40卷2期

• Link 政策論壇 Policy Forum
• 依據流行病學的精準C肝防治先導計劃引領全國性篩檢Epidemiology-based precise hepatitis C pilot control programs leads the official national screening
• 盧勝男、吳慧敏、蒲若芳
  Sheng-Nan Lu, Grace Hui-Min Wu, Raoh-Fang Pwu
• 慢性C型肝炎、篩檢、流行病學、疾病防治
  chronic hepatitis C, HCV, screening, epidemiology, disease prevention
• 臺灣C型肝炎防治的三大策略方向依序為「以治療引領預防」、「以篩檢支持治療」、「以預防鞏固成效」。策略二「以篩檢支持治療」意指透過篩檢找出未認知到自己罹病的民眾，並協助他們接受治療。C型肝炎的本土流行病學資料建立可找出盛行率高的地區，有助於篩檢工作，使C肝防治更為精準。
  The three strategies for the prevention and treatment of hepatitis C in Taiwan are "treatment leading prevention," "screening to support treatment," and "prevention to consolidate effectiveness." The second strategy, "Supporting treatment with screening," means identifying people who are not aware of their illness through screening and assisting them in receiving treatment. The establishment of local epidemiological data of hepatitis C can identify areas with a high prevalence, which will help the screening work and make the prevention and treatment of hepatitis C more accurate.
• 123-126
• 10.6288/TJPH.202104_40(2).PF02

• Link 公衛論壇 Public Health Forum
• 公共衛生師教、考、用之初探—以政府部門用人為例A preliminary study on Public Health Specialists in education, examination and employment-- in the case of public service department
• 謝依霖、古元玲、洪紹淵、莊人祥
  Yuan-Ling Ku, I-Lin Hsieh, Shao Yuan Hung, Jen-Hsiang Chuang
• 公共衛生師、政府部門、人力資源管理、證照制度
  public health specialist, government department, human resource management, certification system
• 公共衛生師法於2020年6月3 日發布施行，該法奠定公共衛生師認證機制與執業範圍等，也使我國成為亞洲第一個通過公共衛生師法的國家。公共衛生師之法制定位奠定後，應思考如何建置公共衛生師整體人力資源發展。本文從政府機關觀點看公共衛生師的教、考、用，並提出公共衛生師進入公部門的建議管道，與創造公共衛生師證照價值與品牌兩項觀點。
  The Public Health Specialist Law was promulgated and implemented on June 3, 2020. The law established the certification system and practice scope of public health specialists. It also made Taiwan the first country in Asia to pass the Public Health Specialist Law. After establishing the legal position of the public health professional, we should think about how to manage the overall human resource development of the public health professional. This article looks at the teaching, examination, and practicing of public health specialists from government agencies' perspective, proposes a channel for public health specialists to enter the public sector, and suggests creating the value and brand of the public health specialist certification.
• 127-132
• 10.6288/TJPH.202104_40(2).109140

• Link 綜論 Review Article
• 台灣青少年藥物濫用研究之文獻回顧Review of studies on adolescent drug abuse in Taiwan
• 林淑君、郭文正、管昱翔
  Shu-Chun Lin, Wen-Cheng Kuo, Yu-Siang Kuan
• 回顧性研究、青少年、藥物濫用
  review study, adolescent, drug abuse
• 本研究回顧1996年至2017年間國內青少年藥物濫用論文，以瞭解其內涵與題材類型之變化。本文以台灣博碩士論文知識加值系統、HyRead Journal台灣全文資料庫、台灣期刊論文索引與華藝線上圖書館，搜尋青少年藥物濫用論文，共取得59篇。研究發現： 這些論文可以分為四大類：論述性、調查性、發展歷程與關連性、以及介入性研究。四類篇數各佔二至三成。依照時序可分三階段，1996-2003年第一階段9篇；2004-2010第二階段20篇； 2011-2017第三階段30篇。這三階段的數量變化有明顯的上升趨勢，反映青少年藥物濫用議題日益受到學界重視。這三階段的論文題材亦隨年代而有變化。在第一階段以論述性文章為最多，偏重藥物濫用或預防計畫之概念介紹；第二階段以介入性論文較多，研究對象與研究方法呈現出多元的樣貌；到了第三階段論文篇數的成長幅度頗大，發展歷程與關聯性以及介入性論文為最多，前者多指出同儕或社會網絡對青少年藥物濫用扮演重要的因素；後者多聚焦在反毒教育課程或預防方案之效果。青少年藥物濫用議題之研究日益受到重視，研究議題多樣性也日益增加，此變化趨勢可能與社會情境、藥物濫用政策的變化相關。
  We reviewed Taiwanese research on adolescent drug abuse for the period from 1996 to 2017 to elucidate the changes in findings and major topics. We consulted the Taiwan Digital Library of Theses and Dissertations, HyRead Journal Taiwan full-text database, Humanities & Social Science Databases Catalog, and Airiti Library. A total of 59 articles on drug abuse among teenagers were identified from 1996 to 2017. The included papers were divided into 4 categories according to their approach: narrative, investigative, interventional, and a focus on developing processes/relevance. The 4 categories each accounted for 20%–30% of all papers. We divided the papers into 3 stages: the first (1996–2003), second (2004–2010), and third (2011–2017) stages included 9, 19, and 31 papers, respectively. The quantitative changes during these 3 stages exhibited a clear upward trend. This trend suggests that the problem of drug abuse among teenagers has been receiving increased attention. The subject matter also varied during the study period. In the first stage, most studies employed a narrative approach and focused on introducing the concept of drug abuse or prevention programs; in the second stage, intervention studies were more prevalent, and the research objects and research methods varied considerably; and in the third stage, studies focused more on developing processes/relevance and interventions. Research on adolescent drug abuse has received increasing attention, and the diversity of research topics has also increased. This change may be related to changes in social conditions and drug abuse policies.
• 133-150
• 10.6288/TJPH.202104_40(2).109128

• Link 綜論 Review Article
• 低價值醫療：國際經驗與對台灣的啟示 Low-value healthcare: international development experiences and the inspiration for Taiwan
• 郭語蓁、譚家惠
  Yu-Chen Kuo, Elise Chia-Hui Tan
• 低價值醫療、過度使用、醫療品質、國際經驗
  low-value care, overuse, health care quality, international experience
• 據經濟合作暨發展組織（OECD）統計，世界各國醫療費用皆有穩定上升的趨勢，為解決財務短絀，健康照護資源之重分配儼然成為政府必須面對的課題，而減少低價值醫療的使用，不僅能夠降低非必要的醫療保健支出，更可同時確保健康照護品質之水準。本文自PubMed及Web of Science等資料庫中進行文獻搜索，最後納入28篇具有量化分析之文獻進行綜合回顧。近年來歐美各國持續提出臨床上不建議執行醫療清單，透過彙整國際上低價值醫療之發展沿革、利用情形以及政策介入效益等資訊，能有助於我國政府在研擬改善低價值醫療項目清單之參佐，除低價值醫療項目定義應符合國情外，具有穩定資料來源以利後續監測也是值得重視的一環，藉由促進醫病溝通、有效率地使用醫療資源，降低低價值醫療利用，以達成「以病人為中心」健康照護理念。
  Health care spending has been growing steadily. With regard to addressing financial challenges in health care systems, health care resource reallocation has become a critical issue worldwide. Reducing the use of low-value health care can minimize health care expenditure and ensure care quality. Evidence-based recommendations, such as the Choosing Wisely lists from the United States and the “Do Not Do” prompts from the United Kingdom have been established. Understanding relevant history, the utilization of low-value health care services, and effectiveness of alternatives from other countries would help the Taiwanese government develop its own lists. Furthermore, country-specific definitions of low-value health care indicators should be formulated, and a stable data source for continual monitoring of utilization is also essential. By promoting patient–doctor communication and efficient health care utilization, the utilization of low-value health care services and patient-centered care can be reduced.
• 151-165
• 10.6288/TJPH.202104_40(2).109142

• Link 原著 Original Article
• 高風險孕產婦健康管理試辦計畫對照護利用及結果之初步影響Preliminary impact of a care management pilot program for high-risk pregnant women in terms of care utilization and outcomes
• 李果鴻、董鈺琪
  Guo-Hong Li, Yu-Chi Tung
• 照護協調性、產前照護、孕婦健康、新生兒健康
  care coordination, prenatal care, maternal health, neonatal health
• 目標：為提高產前照護利用及生產結果，國際間視產前照護協調服務為重要策略。我國自2017年起，實施高風險（社會經濟及懷孕相關風險）孕婦照護協調試辦計畫，因此本研究目的為探討我國針對高風險懷孕婦女實施照護協調試辦計畫對照護利用及結果之初步影響。方法： 本研究使用國民健康署提供之資料，選取於2017年5月至2018年5月間生產之所有孕婦，並以高風險定義相關條件，透過傾向分數配對出未參加計畫者，使用多元二分類邏輯斯迴歸模型，以檢測計畫介入是否有助於改善產婦產前檢查利用至少4或8次、剖腹產、低出生體重、早產及產婦併發症。結果：配對後共納入收案及未收案產婦各621人，參加計畫之產婦相較未參加者， 產檢未達4次、低出生體重之勝算較低，勝算比分別為0.11（95%信賴區間：0.03-0.44）、0.42 （95%信賴區間：0.23-0.77）。結論：高風險孕產婦健康管理試辦計畫之初步成效，可增加高風險產婦產前照護利用至少4次，及降低低出生體重。
  Objectives: To improve prenatal care utilization and birth outcomes, prenatal care coordination for pregnant women is internationally regarded as a critical strategy. Since 2017, a care coordination pilot program for high-risk (socioeconomic- and pregnancy-related risks) pregnant women has been implemented in Taiwan. The objective of this study was to examine the preliminary impact of this program on prenatal care utilization and birth outcomes among high-risk pregnant women. Methods: Data provided by the Health Promotion Administration on all women who gave birth at any time between May 2017 and May 2018 were employed. Propensity score matching and multivariate binary logistic regression were performed to examine whether the program intervention reduced the odds of having fewer than 4 or 8 prenatal care visits, a caesarean section, a baby with low birth weight, a preterm baby, or obstetric complications. Results: Each group included 621 pregnant women after matching. Pregnant women who participated in the program had lower odds of having fewer than 4 prenatal visits or a baby with low birth weight compared with those who did not participate (odds ratio: 0.11, 95% confidence interval: 0.03– 0.44; odds ratio: 0.42, 95% confidence interval: 0.23–0.77). Conclusions: The preliminary impact of the care coordination pilot program is, first, an increase in the proportion of high-risk pregnant women who undergo at least 4 prenatal care visits and, second, a decrease in the proportion of babies with low birth weight in this group.
• 166-175
• 10.6288/TJPH.202104_40(2).109126

• Link 原著 Original Article
• 民眾對全民健保重複用藥關懷函的電話回應：以質性分析探討重複用藥之相關因素Telephonic responses to the National Health Insurance medication duplication reminder letter: a qualitative analysis of factors related to medication duplication
• 蔡雅芳、官晨怡、鄭守夏、王佳雯
  Ya-Fang Tsai, Chen-I Kuan, Shou-Hsia Cheng, Chia-Wen Wang
• 重複用藥、關懷提醒、質性研究、全民健保
  medication duplication, reminder letter, qualitative analysis, National Health Insurance
• 目標：病人安全是全球公共衛生重要的議題之一，中央健康保險署嘗試對重複用藥高風險族群寄發關懷函提醒。本研究以質性方法分析民眾在收到關懷函後來電回應的內容，以瞭解病人認知與解釋重複用藥之相關因素。方法：本研究團隊與健保署合作，根據健保署所提供2019 年1月至3月間確認的重複用藥核扣名單，針對20歲以上且有使用降血糖或降血脂兩類藥品使用者為研究個案，寄發重複用藥提醒關懷函，於2019年7月1日至7月7日，共郵寄出11,000份關懷函，至8月13日止，陸續接獲265通民眾的回應電話，本研究係以民眾回應之內容進行主題分析。結果：根據民眾的電話回應，歸納與整理出以下的六大主題，分別為：民眾對於重複用藥的認知、民眾端認為與解釋重複用藥之個人因素、醫師因素、醫病關係，非醫療情境因素與其他回應等等。結論：重複用藥是一個複雜的問題，其發生存在不同面向的原因，需要病人與醫事人員的共同努力，方可保障病人用藥的安全。
  Objectives: Patient safety is a major issue in global public health. The National Health Insurance Administration (NHIA) in Taiwan introduced a pilot mail-reminder project for patients with duplicated medication. The responses of those who received the reminder letter were qualitatively analyzed to elucidate how they understand and explain the medication duplication. Methods: The research team collaborated with the NHIA and obtained a list of patients with duplicated medication; patients who were aged over 20 years and who received medication for hyperlipidemia and hyperglycemia were selected for this study. A total of 11,000 reminder letters were mailed to the selected patients during July 1–7, 2019. Until August 13, 2019, a total of 265 phone calls were received from the patients. The patients’ responses were analyzed using thematic analysis. Results: Six themes were identified: patient knowledge on medication duplication, patient-perceived individual factors related to medication duplication, patient-perceived doctor factors related to medication duplication, the relationship between health professionals and patients, nonmedical context influencing medication duplication, and other responses. Conclusions: Medication duplication is a complicated matter and exists for various reasons. Thus, a concerted effort is required by patients and health professionals to address this problem and enhance patient medication safety.
• 176-186
• 10.6288/TJPH.202104_40(2).109141

• Link 原著 Original Article
• 以焦點團體訪談探究台灣北區某集中檢疫所醫護人員自願參與防疫任務之分析 Using focus group interviews to investigate the willingness of medical personnel to voluntarily participate in COVID-19 group tasks in a one government quarantine facility in north Taiwan
• 蔡衣帆、黃俐晴、陳頌云、何璇、王嘉寧、楊雅婷、簡郁珊、黃遵誠
  Yi-Fan Tsai, Li-Ching Huang, Sung-Yun Chen, Hsuan Ho, Jia-Ning Wang, Ya-Ting Yang, Yu-Shan Chien, Tsun-Cheng Huang
• 新型冠狀病毒、集中檢疫所、檢疫者、焦體團體訪談、醫護人員
  COVID-19, government quarantine facility (GQF), quarantine subject, focus group interview, medical staffs
• 目標：台灣流行疫情指揮中心為提供新型冠狀病毒檢疫者生活的隔離空間，預防社區群聚擴散而設立集中檢疫所。醫療人員是需接觸檢疫者的第一線人員，易曝露在高危險傳染的工作環境。本研究旨在探討醫療人員為何會自願參與檢疫所防疫任務之原因分析，做為未來招募人員之參考。方法：本研究對象以北部某集中檢疫所衛生組醫護人員為招募族群，採焦點團體訪談，專家檢測訪談大綱內容一致性為91%，訪談結束後以內容分析法進行資料分析與彙整，歸納出受訪者意願概念。結果：共12位參與者，4位男性、8位女性，平均年齡48.1±6.4歲、檢疫所平均服務天數82.1±77.1天。分析訪談結果顯示影響醫護人員自願參與防疫任務共有四個面向和6個原因，分別為第一面向滿足安全需要，其原因為防疫裝備充足、標準作業程序完整、完善職前及在職教育訓練；第二面向滿足愛與歸屬的需要，其原因為工作氛圍良好；第三面向滿足自尊的需要，其原因為台灣SARS防疫經驗；第四面向滿足自我實現的需要，其原因為人本關懷心態。結論：在疫情爆發之際，各國就曾陸續傳出醫護人員不足或不願意參與防疫工作。由本研究結果分析可知指揮中心提供資源環境若能滿足Abraham Maslow需求層次，就能吸引醫療人員自願參與集中檢疫所進行任務。建議制定政策時可依需求評估去滿足各層次需求，方可吸引醫療尖兵投入防疫，持續守護社區人民健康。
  Objectives: The Taiwan Centers for Disease Control have established government quarantine facilities (GQF) to prevent the community spread of COVID-19. Medical personnel are frontline workers who must have contact with individuals in quarantine and are thus at higher risk of infection. As a reference for future recruitment, this study investigated why some medical personnel volunteer to care for individuals in GQF. Methods: The researchers used purposive sampling to recruit participants from a GQF in northern Taiwan. Focus group interviews were administered. The consistency of the interview outline content was 91%. After the interviews, content analysis was performed to examine and summarize the data. The data were coded before comparison, categorization and summarization, producing various core categories. Results: A total of 12 participants voluntarily attended our interviews, compromising 4 men and 8 women, with an average age of 48.1 ± 6.4 years and an average length of service in GQF of 82.1 ± 77.1 days. Our study results revealed four aspects and six reasons that affect the voluntary participation of medical staff in epidemic prevention tasks. The first aspect was meeting safety needs, and the reasons included sufficient personal protective equipment, complete standard operating procedures, and orientation training and in-service education and training. The second aspect was meeting the needs of love and belonging, and the reason included a good working atmosphere. The third aspect was meeting the need for self-esteem, and the reason included Taiwan’s previous SARS epidemic prevention experience. Finally, the fourth aspect was meeting the need for self-realization, and the reason was based on the humanistic concern. Conclusions: At the time of the coronavirus outbreak, various countries reported insufficient medical staff or staff unwilling to participate in epidemic prevention work. Our results revealed that if the environment met the Maslow’s hierarchy of needs, it can attract medical staff to volunteer in GQF tasks. In formulating policies, the needs must be met at all levels, so that medical staff would be willing to participate in epidemic prevention work.
• 187-198
• 10.6288/TJPH.202104_40(2).109145

• Link 原著 Original Article
• 接受政府培訓之運動保健指導員會到社區推廣身體活動嗎？2017年運動保健種子培訓課程之一年追蹤結果Will “exercise health instructors” promote physical activity in communities after official training courses? A one-year follow-up study of “2017 exercise health seeds instructors training program” in Taiwan
• 許秀帆、曾國維、吳品嫻、王英偉、林真夙、成庭甄、陸玓玲
  Hsiu-Fan Hsu, Kuo-Wei Tseng, Pin-Hsien Wu, Ying-Wei Wang, Chen-Su Lin, Chiung-Dan Chang, Ting-Chen Chen, Dih-Ling Luh
• 社區、身體活動、政府培訓計畫、追蹤
  community, physical activity, government training program, follow-up study
• 目標：探討運動保健種子師資培訓課程計畫之學員於培訓後至社區推動身體活動之經驗與其自我效能、教學工具使用經驗和推動態度之關聯性。方法：針對國健署「2017年運動保健種子師資培訓課程計畫」培訓完成之1,598位運動保健指導員，於2018年10月透過電子郵件邀請學員進行線上問卷調查，回應之有效樣本865份(回應率=54.13%)。依變項為受訪者自述2017年受訓後至社區推動身體活動之經驗，自變項包括：個人基本資料、工具使用數、推動態度、推動之自我效能等。透過SAS 9.4版以羅吉斯迴歸進行多變項分析。結果：(一)66.36%的受訪者自述於培訓後一年內至社區推動身體活動。(二)經多變項分析發現與相關變項工作年資超過104個月、社區工作、身體活動推動工具之使用種類數越多者及應用工具推動身體活動之自我效能越高者與「身體活動社區推廣經驗」有正向關聯性。結論：2017年運動保健種子培訓課程之一年追蹤調查發現有超過六成之結訓學員會到社區推廣身體活動，建議未來對此類培訓計畫應於事前規劃更嚴謹之評價研究設計或成本效益分析。
  Objectives: To find the relations among the physical activity promotion experience in communities (PAPEiC), self-efficacy, tool use experience, and promotion attitude of exercise promoters after official training. Methods: The 1,598 sports health instructors trained by the National Health Administration’s “2017 Sports Health Seed Teacher Training Program” were invited to take online surveys via email in October 2018. Respondent rate was 54.13% (n=865). The outcome variable was the self-reported experiences about PAPEiC after official training courses. Independent variable including：general information, tool use experience, promotion attitude, self-efficacy. Multivariate Logistic regression was performed using SAS 9.4 version. Results: (1) 66.36% of respondents reported that they promoted physical activity in the community within one year after the training. (2) The results of the multivariate analysis found that the PAPEiC was significant related with (i) work experience more than 104 months, (ii) community workers, (iii) more types of physical activity promotion tools are used, (iv) higher self-efficacy of using tools to promote physical activity. Conclusions: Our one-year follow-up survey founded more than 60% of the trainees will go to the community to promote physical activities after the official training program. Our results suggest that a more rigorous research design or cost-benefit analysis should be planned for training programs in the future.
• 199-212
• 10.6288/TJPH.202104_40(2).109135

• Link 原著 Original Article
• 台灣南部日間照顧機構老人樣本族群肌少症之盛行率與其相關因素之探討Prevalence and correlates of sarcopenia among a sample of older adults attending daycare centers in Southern Taiwan
• 陳玟潔、邱愛芳、林建志、邱群芳
  Wen-Chieh Chen, Aih-Fung Chiu, Chien-Chih Lin, Chun-Fung Chiu
• 日間照護、日常生活活動、老人、肌少症、洗澡障礙
  daycare, activity of daily living, older adult, sarcopenia, bathing disability
• 目標：瞭解日間照顧機構老人肌少症的盛行率與相關因素。方法：採橫斷式與立意取樣設計，對台灣南部6家日間照顧機構65歲老人進行訪談。收集資料包括基本資料、身體質量指數、簡易心智狀態問卷調查表、巴氏量表，以及肌少症指標（肌肉質量、手握力與6公尺走路速度）。結果：研究樣本共165位（男68位、女97位），平均年齡78.9±8.2歲；1/3個案（34.5%）最近一年內有跌倒情形；約1/4個案（23.6%）的BMI值小於21 kg/m2；超過6成（60.6%）個案有中重度認知缺損；一半以上（53.9%）個案屬於中重度依賴。以2019亞洲肌少症工作小組診斷切點計算，約5成（51.5%）個案有肌少症，男女比率相當。以多變量邏輯斯迴歸（Enter method）分析後，發現與肌少症相關的獨立危險因子有高齡、低身體質量指數、洗澡障礙與平地走動障礙四個變項，其OR值（95% Confidence interval）分別為1.06（1.00–1.12）、0.63（0.53–0.75）、3.76（1.01–13.99）、6.56（1.31–32.92）四個項目（p<0.05），其餘變項如上述兩項以外的巴氏量表中各變項、性別、教育程度、共病指標、一年內有跌倒史，以及認知狀態未達統計顯著。結論：本研究日照機構樣本肌少症盛行率超過五成。對於日照老人合併有低身體質量指數、洗澡能力及平地走動能力障礙者，需特別留意肌少症發生的可能與風險，以便及早偵測並採取相關策略來延緩或降低肌少症導致的相關危害。
  Objectives: Examine the prevalence of sarcopenia and its correlates. Methods: In this cross-sectional study, 68 men and 97 women aged ≥ 65 years were recruited from 6 daycare centers in Southern Taiwan. In addition to recording participant demographic characteristics, the following were measured: body mass index, Short Portable Mental State Questionnaire, Barthel Index, handgrip strength, 6-m walking speed, and muscle mass index (through bioelectrical impedance analysis). The diagnosis of sarcopenia was made according to the 2019 criteria of the Asian Working Group for Sarcopenia (AWGS). Results: Among the 165 participants (mean age: 78.9 ± 8.2 years), 34.5% had fallen in the preceding year, and nearly one-fourth (24.2%) had a BMI value of <21 kg/m2; moreover, 60.6% of participants had moderate to severe cognitive impairment, and 53.9% were moderately to severely dependent in activities of daily living. The prevalence of sarcopenia was 51.5%, which is 6.0% higher than the prevalence obtained when using the criteria recommended by the European Working Group on Sarcopenia in Older People. Multivariate logistic regression revealed that sarcopenia was independently associated with (1) advanced age, (2) a low BMI, and inability to (3) bathe and (4) walk on a flat surface. The odds ratios (95% confidence interval) for these 4 independent variables were 1.06 (1.00–1.12), 0.63 (0.53–0.75), 3.76 (1.01–13.99), and 6.56 (1.31–32.92), respectively. Conclusions: Sarcopenia was highly prevalent in this study’s sample. Instead of merely focusing on older adults with advanced age or a low BMI, health providers should focus more on older adults who are unable to bathe and walk on a flat surface; such people are at particular risk of suffering from sarcopenia, which further leads to serious health problems. Moreover, further intervention to prevent or delay the onset of sarcopenia may improve geriatric care in daycare centers.
• 213-222
• 10.6288/TJPH.202104_40(2).109127

• Link 原著 Original Article
• 台灣大腸癌死亡率之空間分析Spatial analysis of colorectal cancer mortality in Taiwan
• 李宗儒、陳昭榮、李妙純
  Tsung-Ju Li, Jun-Rong Chen, Miaw-Chwen Lee
• 大腸癌死亡率、空間分析、鄰近效應、地理加權廻歸
  colorectal cancer, spatial analysis, neighborhood effects, geographically weighted regression
• 目標：本研究旨在探究台灣大腸癌死亡率之空間分佈，檢驗空間鄰近效應及社會、醫療資源因子之相關性。方法：使用2015年衛生福利部死因統計檔，對台灣349個鄉鎮市區（離島除外）大腸癌死亡率進行空間分析。以空間延遲模型探究大腸癌死亡率之空間鄰近效應。以地理加權廻歸分析鄉鎮市區大腸癌死亡率相關因子的異質性。結果：大腸癌死亡率有空間聚集（Global Moran’s I = .2182），熱區集中新北市、苗栗、嘉義縣及屏東。空間延遲模型不但呈現大腸癌死亡率之正向空間鄰近效應（廻歸係數= .16）；亦具較佳的模型配適度（判定係數= .3217）。空間延遲模型證實整體上，低教育程度比例、老年人口比例、大腸癌發生率愈高及家庭醫師人口比愈低則大腸癌死亡率亦愈高；但，地理加權廻歸估計顯示這些相關之鄉鎮市區估計具異質性，12.9%至79.1%鄉鎮顯著異於平均值。結論：地理資訊系統逐漸普及，未來地區資源分配，應考慮空間相關，評估在地風險及其異質性，以提升資源運用有效性及縮減地區健康不平等。
  Objectives: To explore the spatial patterns of colorectal cancer mortality in Taiwan, examine its neighborhood effect, and identify potentially associated factors. Methods: This study used spatial econometrics to analyze the geographical distribution of colorectal cancer mortality in Taiwan across 349 townships based on the 2015 cause of death statistics from Ministry of Health and Welfare. A spatial lag model was used to examine the neighborhood effects, and geographically weighted regression was applied to investigate the spatial heterogeneity in the relationship of social and medical resources with colorectal cancer mortality. Results: Colorectal cancer mortality exhibited significant spatial clusters (Global Moran’s I = 0.2182), with hotspots in New Taipei city, Miaoli, Chiayi, and Pingtung. The spatial lag model yielded evidence of positive neighborhood effects (β = .16) with acceptable goodness of fit (coefficient of determination = .3217). Moreover, its results indicated that colorectal cancer mortality is associated with areas with higher proportion of limited education, higher proportion of older adults, higher incidence of colorectal cancer, and lower ratio of family physicians to the population. However, the geographically weighted regression revealed a heterogeneous association of these factors with mortality across 349 townships, with 12.9% to 79.1% of towns differing significantly from the mean estimates. Conclusions: With the increasing popularity of the geographical information system, policy makers focused on resource allocation should consider spatial correlation when identifying local risk factors and their heterogeneous effects on health or diseases. Doing so would improve resource effectiveness and reduce regional health inequalities.
• 225-240
• 10.6288/TJPH.202104_40(2).109105

• Link 評論 Commentary
• 評論：肌少症於長照服務：仍待更多的研究Commentary: addressing Sarcopenia in the Long-Term Care Setting in Taiwan: More Work Is Needed
• 吳易謙
  I-Chien Wu
• 無
  none
• 無
  none
• 223
• 10.6288/TJPH.202104_40(2).10912701

• Link 作者回覆 Authors' response to commentary
• 作者回覆：肌少症於長照服務仍待更多研究Authors' response to commentary: addressing sarcopenia in the long-term care setting in taiwan: more work is needed
• 陳玟潔、邱愛芳、林建志、邱群芳
  Wen-Chieh Chen, Aih-Fung Chiu, Chien-Chih Lin, Chun-Fung Chiu
• 無
  none
• 無
  none
• 224
• 10.6288/TJPH.202104_40(2).10912702