39卷6期

• Link 政策論壇 Policy Forum
• 青少年網路成癮Internet addiction in adolescents
• 洪研竣、吳秀英、林煜軒
  Yan-Jun Hong, Shiow-Ing Wu, Yu-Hsuan Lin
• 網路成癮、青少年、網路遊戲失調症、心理健康促進
  internet addiction, adolescents, internet gaming disorder, mental health promotion
• 「網路成癮」（internet addiction）一詞在1996年首次被提出，美國精神醫學會的《精神疾病診斷準則手冊》與世界衛生組織的《國際疾病分類標準》逐漸將「網路遊戲失調症」（internet gaming disorder）列入精神疾病的範疇。網路成癮的盛行率常被誇大，依嚴謹國際標準做出的研究與社會大眾的普遍認知有將近十倍的落差。要處理網路成癮，應先解決青少年在現實生活中人際關係不佳、親子溝通不良、缺乏成就感等問題，讓青少年不需藉網路遊戲，在現實生活中即可滿足需求。網路成癮的介入應循「心理健康促進」模式而非「精神疾病防治」，同時也可建立產、官、學三贏的電子產品標章制度作為改善網路成癮問題相關政策有力的後盾。
  "Internet addiction" was first proposed in 1996. "The Diagnostic and Statistical Manual of Mental Disorders" of the American Psychiatric Association and "The International Statistical Classification of Diseases and Related Health Problems" of the World Health Organization referred to "Internet gaming disorder" included in the category of mental illness. The prevalence of Internet addiction is often exaggerated. Research conducted following rigorous international standards found that the prevalence of Internet addiction has a gap of nearly ten times that of the general public. To deal with Internet addiction, we must solve adolescents' problems first, such as poor interpersonal relationships, poor parent-child communication, and lack of sense of accomplishment in real life, so that adolescents can meet their needs in real life without using online games. The intervention of Internet addiction should follow the method of "mental health promotion" rather than "mental disease prevention." In addition, a win-win electronic product labeling system for industry, government, and academics can be established as a strong backing for Internet addiction relating policies.
• 599-601
• 10.6288/TJPH.202012_39(6).PF06

• Link 公衛論壇 Public Health Forum
• 台灣COVID-19疫情初期實施居家檢疫／隔離措施探討Home quarantine and isolation in Taiwan in response to COVID-19
• 林怜伶、張雅姿、江柏榮、王怡雅、藍一逢、林千玉、蕭慶瞬、劉慧蓉、楊靖慧
  Ling-Ling Lin, Ya-Tzu Chang, Po-Jung Chiang, Yi-Ya Wang, Yi-Feng Lan, Chien-Yu Lin, Ching-Shun Hsiao, Hui-Rong Liu, Chin-Hui Yang
• COVID-19、臺灣、居家檢疫、居家隔離
  COVID-19, Taiwan, Home quarantine, Home isolation
• 2019年12月中國湖北省武漢市爆發COVID-19疫情，臺灣地理位置鄰近中國，交流往來密切，為防堵疫情擴散，預防措施不可不少。本文依時間脈絡分別論述臺灣居家檢疫／隔離措施的實施依據、各類民眾納入居家檢疫的時程、居家檢疫／隔離措施的管理方式、成立關懷中心及設立防疫旅館以完善居家檢疫／隔離服務網絡。截至2020年4月30日，我國確診個案控制在429例，其中居家檢疫者轉確診個案計217例，占總確診人數50.6%，居家隔離轉確診個案計136例，占總確診人數31.7%，各項社區追蹤關懷措施確實發揮居家檢疫／隔離的效果，有效防止個案進入社區，達到及早診治及控制疫情傳播的目的。隨著國內疫情趨緩，防疫新生活運動啟動，民眾逐步回歸正常生活，但國際間疫情仍相當嚴峻，後續檢疫／隔離措施如何依風險分級，進行階段性鬆綁，以及鬆綁後對國內之影響，都是未來防疫策略研擬之重點。
  In December 2019, the COVID-19 epidemic broke out in Wuhan, Hubei Province, China. Taiwan is geographically close to China and has close exchanges; hence, preventive measures are necessary to prevent the spread of the epidemic. This article in time context discusses the implementation basis of Taiwan's home quarantine/ isolation, the schedule for what kinds of people be included in home quarantine, the management method of home quarantine/ isolation, the establishment of care centers and epidemic prevention hotels to improve the home quarantine/quarantine service network. By April 30, 2020, the number of confirmed cases in Taiwan was 429, of which 217 cases came from home quarantine, accounting for 50.6% of the total number of confirmed cases, and 136 cases came from home isolation, accounting for 31.7% of the total number of confirmed cases. Various community follow-up and care measures certainly give full play to the effects of home quarantine/ isolation, effectively preventing cases from entering the community, achieving early diagnosis and treatment, and controlling the spread of the epidemic. As the domestic epidemic slows down and the New Life Movement of Disease Prevention is launched, the people are gradually returning to their normal lives. However, the international epidemic is still severe. How to classify quarantine/ isolation according to risk levels, carry out phased releases, and the impact after the release on the country are the focus of future epidemic prevention strategies.
• 602-610
• 10.6288/TJPH.202012_39(6).109086

• Link 綜論 Review Article
• 日本推動照顧工作師制度之歷史脈絡：回顧1950至1980年代Assessing Japan’s certified care worker training system: 1950s–1980s
• 徐明仿
  Ming-Fang Hsu
• 介護福祉士、照顧工作、專業證照、自立支援
  certified care worker, caregiving, qualification, self-reliance support
• 日本於1987年立法通過介護福祉士制度（本文譯照顧工作師制度），開啟學校教育養成機制與國考證照機制，雙軌並進培育第一線照顧人才。本文以傳統概念性文獻回顧探討日本法制化之歷史沿革，搜尋日本官方歷史性政策文獻資料，從日本資料庫檢索系統IPSS、CiNii、NDL篩選納入12篇（1970-1990年）官方政策文獻、9篇（1970-2020年）日文期刊論文，及自華 藝線上圖書館、台灣期刊論文索引系統計4篇（2000-2020年）相關研究。本文歸納出日本順利推動法制化之因素有四點，中央政府強力主導、社會工作與照顧工作之雙師制度同時法制化、「訓‧用‧勞」三端的支持，以及銀髮產業界的支持。
  Japan passed the Certified Care Worker Act in 1987 and initiated specialized nursing care education and a dual-track approach to national qualification to cultivate care professionals. This study adopted a traditional literature review methodology to investigate the historical evolution of Japan’s legal regime for care workers. It searched for official historical Japanese policy documents (1970–1990) in domestic and foreign databases, including IPSS, CiNii, and NDL. This study identified four major elements contributing to Japan’s success in enacting regulations governing care workers, namely (1) strong central government leadership, (2) the adoption of a dual system for certifying social workers and care workers, (3) a collaborative training system involving both employers and employees, (4) and support from the care industry.
• 611-622
• 10.6288/TJPH.202012_39(6).109122

• Link 原著 Original Article
• 急性水樣腹瀉疫情調查：以伊斯蘭瑪巴德一都市區域為例Acute watery diarrhea in an urban sector of Islamabad in 2018: an outbreak investigation
• Majid Ali Tahir, Amjad Mehmood, Mumtaz Ali Khan, Zakir Hussain, Amna Ali, Aliya Jabeen, Nazia Hassan, Moin Iqbal, Sana Habib Abbasi
  Majid Ali Tahir, Amjad Mehmood, Mumtaz Ali Khan, Zakir Hussain, Amna Ali, Aliya Jabeen, Nazia Hassan, Moin Iqbal, Sana Habib Abbasi
• 急性水樣腹瀉（acute watery diarrhea, AWD）、疫情爆發、調查、供水、排水
  AWD, outbreak, investigation, supply water, drainage
• 目標：為回應聯邦疾病監測及應變單位（Federal Disease Surveillance and Response Unit）所報導位於巴基斯坦伊斯蘭瑪巴德I-9/4區的急性水樣腹瀉（acute watery diarrhea, AWD）個案，巴基斯坦國家衛生研究院（National Institute of Health）派出調查團，前往確認該地疫情、找出風險因素、提出疫情控制建議。 方法：採用描述性研究方法，在2018年7月27日至8月20日期間 探討潛在病因以及該疾病的傳播途徑。本研究透過逐戶調查搭配已建立的AWD個案定義，積極尋找個案，研究期間中一共調查了508戶，確認了46個AWD個案。 結果：研究結果顯示，存儲在不安全飲用容器中的地下水（OR 0.1916, CI 0.0633-0.5798, p < 0.0034）及公共水龍頭提供的飲用水（OR 6.6182, CI 5.2384-25.3678, p < 0.0027）是最有可能導致此次疫情爆發的原因。雖然大部分的個案（n = 30, 65.2%）都知道水質不好，但他們仍然選擇持續飲用，且所有個案家中都有封閉式排水的廁所設備（100%），此因素可能引爆疾病傳染。最常見的徵兆和症狀為腹瀉、腹絞痛、嘔吐、發燒等，此地區居民有良好的經濟地位以及教育程度。 結論：此地區AWD疫情爆發的狀況顯示出，公共區域的供水隨時都有可能受到污染，進而造成疫情爆發。
  Objectives: In response to the reports of presence of acute watery diarrhea (AWD) in sector I-9/4 of Islamabad, Pakistan, the Federal Disease Surveillance and Response Unit of the National Institute of Health (NIH) Islamabad appointed an outbreak investigation team to confirm the outbreak, identify risk factors and formulate recommendations for control. Methods: A descriptive study was conducted from July 27 to August 20, 2018 to investigate the potential causation of illness and modes of transmission in the outbreak. Active case finding started through a house-to-house case search and the establishment of a case definition. A total of 46 cases of AWD were identified by surveying 508 homes during the study period. Results: The study results revealed that ground bore water (OR 0.1916, CI 0.0633-0.5798, p < 0.0034) and public supply water (OR 6.6182, CI 5.2384-25.3678, p < 0.0027) stored in unsafe utensils for drinking are probable causes of this outbreak. Despite most of these people (n = 30, 65.2%) being aware of the poor quality of the water, they still consuming it. All cases had closed drained toilet facilities at their homes which may have resulted in triggering of the infection. Commonly witnessed signs/symptoms included loss of motion, abdominal cramps, vomiting and fever. People living in this sector belong to an excellentsocio-economic class. Conclusions: The outbreak of AWD in this area revealed that the public water supply may become contaminated at any instance resulting in an outbreak.
• 623-631
• 10.6288/TJPH.202012_39(6).108107

• Link 原著 Original Article
• 台灣肌萎縮性脊髓側索硬化症的發生率、盛行率及死亡率 Incidence, prevalence and mortality of amyotrophic lateral sclerosis in Taiwan
• 陳瑞鴻、李子奇
  Jui-Hung Chen, Charles Tzu-Chi Lee
• 肌萎縮性脊髓側索硬化症（ALS）、全民健保資料庫、發生率、盛行率、死亡率
  amyotrophic lateral sclerosis (ALS), National Health Insurance Research Database, incidence, prevalence, mortality
• 目標：肌萎縮性脊髓側索硬化症（Amyotrophic Lateral Sclerosis, ALS）為一重大疾病，監測其基礎流行病學指標以掌握此疾病的流行趨勢至為重要。本研究分年度進行台灣的ALS發生率、盛行率及死亡率等統計。 方法：本回顧性世代研究從重大傷病資料庫納入1999年1月1日至2017年12月31日間新診斷ALS案例，並串連台灣全民健保資料庫與全國死因資料檔進行分析。 結果：2008-2015年逐年的ALS年齡標準化發生率約在每10萬人0.33-0.44人間；年齡標準化盛行率從2008年的1.54人上升至2015年的2.31人（每10萬人）。1999-2016年期間在初診日後的5年內有很高的死亡率（年粗死亡率14.7%~19.7%）。另在僅納入確定死亡個案的分析中，經氣切、非侵入型呼吸器使用或胃造口手術的個案其平均存活期則顯著提高（分別為4.92年比2.66 年，3.56年比2.45年及3.75年比3.02年）。 結論：延續1999-2007年對台灣ALS流行病學之研究，本研究顯示於2008-2015年的逐年發生率趨於穩定，而逐年盛行率有增加的趨勢。初診日後5年內有很高的死亡率，而氣切、非侵入型呼吸器及胃造口可延長病患的存活時間。
  Objectives: Amyotrophic lateral sclerosis (ALS) is a serious disease. Therefore, monitoring basic epidemiological indicators for clarifying the epidemic trend is crucial. Yearly epidemiological statistical data were determined to assess the incidence, prevalence, and mortality of ALS in Taiwan. Methods: In this population-based retrospective cohort study, patients who were newly diagnosed with ALS from January 1, 1999, to December 31, 2017, were enrolled from the Registry for Catastrophic Illness Patient Database. Medical claims from the National Health Insurance Research Database and national mortality database were linked for further analysis. Results: The age-standardized incidence rate of ALS in 2008-2015 was approximately 0.33 to 0.44 per 100,000 people. The age-standardized prevalence rate increased from 1.54 in 2008 to 2.31 in 2015 (per 100,000 people). High mortality rate (annual crude mortality rate = 14.7%–19.7%) was observed within 5 years after the date of the first diagnosis in 1999–2016. The analysis of confirmed death cases only indicated that the average survival time improved significantly in patients who underwent tracheostomy, noninvaive ventilator use, or gastrostomy (4.92 years versus 2.66 years, 3.56 years versus 2.45 years and 3.75 years versus 3.02 years, respectively). Conclusions: Following ALS epidemiological data during 1999-2007 in Taiwan, this study revealed that the annual incidence rate of ALS in Taiwan was stable from 2008 to 2015. However, the trend of the annual prevalence rate increased gradually. The mortality rate within 5 years after the initial diagnosis was high, and treatment with tracheostomy, noninvasive ventilator use, and gastrostomy can prolong survival time.
• 632-642
• 10.6288/TJPH.202012_39(6).109093

• Link 原著 Original Article
• Surge capacity解析與規劃—八仙事件的醫院實證Exploring and planning surge capacity – hospitals’ empirical evidence in Formosa Fun Coast Dust Explosion
• 莊秀文
  Sheu-Wen Chuang
• 大量傷患事件、八仙事件、緊急應變、突發湧入作業能量（surge capacity）
  mass casualty incident, Formosa Fun Coast Dust Explosion, emergency response, surge capacity
• 目標：本研究目的是針對突發湧入作業能量（surge capacity）的意義與規劃，以八仙粉塵暴燃事件（八仙事件）實證進行釐清與解析，以提升該名詞的在災害應變計畫中的應用。 方法：收集四家初期收治八仙傷患醫院的基本能量資料、急診室大量傷患湧入期間的傷病患檢傷、出入急診時間、轉院/轉房等紀錄，以及相關文獻。採用流程追蹤分析方法，建立傷病患流動與急診負荷變化的時間圖列，並計算各醫院過載時間、負荷指數、以及負荷上升與減緩指數，進一步比較醫院間大量傷患湧入對於突發湧入作業能量的需求變化樣態與速率。 結果：八仙事件造成四家醫院呈現四種傷病患超載的緊急醫療服務需求模型，其中MM和TH醫院的過載時間與負荷指數較高，顯示該二醫院資源供需的差距最大，以及醫院應變的相對困難度較高。基於醫院規模與急診平日診量之差異，MM與TH醫院衡量突發湧入作業能量的病床基準並不一致。另外，MM的負荷變化速率亦高於TH，對於資源短缺的因應，視緊急醫療處置內容與短缺項目，兩家醫院採取類似或差異化的調適性（韌性）作為，來應對醫療處置能量間的差距。 結論：Surge capacity 並不能統一單一衡量指標，如空床數，來運算出“最大”的計量，而是依照大量傷患的規模與醫院的特性，設置適當的衡量基準。Surge capacity的規劃宜以突發湧入作業能量概念結合韌性能力，並加強系統要素在資源規劃的角色，同時，參考過載時間、負荷增減速率等多元性的因素，做為未來大量傷患緊急應變計畫的整備策略。
  Objectives: To investigate and compare hospitals’ surge capacity during the Formosa Fun Coast Dust Explosion (FFCDE) to promote refined applications of surge capacity in disaster response planning. Methods: We collected the following data from four initial receiving hospitals after the FFCDE: basic hospital capacity; emergency department (ED) patient log data, including triage, arrival time, departure or discharge time, and ED stay duration; and related literature. Process tracking analysis was employed to establish a time chart of patient flow against the ED workload. Each hospital’s overload time, load index, load accumulated index, and load relief index were calculated and used to compare the effects of burn patient influx and demand patterns on the overload rates of the four hospitals with respect to surge capacity. Results: After FFCDE, the four hospitals presented four types of dynamic overload patterns, all of which illustrated their emergency medical service demand statuses. The overload time and load index of the MM and TH hospitals were relatively high, indicating that these hospitals had the largest resource supply–demand gap. Moreover, the two hospitals had some difficulty in eliciting response. The differences between hospital size and average number of daily ED patient visits indicated differences in metrics of bed size measurement used by the MM and TH hospitals for measuring surge capacity. Furthermore, the load change rate was higher in hospital MM than in hospital TH. Depending on the content of emergency medical treatment and shortage items, the MM and TH hospitals elicited similar or different responses to cope with medical resource shortages. Conclusions: Surge capacity was not consistently calculated as a “maximum” measurement of only one metric (e.g., number of empty beds), but it was set using appropriate measurements based on the mass casualty size and characteristics of each hospital. Surge capacity is defined as the capacity to satisfy sudden demand due to patient influx during or after a disaster. Hospitals should integrate the concept of surge capacity with resilience, strengthen the role of their system elements during surge capacity planning, and adopt multiple dimensions, including resource volume, overload time, load accumulated index, and relief index, when conducting surge capacity planning for disaster response.
• 643-655
• 10.6288/TJPH.202012_39(6).109096

• Link 原著 Original Article
• 週日門診開診狀況與忠誠病人急診利用之相關性探討After-hours access to ambulatory care on sunday and utilization of emergency department for loyal patient
• 蔡金玲、郭年真
  Chin-Ling Tsai, Raymond N. Kuo
• 忠誠病人、固定就醫地點、急診利用、常規時間外就醫
  loyal patients, usual source of care, emergency visit, after-hours visit
• 目標：探討週日使用西醫醫療資源的患者特質，並探討病人特性、醫事機構特性及院所週日門診開診狀況對忠誠病人急診利用之影響。 方法：本研究採用健保資料庫，研究期間為2016年至2018年，以有固定就醫院所之病患為主要研究對象，使用羅吉斯迴歸分析「固定就醫院所週日開診狀況」、「病人特性」、「醫療利用」、「醫事機構特徵」對忠誠病人選擇門診或急診醫療之影響。 結果：研究結果顯示男性、65歲以上的老人、低收入戶、有共病症、有重大傷病、身心科就醫病史、門診就醫次數低、有住院的紀錄、就醫時間越晚、就醫科別為外科、兒科、忠誠院所特約層級別越高、就醫院所位於高度都市化市鎮者、忠誠院所位於低度都市化市鎮者、開診率較低的醫療區更容易至急診就醫，在控制其他變項後，院所週日未開診則其忠誠病人至急診的風險顯著高於有開診的院所（OR=12.72，95%CI: 12.56-12.87）。 結論：研究顯示院所週日開診與否與其忠誠病人急診利用相關，因此建議衛生主管機關除提供誘因鼓勵假日開診外，強化基層醫療照護系統、宣導民眾應用資訊科技，提升資料查詢便利性及正確性，使西醫基層醫療照護的可及性及可近性提高，促進醫療資源有效利用，以減少假日急診壅塞情形。
  Objectives: Barriers to timely access to usual sources of medical care lead patients to use the emergency department as a ready alternative. This study aims to determine the characteristics of patients who use medical resources on Sundays. We also examined the relationship between emergency department visits and barriers to receiving usual sources of care in a timely manner for loyal patients. Methods: Data from 2016 to 2018 were obtained from Taiwan’s National Health Insurance Research Database, and the study estimated of medical care utilization in the past year. Patients were classified as having a usual source of care if they made 80% or more of their total ambulatory visits to the same clinic. Descriptive statistics and logistic regression analyses were used to determine relationships between the medical service provided on Sundays and the use of the emergency department by loyal patients. Results: This study included 2,952,002 ambulatory and emergency department visits from 1,449,968 loyal patients. Patients who had a higher risk of emergency visits had the following characteristics: male, over 65 years of age, low-income, co-morbidities, major injuries, poor physical health, or poor mental health. In terms of medical use, the following was also associated with a higher risk of emergency visits by patients: low outpatient visits, having a record of hospitalization in the past year, after-hours visits, medical needs for surgery, or pediatrics. The positive associations between barriers to receiving usual source of care in a timely manner and emergency department usage persisted even in multiple logistic regressions that adjusted for patient characteristics, medical use, and characteristics of medical institutions. The risk of emergency department visits was significantly higher among loyal patients whose usual clinics did not provide medical services that met their needs than among patients whose usual clinics did meet their needs (OR=12.72, 95%CI:12.56-12.87). Conclusions: The results indicate that loyal patients who have barriers to their usual source of medical care are more likely to utilize the emergency department. Improving the availability and accessibility of primary medical care on Sundays may help reduce rates of emergency department use and resolve current situations of unmet medical needs.
• 656-668
• 10.6288/TJPH.202012_39(6).109108

• Link 原著 Original Article
• 社區長者身、心、社會衰弱量表之切點初探：以台北兩行政區為例 Pilot study on cutoff values of physical, psychological and social frailty indexes in Taiwan community-dwelling older people
• 鐘子婷、陳端容、陳秀熙、葉彥伯、張睿詒、陳殷正、陳鵬宇、陳雅美
  Zi-Ting Zhong, Duan-Rung Chen, Hsiu-Hsi Chen, Yen-Po Yeh, Ray-E Chang, Yin-Cheng Chen, Peng-Yu Chen, Ya-Mei Chen
• 身體衰弱、心理衰弱、社會衰弱、身、心、社會衰弱整合量表（MSTQ: Modified SOF TFI QSFS Integrated Frailty Tool）、切點
  physical frailty, psychological frailty, social frailty, MSTQ: Modified SOF TFI QSFS Integrated Frailty Tool, cutoff values
• 目標：為提早篩檢長者延緩不良健康結果，探討身體（SOF+緩慢、SOF+握力）、心理（TFI, Tilburg Frailty Indicator）、社會性衰弱指標（QSFS, Questionnaire to define Social FrailtyStatus），以及整合性衰弱指標（MSTQ, Modified SOF TFI QSFS Integrated Frailty Tool）合適台灣族群的最佳切點。 方法：收案對象為台灣北部城市兩個行政區的65歲以上長者（行政區一，n=471、行政區二，n=703），以AUC探討工具鑑別力，以約登指數找最適切點。 結果：身體指標「衰弱」≥2分，「前衰」=1分；心理指標「衰弱」≥3分，「前衰」=2分；社會指標「衰弱」≥2分，「前衰」=1分。整合性衰弱指標「衰弱」≥4分，「前衰」=3分，鑑別力比單一衰弱面向好。衰弱盛行率方面，行政區(二)身體衰弱（SOF+緩慢）盛行率11.6%；（SOF+握力）14.5%；心理衰弱9.0%；社會衰弱20.0%；身（SOF+緩慢、SOF+握力）、心、社會整合量表衰弱24.6%、25.5%。 結論：本研究提供身體、心理、社會性衰弱指標之「衰弱」與「前衰」切點做篩檢標準。身體（SOF+握力）、心理、社會及整合性衰弱指標鑑別力之敏感性比起（SOF+緩慢）略好。不過，仍建議依需求選擇適合量表。
  Objectives: Screening for frailty among older people to guard them against adverse health outcomes is a crucial task as the population ages. This study sought to find the most optimal cutoff values for physical (SOF-walking speed、SOF-handgrip), psychological (TFI, Tilburg Frailty Indicator), and social frailty indexes (QSFS, Questionnaire to define Social Frailty Status), and Modified SOF TFI QSFS Integrated Frailty Tool (MSTQ) in Taiwanese community-dwelling older people. Methods: The study used cross-sectional survey data in two secondary sets collected from two municipalities in Taipei, with 471 and 703 older adult participants, respectively. Spearman’s rank correlation analysis was used to assess the association of three dimensions of frailty. Receiver operator characteristic curves were generated to determine the discriminant functions for these frailty indexes. Results: Modest associations were found between physical, psychological, and social frailty. The full integrated frailty indexes, which combined the three separate indexes, showed an improved discriminant function (cutoff values: frail ≥4, pre-frail = 3) relative to the single index. The cutoff values suggested for Taiwanese older adults was as follows: physical frailty (frail ≥2, pre-frail = 1), psychological frailty (frail ≥3, pre-frail = 2), and social frailty (frail ≥2, pre-frail = 1). Conclusions: Our findings supported the use of the full integrated frailty index and provided cutoff values to screen older community-dwelling people for frailty. The discriminate ability of the MSTQ was better to include SOF-handgrip comparing to include SOF walking speed as physical frailty. Researchers can select either one of the indexes as needed.
• 671-685
• 10.6288/TJPH.202012_39(6).109109

• Link 原著 Original Article
• 肺炎住院病人特性及住院天數之影響因子Characteristics and factors influencing length of stay in hospitalized patients with pneumonia
• 沈季香、楊麗玉
  Chi-Hsiang Shen, Li-Yu Yang
• 肺炎、住院天數、住院病人
  pneumonia, length of stay, inpatient
• 目標：隨著人口高齡化，肺炎的發生率有逐年攀升趨勢，不僅是國人健康的一大威脅，隨著住院天數的延長，更會增加健康醫療服務的經濟負擔。本研究目的係探討肺炎住院病人特性及住院天數的影響因子。 方法：採回溯性相關性研究，從病歷的次級資料進行分析，研究對象為2013年至2017年台灣南部某醫學中心之內科住院病人，以羅吉斯迴歸分析檢定病人特性與住院天數之相關性及影響程度。 結果：本研究收集初診斷肺炎住院之病人共488人，平均年齡72.3（±17.9）歲，平均住院天數為17.6天。研究發現鼻胃管留置（p < 0.001）、共存疾病數（p = 0.031）與住院天數達顯著性相關。進一步以羅吉斯迴歸分析影響住院天數長短的因素發現，有鼻胃管留置者（β = 1.525, p < 0.001）、執行胸腔物理治療者（β = 0.622, p = 0.002），其住院超過12天的風險越高，其中以鼻胃管留置的相關性最高。 結論：影響肺炎住院天數的因素主要為鼻胃管留置，故建議醫療照護人員應適時評估個案鼻胃管留置的必要性，以期能降低住院天數，提供未來醫療機構改善肺炎住院天數之參考。
  Objectives: With population aging, the incidence of pneumonia is increasing yearly, representing a major threat to people’s health in Taiwan as well as contributing to increasing lengths of hospitalization and the economic burden of health care. The purpose of this study was to investigate the influence of the characteristics of patients with pneumonia on their length of hospital stay. Methods: A retrospective correlation study was conducted. Data were collected from 2013 to 2017 in the medical ward of a medical center located in southern Taiwan. Logistic regression analysis was performed. Results: A total of 488 patients with pneumonia were recruited and enrolled as participants. The mean age of the participants was 72.3 (±17.9) years, and the mean length of stay was 17.6 days. The results demonstrated that the use of nasogastric tubes (p < .001) and comorbidities (p = .031) were both significantly correlated with length of stay. Logistic regression analysis indicated that the use of a nasogastric tube (β = 1.525, p <.001) and chest physical therapy (β = 0.622, p = .002) increased the risk of the length of stay extending to more than 12 days, with nasogastric tubes exhibiting the highest correlation. Conclusions: The use of nasogastric tubes affects the length of hospital stay of pneumonia inpatients. We therefore suggest that clinical nurses assess the necessity of nasogastric tube indwelling, as selective deployment may reduce the length of hospital stay of patients with pneumonia. This study can serve as a reference for clinicians seeking to reduce the length of stay of patients with pneumonia.
• 686-695
• 10.6288/TJPH.202012_39(6).109101

• Link 原著 Original Article
• 台北都會區不同性別高齡者休閒時間身體活動和靜態行為與健康生活品質之關係Gender differences in the relationships among leisure-time physical activities, sedentary behaviors, and Health-Related Quality of Life for older adults in Taipei metropolitan area
• 王立亭、方怡堯、何信弘、張少熙
  Li-Ting Wang, I-Yao Fang, Hsin-Hung Ho, Shao-Hsi Chang
• 老年人、休閒活動、久坐行為、生活品質
  elderly, leisure activity, sedentary behavior, Health-Related Quality of Life
• 目標：身體活動不足與過量靜態行為已被證實為兩個獨立的健康危險因子，且存在著性別差異。 方法：本研究為橫斷性調查，採用電腦輔助電話訪談對台北市65歲以上高齡者進行調查，有效樣本1,068份（年齡72.3±6.1歲，女性54.6%），所有參與者使用SF-8評估健康生活品質、國際身體活動量表-長版，瞭解休閒時間身體活動水平和強度，及使用靜態行為量表得知久坐概況。 結果：休閒時間身體活動（總時間、中高強度、步行時間）和健康生活品質（生理、心理健康及總分）的平均上數觀察到性別差異，但在靜態行為（靜態時間及看電視時間）方面則無性別差異。進一步分析，發現女性休閒時間身體活動和步行時間越多，可顯著正向預測生理健康與整體健康生活品質；但男性皆無顯著關聯。靜態行為方面，男性靜態時間愈多，可顯著負向預測其生理健康；看電視時間越多，生理、心理及整體健康較差；但女性則無相關發現。 結論：本研究發現評估健康生活品質時，區分性別、身體活動和靜態行為是重要的。建議未來提供高齡者健康生活品質促進之訊息時，可針對不同性別及行為進行更有效的介入。
  Objectives: Insufficient physical activity and sedentary behavior in two great a quantity have been proved to present different health risks to different sexes. Methods: This study utilized a cross-sectional survey. Data were collected by conducting computer-assisted telephone interviews (CATI) to investigate the health of individuals aged 65 and over in Taipei City. A total of 1,068 valid samples were obtained (age = 72.3±6.1 years, 54.6% were women). The participants’ HRQoL were assessed using the SF-8 questionnaire, the level and intensity of their leisuretime physical activity (LTPA) were assessed using the long form of the International Physical Activity Questionnaire (IPAQ), and the extent of their sedentary behaviors was assessed using the Measure of Older Adults’ Sedentary Time (MOST) questionnaire. Results: Differences between genders were observed for LTPA (overall, MVPA, walking) and HRQoL (physical health, mental health, overall), but not for sedentary behavior (sedentary time and TV viewing). For the female participants, a higher overall LTPA and an increase in the time spent walking were positive predictors of good physical health and overall HRQoL. No significant associations were found between men. For the male participants, increase in sedentary behaviors was a significant negative predictor of physical health. For males who spent an increased amount of time watching TV, this two was a negative predictor of physical health, as well as of mental health and overall HRQoL. There were no relevant findings for women. Conclusions: These findings highlighted the importance of considering gender differences and the level and intensity of PA and SB when evaluating HRQoL. The results provided an important insight into the promotion of HRQoL for older adults. Future research could examine more effective interventions targeting specific genders and behaviors.
• 696-708
• 10.6288/TJPH.202012_39(6).109100

• Link 評論 Commentary
• 評論：週日門診開診狀況與忠誠病人急診利用之相關性探討Commentary: after-hours access to ambulatory care on Sunday and utilization of emergency department for loyal patient
• 謝慧敏
  Hui-Min Hsieh
• 無
  none
• 無
  none
• 669
• 10.6288/TJPH.202012_39(6).10910801

• Link 作者回覆 Authors' response to commentary
• 作者回覆：週日門診開診狀況與忠誠病人急診利用之相關性探討Author’s response: after-hours access to ambulatory care on Sunday and utilization of emergency department for loyal patient
• 蔡金玲、郭年真
  Chin-Ling Tsai, Raymond N. Kuo
• 無
  none
• 無
  none
• 670
• 10.6288/TJPH.202012_39(6).10910802