital: cross-national analysis of international social survey data
• 高美英、吳齊殷
  Meei-Ying Kao, Chyi-In Wu
• 健康、社會資本、社會信任、社會參與
  health, social capital, social trust, social participation
• 目標：近年來關於社會資本對健康的影響之探討漸多，許多研究皆指出不同層次的社會資本對健康的效益。然而，大部分的研究結果卻仍然有諸多限制。若無法釐清社會資本的外生性，以及缺乏對社會資本跨脈絡效應的理解等等，這些問題限制了過往研究結果的可推論性。本研究運用大規模的跨國資料，分析個人社會資本在不同非正式與正式的社會資源整合條件下，對健康的影響。方法：使用由全球數十個國家調查機構合作蒐集之跨國調查資料，國際社會調查（International Social Survey），取2007年休閒生活組與2017年網絡組兩筆資料進行分析。結果：個人的社會信任與社會參與皆與健康有正向連結，在「高社會資本國家」或「OECD國家」的社會參與對健康的正面影響更加明顯；而社會信任僅有在「高社會資本國家」對健康有額外的正向效應，在「OECD國家」則無此現象。結論：這個發現有助於我們重新理解不同面向社會資本對健康的作用方式，以及其效應如何受所處社會條件的影響而改變。
  Objectives: The impact of social capital on health is increasingly discussed. Many studies have highlighted the health benefits of social capital. However, most research results are affected by limitations. Failure to clarify the exogenous nature of social capital and the cross-contextual effects of social capital may limit the inferences of other research. Therefore, in this study, largescale multinational data are used to analyze the effect of individual social capital on health in various informal and formal social resource conditions. Methods: Data came from International Social Surveys, which are collected by dozens of national survey agencies worldwide. Data from the 2007 leisure life group and the 2017 network group were used for analysis. Results: Individual social trust and social participation are positively linked to health, and social participation has a more positive effect on health in countries with high social capital or in Organisation for Economic Co-operation and Development (OECD) countries. In countries with high levels of social capital, social trust exerts an additional positive effect on health, but this does not occur in OECD countries. Conclusions: This finding facilitates the reevaluation of how social capital affects health and how its effects depend on social conditions.
• 509-521
• 10.6288/TJPH.202010_39(5).109020

• Link 原著 Original Article
• 探討資訊監測系統導入傳染病疫情控制之實證研究：以台灣登革熱為例Implementing a surveillance system to control epidemics of infectious diseases: an empirical study on dengue fever in Taiwan
• 黃維民、黃露葵、林慧茹、羅浚晅、林嘉瑩
  Wei-Min Huang, Lu-Kuei Huang, Huei-Ru Lin, Chun-Hsuan Lo, Chia-Ying Lin
• 資訊監測系統、傳染病疫情、實證研究、登革熱、台灣
  surveillance system, epidemic, empirical study, dengue fever, Taiwan
• 目標：對台灣各縣市衛生行政機關之防疫人員做實證調查，對於登革熱監測系統的導入與使用行為，分析其關鍵影響因素及阻力。方法：採用結構式問卷調查法，以解構式計畫行為理論為核心，並加入組織互動、任務特性等外部變數建立完整研究概念架構。在資料分析上，透過統計軟體SPSS 22.0進行敘述性統計，包括信度和效度分析。另外，藉由統計軟體 Smart PLS 3.2進行路徑分析及模型預測力估計。結果：母體數目為782人，共回收有效問卷388份，回收率為50.63%。包括知覺有用與知覺易用等11個假設構面對使用行為與意圖有顯著影響（p<0.01）。結論：本研究模型對影響衛生單位導入及公共衛生防疫人員使用登革熱監測系統使用意圖之因素解釋力為47.1%。本研究結果將有助於釐清與支持公共衛生單位導入監測系統之關鍵影響因素。
  Objectives: This empirical study analyzes the key factors influencing the implementation and use of the dengue fever surveillance system in Taiwan by conducting a survey for the epidemic prevention staff in Taiwanese public health administration. Methods: We use a structural questionnaire survey and consider the decomposed theory of planned behavior to be the core theoretical foundation. To build a more complete research framework, we add external variables, accounting for organizational interaction and task characteristics, to the core theoretical foundation. Descriptive statistics are obtained and reliability and validity tests are conducted using SPSS v22.0. In addition, we use Smart PLS v3.2 to conduct a path analysis and estimate the power of the predictive model. Results: The study has 782 samples, with 388 valid questionnaires and a response rate of 50.63%. The results indicate that 11 hypotheses, including perceived usefulness and perceived ease of use, significantly affect the behavior and intent of use (p < .01). The 11 hypotheses proposed in our research framework have positive correlations. Conclusions: The empirical model proposed in this study has a good explanatory power of 47.1%. Our findings help identify key factors affecting the implementation and use of the dengue fever surveillance system by public health administration staff members in Taiwan.
• 522-535
• 10.6288/TJPH.202010_39(5).109076

• Link 原著 Original Article
• 台灣自殺死亡率趨勢之改變：連結點迴歸分析（1971-2018年）Changing suicide trends in Taiwan: a joinpoint regression analysis from 1971 to 2018
• 張奕涵、廖士程、林倩宇、許嘉月、張書森
  Yi-Han Chang, Shih-Cheng Liao, Chien-Yu Lin, Chia-Yueh Hsu, Shu-Sen Chang
• 自殺、自殺率、趨勢、連結點迴歸、台灣
  suicide, suicide rates, trend, joinpoint regression, Taiwan
• 目標：台灣自殺死亡率在近十年間不再明顯下降，本研究藉由分析1971-2018年間性別、年齡別和方法別自殺率趨勢之轉折，了解近十年自殺率趨勢改變之特徵。方法：使用全國死因資料，計算15歲以上年齡標準化年自殺率和性別別、年齡別（15-24、25-44、45-64和65歲以上，即青、壯、中和老年）與方法別（上吊、中毒、燒炭、墜落、溺水和其他方法）自殺率。使用連結點迴歸分析來確認自殺率趨勢的轉折點。結果：整體自殺率在1971-1992年間呈下降趨勢，降幅以1980年代晚期最為明顯，其後自殺率上升至2006年達到高峰後下降，在2011年發生轉折，未再有明顯下降，此轉折主要發生於青、壯、中年男性和青年女性，他們的主要自殺方法包括上吊、燒炭與墜落都呈現類似變化。研究期間台灣主要自殺方法由中毒轉變為上吊、 燒炭、中毒與墜落，同時，不同性別年齡層有不同的主要自殺方法。結論：近十年間台灣自殺率不再繼續下降，不同性別年齡層的自殺率趨勢與常見自殺方法亦有所差異。未來需進一步研究導致不同人口族群自殺率趨勢改變的性別年齡別特定因素，以利防治策略之擬定。
  Objectives: Suicide rates in Taiwan did not continue their previous downward trend during the past ten years. This study aimed to investigate suicide trends and assess differences by sex, age, and method in Taiwan between 1971 and 2018 to better understand the pattern of changes in trends over the last ten years. Methods: Suicide data were extracted from Taiwan’s national cause-of-death mortality data files. Annual age-standardized suicide rates for population aged ≥ 15 years and suicide rates by sex, age (15-24, 25-44, 45-64, and ≥65 years), and method (hanging, poisoning, charcoal burning, jumping, drowning, and other methods) were calculated. Joinpoint regression was used to identify the years in which suicide trends changed. Results: Age-standardized suicide rates decreased between 1971 and 1992, with the most marked decline observed during the late 1980s. Suicide rates subsequently increased to reach a relative peak in 2006 and then decreased until 2011, after which the downward trend changed to a stable trend. The recent changes in suicide trends were mainly observed in males aged 15-64 and females aged 15-24. We observed similar changes in these groups for trends in suicide rates of common suicide methods including hanging, charcoal burning, and falling. The most common methods of suicide changed from poisoning to hanging, charcoal burning, poisoning, and falling in Taiwan over the study period. Furthermore, the main methods of suicide differed by sex and age groups in recent years. Conclusions: Suicide rates did not continue to fall in Taiwan over the last decade, with differences in trends and common suicide methods across different sex and age groups. Further research is required to identify sex- and age-specific factors contributing to recent changes in suicide trends in various demographic groups to inform suicide prevention strategies.
• 536-552
• 10.6288/TJPH.202010_39(5).109081

• Link 原著 Original Article
• 代謝健康/不健康之肥胖/過重與心血管疾病風險間的關係：台灣具代表性的世代研究Association between metabolically healthy/ unhealthy obesity/overweight and the risk of cardiovascular disease: a representative cohort study in Taiwan
• 葉姿麟、簡國龍
  Tzu-Lin Yeh, Kuo-Liong Chien
• 代謝健康肥胖、代謝症候群、心血管疾病、三高主題資料庫、社區前瞻性世代研究
  metabolically healthy obesity, metabolic syndrome, cardiovascular disease, Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia databases, community-based prospective cohort study
• 目標：探討台灣代謝健康肥胖者（Metabolically healthy obesity, MHO）和心血管疾病（Cardiovascular disease, CVD）間的關係。方法：受試者來自於三高主題資料庫。本研究將身體質量指數（body mass index, BMI）區分為：體重過輕（BMI < 18.5 kg/m2）、正常體重（BMI 18.5至23.9 kg/m2）和肥胖/過重（BMI ≥24 kg/m2）。無糖尿病、高血壓、高血脂症且符合以下 定義為代謝健康：(1)空腹三酸甘油酯 <150 mg/dL；(2)男性高密度脂蛋白膽固醇 ≥40 mg/dL或女性高密度脂蛋白膽固醇 ≥50 mg/dL；(3)空腹血糖 <100 mg/dL；(4)收縮壓 <130且舒張壓 <85 mmHg。研究終點是以全民健康保險資料確認之發生CVD事件或死亡。使用Cox迴歸模型估計風險比（hazard ratio, HRs）和95%信賴區間（confidence interval, CI）。結果：5,719名受試者年齡平均值（標準差）為44.0（15.5）歲，50.2%為女性，其中1,479名為參考組（代謝健康正常體重者），493名MHO者平均年齡43.3歲，女性比例47.1%。在追蹤中位數（四分位差）13.7（13.6-13.8）年間，共發生了449個CVD事件或死亡，其中MHO組發生了25個CVD事件或死亡。MHO組經多變項調整後之HR為1.75，意即相較於參考組顯著增加了75%的CVD風險，5%CI為1.02-2.99。結論：無論目前代謝健康與否，鼓勵所有肥胖者應積極維持正常體重，以減少將來之CVD風險。
  Objectives: To investigate the relationship between individuals with metabolically healthy obesity (MHO) and the cardiovascular disease (CVD) risk in Taiwan. Methods: Participants from the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia databases were recruited, and classified into three body mass index (BMI) categories: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5 to 23.9 kg/m2), and overweight/obesity (BMI ≥24 kg/m2). Participants without diabetes, hypertension, hyperlipidemia and had healthy metabolic profiles (1) fasting triglyceride <150 mg/dL; (2) high-density lipoprotein cholesterol ≥40 mg/dL in men or ≥50 mg/dL in women; (3) fasting glucose <100 mg/dL; (4) systolic blood pressure <130 and diastolic blood pressure <85 mmHg were defined as metabolically health. Our endpoints were CVD events or death, ascertained by the National Health Insurance Research Database. Multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CI) by Cox regression analysis were performed. Results: A total of 5,719 participants with mean (standard deviation) age 44.0 (15.5) years old, 50.2% women was recruited. Among the total participants, 1,479 individuals were metabolically healthy normal weight (the reference group), 493 participants were the MHO group with the mean age 43.3 years old and women percentage 47.1%. During a median (interquartile range) follow-up time of 13.7 (13.6-13.8) years, 449 ascertained CVD events or deaths developed, 25 CVD events or deaths developed in the MHO group. Compared with the reference group, MHO had a significant higher CVD risk, adjusted HR with 95% CI was 1.75 (1.02-2.99). Conclusions: Aggressive body weight control, even in current metabolically healthy status, is mandatory for CVD control.
• 553-564
• 10.6288/TJPH.202010_39(5).109111

• Link 原著 Original Article
• 醫院護理主管領導行為、團隊健康氣候及護理人員職場幸福感之多層次研究：護理人員健康行為之中介效果驗證Multilevel research on leadership behaviors of nursing supervisors, healthy team climate, and workplace well-being of nurses: mediating effect of nurse health behavior
• 林雅雯、鍾玉珠
  Yea-Wen Lin, Yu-Chu Chung
• 護理團隊、魅力領導、健康氣候、健康行為、職業幸福感
  nursing team, charismatic leadership, healthy climate, health behavior, workplace well-being
• 目標：本研究旨在針對護理團隊主管領導行為、團隊健康氣候、護理人員健康行為及職場幸福感之關聯性進行多層次分析。方法：採用橫斷性研究設計，以便利取樣方式選取願意參與研究之護理團隊及其護理人員，共選取43組護理團隊，共計663人。本研究問卷包括魅力領導、組織健康文化、健康促進生活及職場幸福感量表，以及背景變項。結果：單一層次關係的驗證結果顯示，護理團隊主管領導之形塑文化行為對團隊健康氣候三構面都有顯著正向影響，護理人員健康行為對護理團隊主管領導之形塑部屬行為影響護理人員之職場幸福感三構面都具有部分中介效果。跨層次關係的驗證結果顯示，團隊健康氣候會影響護理人員的職場幸福感三構面，團隊健康氣候對職場幸福感三構面的影響乃透過健康行為的部分中介作用而產生。結論：研究發現護理團隊主管領導行為對於團隊的健康氣候、護理人員的健康行為與職場幸福感構面間存在一定的影響性，更突顯護理團隊主管領導的重要性。
  Objectives: This study was a multilevel analysis on the relationship between leadership behavior of nursing supervisors (including culture shaping behaviors and subordinate shaping behaviors), healthy team climate, nurses’ health behavior, and nurses’ workplace well-being. Methods: This cross-sectional study was conducted using the questionnaires include Charismatic Leadership Scale, Organizational Health Culture Scale, Health Promotion Lifestyle Scale, Workplace Well-being Scale, and background variables. Convenience sampling was used to select nurses from each of 43 nursing teams, and the questionnaire was distributed to 663 nurses. Following the calculation of descriptive statistics, hierarchical regression analysis was conducted to assess the relationships among single-level constructs. Subsequently, hierarchical linear modeling was used to assess the relationships among cross-level constructs. Results: Regarding single-level relationships, culture shaping behaviors of leadership significantly affected all three dimensions of the healthy team climate. In addition, the effects of culture shaping behaviors of leadership on three dimensions of the workplace well-being of nurses were partially mediated by nurses’ health behavior. Regarding cross-level relationships, the healthy team climate affected three dimensions of workplace well-being of nurses, and this effect was partially mediated by nurses’ health behavior. Conclusions: By using a multilevel model, this study demonstrated that the leadership behavior of the nurse leader affects the team climate, nurses’ health behavior, and nurses’ workplace well-being. The findings highlight the importance of leadership in the nursing team.
• 565-577
• 10.6288/TJPH.202010_39(5).109059

• Link 實務 Public Health Practice
• 台灣使用自動化編碼系統與國際疾病分類第十版對死因統計之影響：雙軌編碼研究台灣使用自動化編碼系統與國際疾病分類第十版對死因統計之影響：雙軌編碼研究
• 呂宗學
  Tsung-Hsueh Lu
• 死因統計、可比較性研究、雙軌編碼研究、國際疾病分類、死亡率趨勢
  cause of death statistics, comparability study, bridge coding study, International Classification of Disease, mortality/trends
• 目標：評估台灣使用自動化編碼系統與國際疾病分類第十版選擇原死因（新制）對於死因統計之影響。方法：本研究將2007年所有死亡個案同時使用新制與舊制（編碼人員使用國際疾病分類第九版人工選擇原死因）進行編碼，計算死因別可比較性比值（新制死亡數/舊制死亡數）。本研究探討改制後對兩種死因統計列表清單之影響，一是主要（十大）死因排序列表， 二是美國國立衛生統計中心使用的113分類項列表。結果：使用新制與舊制前三名死因排序相同，但是死亡數卻有差異。新制比舊制死亡數，惡性腫瘤少2,544人，心臟疾病多2,274人，腦血管疾病少2,144人。舊制支氣管炎肺氣腫氣喘死亡數為1,165人排名第十二，新制慢性下呼吸道疾病死亡數5,314人排名第七。新制/舊制死亡數比值大於2.0的死因是敗血症（2.751），病 毒性肝炎（2.385）與本態性高血壓及高血壓性腎臟疾病（2.102）。比值小於0.7的死因是阿茲海默症（0.250）與支氣管炎（0.638）。結論：本雙軌編碼研究指出，造成某些死因別死亡數新制與舊制差異較大的原因有兩個：一是對應統計列表死因分類項涵蓋編碼的詳細度與範圍差異不同造成，二是台灣不少死亡證明書開具者習慣將明確死因診斷填在第二或第三個診斷，造 成編碼人員與自動化編碼系統的判斷不同。建議分析台灣2008年前後死因別死亡率趨勢時，首先要確認所要探討的對應統計列表死因分類項涵蓋編碼的詳細度與範圍，新舊制是否有很大差異；二是使用轉換比值進行調整；三是使用多重死因分析進行補充。
  Objectives: To assess the effects of implementing an automated coding system and the International Classification of Disease (ICD) 10th Revision (ICD-10) on mortality statistics in Taiwan. Methods: We used a new automated coding system based on ICD-10 (automatic ICD-10) to assign the underlying cause of death (UCOD) for all deaths occurring in 2007. We then compared the number of deaths according to automatic ICD-10 with that coded manually by coders according to ICD-9 (manual ICD-9). The comparability ratio (CR, automatic ICD-10/ manual ICD-9) for a specific cause of death (COD) category was calculated. We assessed the impact on two mortality tabulation lists: the main (10 leading) tabulation list and the 113-category tabulation list used by the US National Center for Health Statistics. Results: The three leading CODs were the same according to both methods: malignant neoplasm, heart diseases, and cerebrovascular diseases. However, compared with manual ICD-9, automatic ICD-10 recorded 2,544 more deaths for malignant neoplasm, 2,274 more deaths for heart diseases, and 2,144 fewer deaths for cerebrovascular diseases. In all, 1,165 deaths were recorded under the bronchitis, emphysema, and asthma category, which ranked 12th according to manual ICD-9. By contrast, 5,314 deaths were recorded under the chronic lower respiratory disease category, which ranked 7th according to automatic ICD-10. Three CODs had CR > 2: septicemia (2.751), viral hepatitis (2.385), and essential hypertension and hypertensive renal disease (2.102). By contrast, two CODs had CR < 0.7: Alzheimer’s disease (0.250) and chronic and unspecified bronchitis (0.638). Conclusions: The results of this bridge coding study indicated large differences between the new and old methods in some COD categories. Two possible reasons are identified for this discrepancy. First, the level and range of codes included in the corresponding tabulation COD categories were different. Second, many medical certifiers recorded more specific COD diagnoses as the second and third diagnoses, which resulted in differences in judgment between coders and the automated system when assigning the UCOD. We recommend three measures when examining cause-specific mortality trends before and after 2008 in Taiwan. First, large differences in the level and range of codes included in corresponding COD categories should be evaluated. Second, the CR should be used for adjustment. Third, multiple COD data should be analyzed as a complement.
• 578-597
• 10.6288/TJPH.202010_39(5).109039