40卷4期

• Link 政策論壇 Policy Forum
• COVID-19疫情中的精神健康議題Mental health issues in the COVID-19 pandemic
• 顏正芳
  Cheng-Fang Yen
• COVID-19、精神健康
  COVID-19、mental health
• 新型冠狀病毒疾病（c o r o n a v i r u s disease-2019, COVID-19）於全世界肆虐， 台灣亦深受其害。以生態學角度來看， 精神健康是個人和環境互動的結果，而 COVID-19對於個人、家庭、學校、鄰里、 職業環境、大社會經濟和政策都造成重大 衝擊。截至2021年7月10日止，在PubMed 以“COVID-19”和“mental health”為關鍵字， 可搜尋到將近一萬篇論文，其中整合分 析（meta-analysis）論文就有144篇，顯示 COVID-19疫情中的精神健康已被視為重大 的公共衛生議題。以下將依照COVID-19對 於一般民眾、感染者、醫療人員、弱勢族群 之精神健康的影響，分別進行介紹。
  Coronavirus disease-2019 (COVID-19) is raging worldwide, and Taiwan is also suffering from it. From an ecological perspective, mental health results from the interaction between individuals and the environment, and COVID-19 has a significant impact on individuals, families, schools, neighborhoods, occupational environments, social economy, and policies. As of July 10, 2021, in PubMed with "COVID-19" and "mental health" as keywords, nearly 10,000 papers can be searched, including 144 meta-analysis papers, showing that Mental health in the COVID-19 epidemic has been regarded as a significant public health issue. Therefore, the following will be introduced separately according to the impact of COVID-19 on the mental health of the general public, infected persons, medical personnel, and vulnerable groups.
• 347-350
• 10.6288/TJPH.202108_40(4).PF04

• Link 公衛論壇 Public Health Forum
• 台灣HIV感染者的口腔照護現況與展望The current status and the prospect of oral care for people living with HIV in Taiwan
• 陳韋翰
  Wei Han Chen
• HIV感染者、口腔照護
  HIV Infected, oral care
• HIV會對感染者的口腔健康造成影響，使感染者比非感染者有更高的牙科治療需求。根據美國牙科學會（American Dental Association）建議，以及疾病管制署訂立的「牙科感染管制措施指引」，HIV感染者不但可以接受常規牙科治療，且感染管制原則與其他血液傳染疾病並無差異，理論上牙科診所的人力、設備足以照顧大部分感染者，但感染者難以尋求牙科治療，導致牙科需求未被滿足的情況仍舊存在，而且比其他醫療科別更加嚴重，這個情況會影響感染者的口腔健康，並降低感染者的口腔健康相關生活品質。
  HIV affects infected people's oral health, making infected people have a higher demand for dental treatment than non-infected people. According to the American Dental Association's recommendations and the "Guidelines on Dental Infection Control Measures" set by the Centers for Disease Control, HIV-infected persons can not only receive conventional dental treatment, but the principles of infection control are no different from those of other blood-borne diseases. Theoretically, dental clinics have sufficient staffing and equipment to take care of most infected persons. However, it is difficult for infected persons to seek dental treatment compared to other medical departments, resulting in unsatisfied dental needs. This situation will affect the oral health of infected persons, snd reduce the oral health-related quality of life of infected persons.
• 351-354
• 10.6288/TJPH.202108_40(4).110040

• Link 綜論 Review Article
• 日本長照領域推動自立支援照顧模式經驗之初探A preliminary study on promoting the self-reliance support model in long-term elder care in Japan
• 徐明仿
  Ming-Fang Hsu
• 介護福祉士、自立支援、維護尊嚴、照顧工作、自主性參與
  certified care worker, self-reliance support, upholding dignity, care work, willingly participate
• 面臨身心功能逐漸衰退的老年長照需求者，照顧工作者應如何推動「自立支援」照顧模式，如何協助老年長照需求者提升其生活自理能力，是本文欲闡明之關心所在。有鑑於我國長照界推動的自立支援照顧模式是取經自日本長照界，本文收集日本1988年至2000年之老年長照政策官方文獻以及日本近三年出版之介護福祉士教科書及照顧工作者培訓教科書，篩選納入章節含有「尊嚴」、「自立」、「自立支援」、「照顧的基礎」計8冊，以概念性文獻回顧日本政府與日本社福學者是如何詮釋老年長照領域之「自立支援」理念以及透過推動「自立支援」照顧模式，如何將照顧工作內涵朝「廣義」概念發展。本文歸納出日本長照領域推動「自立支援」照顧模式之特色與意義各有五點；於長照實務場域中的推動步驟含有七項流程；日本培育照顧工作者具備之專業能力包含六個面向，可供我國未來探討「廣義」照顧工作內涵以及規劃照顧工作者提升其專業能力內涵之參考
  This aim of this study was to address how care workers can promote the self-reliance support model and assist elderly people to enhance their self-reliance capabilities when facing the physical and mental deterioration associated with old age. We searched for the terms “dignity,” “selfreliance,”“self-reliance support,” and “foundations of care work” in eight certified care worker training textbooks for the past 3 years. A conceptual literature review approach was adopted for examining how Japanese social affairs researchers interpret the concept of self-reliance in longterm elder care. Subsequently, we expanded the caregiving content to a more general concept through promotion of the self-reliance caregiving model. Finally, the study identified five characteristics of the self-reliance caregiving model in use in the long-term care sector in Japan. We discuss seven steps for promoting appropriate practices in the long-term care field and argue that the core professional competence of Japanese care workers is to put “upholding dignity” and “self-reliance” into practice. Additionally, six aspects of professional capability training were identified in this study. The insights gleaned can be a reference on general caregiving for Taiwanese care workers that may be used to enhance their professional capabilities.
• 355-370
• 10.6288/TJPH.202108_40(4).110033

• Link 原著 Original Article
• 新北偏區衛生所長照All-In-One計畫之成效評估Effectiveness of All-In-One program of long-term care in rural health centers of New Taipei City
• 吳肖琪、蔡惟丞、吳義勇、陳潤秋、高淑真、陳玉澤、吳玉鳳、汪辰陽
  Shiao-Chi Wu, Wei-Cheng Tsai, Yee-Yung Ng, Ran-Chou Chen, Shu-Cheng Kao, Yu-Che Chen, Yu-Feng Wu, Chen-Yang Wang
• 衛生所、偏遠地區、長照計畫2.0、長照服務利用、長照All-In-One
  health center, rural area, Long-Term Care 2.0, long-term care utilization, Long-Term Care All-In-One
• 目標：衛生所是政府守護社區及偏鄉民眾健康的基層機關。新北市為扭轉偏區長照服務資源不足的困境，2018年推展「長照All-In-One計畫」，讓13個偏區衛生所皆成為照管分站，讓偏區民眾可在衛生所獲得長照的服務。本研究目的為評估新北市偏區衛生所執行此計畫之成效。方法：採回溯性世代研究，由新北市衛生局從衛生福利部「照顧服務管理平台」擷取新北市2018年1月至2019年6月長照2.0服務資料，依照管專員每半年對個案至少評估一次，將資料區分為三個半年時段（P1、P2、P3）進行分析，將每個研究時段的使用資料歸人定義長照2.0使用者半年使用費用、人均月費用。以廣義估計模型（Generalized estimating equations,GEE）分析偏區與都會區在三個研究時段使用長照2.0服務的變化趨勢。結果：在2018上半年（P1）計畫剛開始時，新北市偏區長照2.0使用率低於都會區（7.46% vs 7.72%）；至2019上半年（P3），偏區已明顯高於都會區（14.6% vs 13.0%）。控制其他變項後，偏區半年長照使用費用於2018上半年（P1）雖然較都會區低（b=-7,116.76, p<0.05），但城鄉差距在P2及P3逐漸縮小，至P3偏區增加量已顯著較都會區多（b=3,113.96及b=6859.47，p>0.05及p<0.05）；新北市人均月費用P3顯著較P1低（b=-1,076.73, p<0.05），偏鄉降低的情形較都會多，但未達統計上顯著差異（b=-754.83, p>0.05），可能與偏區使用人數快速增加有關。結論：All-In-One計畫藉由照管專員人力挹注與輔導，使偏區衛生所從傳統提供醫療、公共衛生預防保健服務，擴增為具長照管理中心分站，兼有物理治療與輔具資源中心之功能；此模式值得各縣市參考。
  Objectives: A health center is a fundamental governmental institution that protects people’s health, particularly in rural districts. For overcoming the shortage of long-term care (LTC)resources in rural districts, the Health Affairs Bureau of New Taipei City has implemented the All-In-One program in 13 rural health centers since 2018. The aim of this study was to evaluate the effectiveness of the All-In-One program. Methods: This retrospective cohort study was conducted through extraction of the data of LTC service users in New Taipei City from January 1, 2018, to June 30, 2019, from the Care Service Management Information Platform database of the Ministry of Health and Welfare. The extracted data were divided into 3 periods: P1 (from January 1, 2018, to June 30, 2018), P2 (from July 1, 2018, to December 31, 2018), and P3 (from January 1, 2019, to June 30, 2019). The trends in the LTC service 2.0 use rate and 6- and 1-month expenditure per user in each period in rural and urban districts were analyzed using generalized estimating equations. Results: Because the All-In-One program began in 2018, the usage rate of LTC service 2.0 in P1 was lower in rural districts than in urban districts (7.46% vs. 7.72%). In P3, the usage rate of LTC service 2.0 in rural districts was significantly higher than that in urban districts (14.6% vs. 13.0%, p < .05). After controlling other variables, the LTC 6-month expenditure per user in rural districts was less than that per user in urban districts during P1 (b = −7,116.76, p < .05). However, the 6-month expenditure per user increased significantly faster in rural districts than in urban districts in P2 and P3 (b = 3,113.96 and 6,859.47, respectively; p > .05 and p < .05). The decline in expenditure per month per user between P1 and P3 was significant (b = −1,076.73, p < .05). However, the decline in expenditure in rural districts tended to be quicker than that in urban districts (b = −754.83, p > .05). This may have been related to the increased usage rate. Conclusions: All- In-One programs in rural districts have empowered rural health centers to provide not only medical and public health services but also physiotherapy and assistive devices as a substation of LTC management centers. The All-In-One program is worth considering by other counties and cities for improvement of LTC in rural districts.
• 371-381
• 10.6288/TJPH.202108_40(4).110022

• Link 原著 Original Article
• 環境汙染物與大腸直腸癌關聯性之台灣單一醫學中心前驅性研究A pilot study examining the relationship between environmental contaminants and colorectal cancer at a single medical institute in Taiwan
• 儲天輝、周育緯、林聖倫、林淑芬、陳鴻華、胡萬祥、陳彥仰、張簡國平、張峻桓、蔡孟錡、黃昭誠
  儲天輝、周育緯、林聖倫、林淑芬、陳鴻華、胡萬祥、陳彥仰、張簡國平、張峻桓、蔡孟錡、黃昭誠
• 大腸癌、環境汙染物、微量分析、酵素免疫分析法
  colorectal cancer, environmental contaminants, microanalysis, enzyme-linked immunosorbent assay
• 目標：大腸直腸癌(CRC)在惡性腫瘤中具高發生率與死亡率，台灣CRC病患急劇增加可能與環境汙染物(多環芳香烴碳氫類化合物、硝酸鹽和亞硝酸鹽類)有關。因此，本篇研究探討此類汙染物與台灣CRC的相關性。方法：配對的CRC患者血漿與腫瘤組織檢體取自高雄長庚紀念醫院組織銀行，由正修科技大學超微量研究科技中心萃取後，以酵素免疫分析法測定其中之硝酸鹽及亞硝酸鹽濃度，另以氣相層析儀串聯質譜儀進行16種多環芳香烴偵測。結果：因血漿中所含之亞硝酸鹽及多環芳香烴均未檢出，後續實驗針對硝酸鹽進一步分析。實驗結果顯示CRC病患血漿的硝酸鹽濃度與對照組無顯著差別，但腫瘤組織中的硝酸鹽含量顯著高於配對的血漿。但是，硝酸鹽濃度在配對的CRC血漿與腫瘤組織中不具顯著關聯，且不同期別CRC的血漿與腫瘤組織硝酸鹽含量也無顯著差異。結論：此較小樣本數之前驅性研究顯示血液與腫瘤中硝酸鹽含量與CRC的相關性並不顯著，但是可提供後續進一步研究的重要潛在參考依據。
  Objectives: Colorectal cancer (CRC) is a major health problem with high incidence and mortality rates worldwide. The increased incidence of CRC in Taiwan may be associated with environmental contaminants such as polycyclic aromatic hydrocarbons (PAHs), nitrate, and nitrite. Accordingly, in this study, the relationship between these contaminants and CRC was investigated. Methods: Paired plasma and tumor tissues of CRC patients were obtained from the Tissue Bank at Kaohsiung Chang Gung Memorial Hospital. The samples were extracted and analyzed using enzyme-linked immunosorbent assay and gas chromatography-tandem mass spectrometry for detecting the concentrations of nitrate/nitrite and 16 types of PAHs, respectively, at the Super Micro Mass Research & Technology Center, Cheng Shiu University. Results: Nitrite and the 16 types of PAHs were undetectable in the plasma; thus, only nitrate was selected for further investigation. The data indicated that the plasma levels of nitrate were not significantly different between the CRC and control groups. Notably, the average levels of nitrate in tumor tissues were significantly higher than the average plasma levels, but the nitrate levels in paired plasma and tumor tissues did not show a significant correlation. Moreover, no significant difference in the nitrate levels of plasma and tumor tissues was found in patients with different tumor stages. Conclusions: In this pilot study, no significant correlation was found between the nitrate levels in plasma and tumors of CRC patients, which could be caused by the smaller study cohort. However, the result is a potentially valuable reference for further research.
• 382-393
• 10.6288/TJPH.202108_40(4).110037

• Link 原著 Original Article
• 以質性研究探討台灣推動復能服務之困境與因應策略—從服務提供者觀點分析A qualitative study on the difficulties and strategies for promoting reablement services in Taiwan from the perspectives of providers
• 蔡宜蓉、毛慧芬、林佳萱、李玉春、張玲慧
  蔡宜蓉、毛慧芬、林佳萱、李玉春、張玲慧
• 復能、長期照護、質性研究、紮根理論、困境與因應
  無none
• 目標：台灣長期照顧十年計畫2.0自2018年，建立長期照顧新模式，推動復能服務，強調功能性訓練，與長照1.0以身體功能改善為目標的居家復健有所差異。本研究探討專業人員於照護模式的改革中，實務遇到的困難與因應策略。方法：採紮根理論，以南部某縣市所舉辦之復能輔導會議及世界咖啡館討論中，針對復能執行現況與經驗之討論紀錄進行質性分析。參與者包含參與討論之復能團隊人員（如：照顧管理專員、個案管理師、職能治療師、物理治療師及護理師等）。結果：共690人參與活動。實務面臨之困難，共歸納出兩個主題：(1)「對復能無共識」：對復能原則的理解有限或誤解，及建立共識的教育訓練不完善；和(2)「無法有效地團隊合作」：參與人員多與溝通管道不足。因應策略主題有(1)「以個案及其目標為中心」，可行辦法包括個別化目標、關係建立、了解潛能；和(2)「建立新的團隊架構與互動機制」：共同訪視、教育訓練與建立新的溝通管道。結論：推動復能時，從價值觀改變、教育宣導，到服務團隊之配套和整合不足，致使照護模式的改革困難。本研究提出可供參考的策略，未來可納入政策制訂者及服務使用端的觀點更深入探討。
  Objectives: Compared with Long-term Care 1.0 in Taiwan that emphasizes improving physical function with home-based rehabilitation, Long-term Care 2.0 adopts a home-based Reablement approach that emphasizes functional training. This study explores the practical obstacles when the providers implemented reablement and proposes corresponding strategies. Methods: Grounded Theory was adopted to qualitatively analyze the records of World Café meetings and advisory meetings collected from the Reablement Improvement Project in a southern city. Participants were the members of reablement teams who participated in the meetings (such as care managers, case managers, occupational therapists, physical therapists, and nurses). Results: 690 people participated. The practical difficulties of implementation included: (1) a limited understanding or misinterpretation of reablement and inadequate staff training to form a consensus on what reablement constitutes, and (2) difficulty in building an inter-disciplinary reablement network. The strategies to overcome these obstacles include (1) a client-centered and goalcentered approach, such as rapport building, individual goal-setting, and potential assessment and (2) exploration of a workable teamwork and communication mechanism, such as joint visits, joint staff training, and new communication platforms. Conclusion: Differing care values about aging and family and inadequate instructions and dissemination of the policy information contributed to the difficulties of implementing reablement. We proposed corresponding strategies for future research and policy making. Perspectives from policy makers and service users can be further explored.
• 394-405
• 10.6288/TJPH.202108_40(4).110039

• Link 原著 Original Article
• 影響醫師使用分級醫療電子轉診系統因素與成效評估之初探Factors determining physicians’ perspectives on bidirectional electronic referral systems’ use and performance
• 陳定紘、蕭如玲、陳奕翰
  Ting-Hung Chen, Ju-Ling Hsiao, Yi-Han Chen
• 分級醫療電子轉診系統、醫師、資訊系統持續使用的後接受模式、使用成效
  bidirectional electronic referral system, physician, post-acceptance model of information system continuance, individual performance
• 目標：確立影響醫師持續使用分級醫療電子轉診系統之關鍵因素與成效，以強化系統功能與服務需求，提昇病患持續照護品質，落實分級醫療制度的推動。方法：本研究以資訊系統持續使用的後接受模式為基礎，結合認知易用性、信任與使用成效，來探討影響醫師持續使用轉診系統之因素與使用成效，針對有使用轉診系統經驗之醫師進行問卷調查。回收有效問卷為121份（55.5%），採SmartPLS3.2.6進行資料分析。結果：影響醫師對電子轉診系統之期望確認、認知易用性、認知有用性、滿意度、信任對持續使用（R2=0.584）皆有顯著影響，持續使用亦顯著影響使用成效R2=0.421）。其中使用成效以「能更有效率完成雙向轉診」、「提昇病患照護品質」及「有效掌握轉診病人的動態」為排序前三項。結論：結果可提供推動分級醫療轉診歷程中，持續關注影響醫師持續使用電子轉診系統之因素與使用成效，以作為系統改善的依據，促進醫療資訊流暢，達成分級醫療之利基。
  Objectives: This study investigated physicians’ perspectives on factors influencing the continuing use and performance of bidirectional electronic referral systems. Methods: The postacceptance model of information systems continuance is extended, with perceived ease of use, trust, and individual performance used to identify critical factors affecting bidirectional electronic referral systems’ continuance and performance. A survey questionnaire was administered to collect data from physicians experienced in using such systems. Of the 218 questionnaires distributed, 121 valid questionnaires were returned, corresponding to a valid response rate of 55.5%. The data were analyzed using SmartPLS 3.2.6 software. Results: Continuance (R2 = .584) was mainly affected by confirmation, perceived usefulness, perceived ease of use, trust, and user satisfaction, whereas individual performance (R2 = .421) was affected by continuance. Moreover, the primary three uses of bidirectional electronic referral systems comprised the efficient completion of bidirectional referrals, enhancement of patients’ quality of continuing care, and effective monitoring of patients’ locations and activities. Conclusions: The findings serve as a reference for formulating a bidirectional referrals policy, charting bidirectional electronic referral systems’ performance, and improving these systems. In addition, they provide insights into factors influencing physicians’ continued use of these systems and facilitate the promotion of seamless medical information flows and the development of bidirectional referral niches.
• 408-416
• 10.6288/TJPH.202108_40(4).109150

• Link 原著 Original Article
• 評價復原力介入對第1型糖尿病青少年的自我照顧行為及血糖控制之成效Evaluation of the effectiveness of a resilience intervention for selfcare behavior and glycemic control of youth with type 1 diabetes
• 唐善美、陳百薰、王瑞霞、王慈柔
  Shan-Mei Tang, Bai-Hsiun Chen, Ruey-Hsia Wang, Tzu-Jou Wang
• 復原力、第1型糖尿病青少年、自我照顧行為、生活品質、糖化血色素
  resilience, youth with type 1 diabetes, self-care behaviors, quality of life, glycolated hemoglobin
• 目標：研究顯示第1型糖尿病青少年的血糖控制較差，復原力強調協助青少年利用優勢克服逆境。本研究目的是探討復原力介入後對第1型糖尿病青少年的自我照顧行為、生活品質、復原力及糖化血色素之成效。方法：本研究為類實驗性研究設計，在南臺灣三大醫學中心採方便取樣共125位10-18歲第1型糖尿病青少年隨機分派為兩組，對照組（n = 80）如過去的一般照護，未提供任何介入，而實驗組（n = 45）會接受共三個月復原力介入策略，包括認識自己及激發覺醒、解決問題、接受、轉移注意力及情緒支持，並透過兩次面訪及三次的電訪進行追蹤。介入前、介入後三個月皆測量自我照顧行為、復原力、生活品質及糖化血色素，介入後六個月再收集一次糖化血色素值。採用頻率、百分比、平均數、標準差、卡方檢定、t檢定及廣義估計方程式進行資料分析。結果：研究發現實驗組的自我照顧行為（p = .030）及復原力（p< .001）於介入後三個月，提升改變 顯著高於對照組；實驗組於介入後三個月及六個月的糖化血色素降低的改變量顯著高於對照組（p < .001），而兩組的生活品質改變 未達顯著差異。結論：本研究可提供實務、研究及教育界能以復原力介入為基礎，來改善第1型糖尿病青少年自我照顧行為及糖化血色素的控制。
  Objectives: Youth with type 1 diabetes have poor glycemic control. Resilience interventions emphasize helping youth use their advantages to overcome adversity. The purpose of this study was to investigate the effectiveness of a resilience intervention in improving the self-care behavior, resilience, quality of life, and glycosylated hemoglobin of youth with type 1 diabetes. Methods: A quasi-experimental design was used. Convenience sampling was adopted to recruit 125 participants aged 10–18 years and having type 1 diabetes from three major medical centers in southern Taiwan. The participants were randomly assigned to two groups. Those in the control group (n = 80) received general care as in the past without the intervention. Those in the experimental group (n = 45) received a 3-month intervention on resilience strategies, including self-awareness, problem-solving, acceptance, distraction, and mental support. Two face-to-face interviews and three telephone interviews were then conducted for tracking. Self-care behavior, resilience, quality of life, and glycosylated hemoglobin were measured before the intervention and 3 months postintervention, and glycosylated hemoglobin values were collected again 6 months postintervention. Frequency of use, percentage, average, standard deviation, chi-square test, t test, and generalized estimating equation were used in data analysis. Results: The improvement in selfcare behavior (p = .03) and resilience (p < .001) of the experimental group at 3 months postintervention was significantly greater than that of the control group; the reduction in glycosylated hemoglobin in the experimental group at 3 and 6 months postintervention was also significantly higher (p < .001). Change in quality of life did not differ significantly between the groups. Conclusions: The study offers a reference to practical, research, and education circles for using a resilience intervention as the basis to improve the self-care behavior, resilience, and hemoglobin glycosylation control of youth with type 1 diabetes.
• 419-428
• 10.6288/TJPH.202108_40(4).109143

• Link 原著 Original Article
• 長期照顧機構中中風住民潛在不適當的藥物使用：使用Beers標準觀察的個案Potentially inappropriate medication use among stroke residents of a long-term care facility: an observational case study using the Beers Criteria
• 刑志彬、連嘉豪、李仁愛、樊雪春、陳世銘、賴誠斌、蔡宜樺
  Chih-Pin Hsing, Jia-Haur Lian, Jen-Ai Lee, Hsueh-Chen Fan, Shih-Ming Chen, Cheng-Pin Lai, Yi-Hua Tsai
• Beers標準、不當用藥情況、中風、長期照顧、處方優化
  Beers Criteria, potentially inappropriate medication, stroke, long-term care, deprescribing
• 目標：研究欲探索長期照顧機構罹患中風住民（≥ 65歲）在潛在不適當用藥之人口變項情形、藥品類項，以及處方優化的合作經驗。方法：本研究是個案研究法，對象為台北市某區域醫院附設長期照顧機構22位住民，使用前瞻性的橫斷式研究蒐集資料，包含有(一)長期照顧機構住民基本資料（性別、年齡、用藥種類）和(二)不適當用藥盛行率、介入用藥結果。結果：本研究參與對象的慢性疾病數以4種最多，處方用藥數則以6-10種居多，在潛在不適當用藥方面，以Quetiapine居多。在處方優化有15位住民用藥需與醫師討論處方優化事宜，所佔比例為68.2%。結論：本研究透過2019年的Beers標準，發現長期照顧機構罹患中風住民用藥狀況有其特殊性，醫師依據個別住民的特定情況，考量藥物使用之目的性、有效性、迫切性、劑量合理性等，建議採用醫師與藥師的合作模式，並搭配Beers標準為參考，以降低潛在不適當用藥與 處方優化。
  Objectives: The demographic variables and drug use of stroke residents (aged ≥ 65 years) in long-term care facilities were explored for potentially inappropriate medication use, and a cooperation model for prescription optimization was examined. Methods: A total of 22 residents of a regional hospital in Taipei City were included. Data on the following were collected through a prospective cross-sectional method: (1) basic information (sex, age, types of medication), (2) prevalence of potentially inappropriate medication use, and (3) results of the medication intervention. Results: The maximum number of chronic diseases of any participant was four. The participants used 6 to 10 prescribed medications. Quetiapine was the foremost potentially inappropriate medication. The medications of 15 residents (68.2% of the participants) required discussion with attending physicians for deprescribing. Conclusions: Using the Beers criteria, the study determined that the prescriptions and medications of stroke residents in a long-term care facility exhibited unique characteristics. Attending physicians consider factors including the purpose, effectiveness, urgency, and rationality of dosage according to the specific conditions of individual residents when making prescriptions. The adoption of a cooperation model between physicians and pharmacists is recommended, as is the use of the Beers criteria as a reference to reduce potentially inappropriate medications and to promote prescription optimization.
• 429-440
• 10.6288/TJPH.202108_40(4).110049

• Link 原著 Original Article
• 「兒童版飲食態度量表-26題」應用於本土國小高年級兒童之切點探究Exploration of the optimal cutoff point of the ChEAT-26 in grade 5 and 6 elementary school students in Taiwan
• 陳宇平
  Yu-Ping Chen
• 飲食障礙、兒童版飲食態度量表-26題、國小、切點
  eating disorders, ChEAT-26, elementary school, cut-off point
• 目標：探究「兒童版飲食態度量表-26題」（ChEAT-26）在台灣國小高年級兒童使用的最佳切點，期有效應用以降低本土飲食障礙之年輕與嚴重化。方法：採兩階段設計進行：1.邀請願意配合研究之南台灣四所國小，先以「ChEAT-26」對各校五、六年級學生共1859位進行集體施測；2.再依量表總分並考慮正異常組人數相當之原則，按比例以分層隨機抽樣方式，在四 校共抽取到380人，進一步取得家長同意書人數為276人（72.6%），安排進入第二階段診斷性晤談。結果：針對276位兒童進行第二階段診斷性晤談後，發現有5位學生診斷為陽性。以ROC曲線分析發現，當切點為16.5時，「ROC」曲線下面積（AUC）為0.704、敏感度80%、特異度44.3%乃較佳之切點；且因「ChEAT-26」為整數計分，亦即在實務上，將17分設為切點更方便應用。結論：「ChEAT-26」在台灣國小高年級學生使用時，飲食障礙高危險群之篩選切點以17分為宜，文末針對結果進行討論與建議。
  Objectives: The optimal cutoff point of the 26-item Children’s Eating Attitude Test (ChEAT-26) used in grade 5 and 6 elementary school students was explored in Taiwan with the aim of effectively screening and managing eating disorders. Methods: A two-stage design was adopted: (1) four elementary schools willing to participate in the research were enrolled, and the ChEAT-26 was applied in 1,859 students in grades 5 and 6; and (2) 380 people were selected through stratified random sampling, and 276 people (72.6%) were enrolled in the second stage of diagnostic interviews after parental consent was obtained. Results: The second-stage diagnostic interview with 276 children revealed a positive result for 5 children. The most suitable cutoff point was 16.5, where the area under the receiver operating characteristic curve, sensitivity, and specificity were 0.704, 80%, and 44.3%, respectively. Furthermore, because ChEAT-26 scores are integer scores, it is more convenient to use 17 as the cutoff point when applying. Conclusions: When the ChEAT-26 is used for senior students in Taiwan’s elementary schools, the cutoff point for screening high-risk groups for eating disorders is 17. The article concludes with a discussion and recommendation regarding the optimum ChEAT-26 score.
• 441-452
• 10.6288/TJPH.202108_40(4).110036

• Link 研究紀要 Research Brief
• 臺北榮民總醫院婦產部對COVID-19疫情的感染管制措施與成效COVID-19 control measures and their effectiveness in the Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
• 廖淑貞、簡莉盈
  Shu-Chen Liao, Li-Yin Chien
• COVID-19、婦產部、感染管制、成效
  COVID-19, obstetrics and gynecology department, infection control, effectiveness
• 目標：新型冠狀病毒全球大流行，需有由中央到醫院、院級到各科部的多層級全面防疫措施，以兼顧防疫與照顧品質。本案旨在探討臺北榮民總醫院婦產部採行的感染管制措施與成效。方法：針對高風險個案、新生兒運送、親職教室、訪客眾多四個防疫問題點，研擬及早鑑別風險、減少嬰兒暴觸感染機會、採行替代方案、採行訪客管理四個策略，制定執行措施，於待產室、產房、手術室及普通病房落實執行。結果：2020年全年共照顧16位高危險個案，無確診案例、無院內感染發生，2020年1月到6月純母乳哺餵率44.8%，較往年同期增加1.3~1.5%，親子同室率7.7%，相較去年同期無改變，依期別產前親職教室準媽媽出席率4.4%、4.7%，相較去年無明顯變化；準爸爸出席率1.8%、1.6%，相較去年下降0.7~1.1%；這些比較均無統計上顯著差異。結論：疫情期間調整照護模式，純母乳哺餵率及親子同室率未受影響。顯現防疫限制下，仍可維持醫療品質。
  Objectives: The coronavirus disease (COVID-19) pandemic requires multilevel comprehensive epidemic prevention measures from the central government to hospitals and from hospitals to departments in order to control it. The aim of this study was to assess the effectiveness of infection control measures implemented by the Department of Obstetrics and Gynecology, Taipei Veterans General Hospital. Methods: Strategies were developed to deal with high-risk cases, newborn transportation, parental classes, and visits and companions. These strategies included early risk identification, infant exposure reduction, alternative health education tactics, and visitor management. Results: In 2020, 16 high-risk patients received care at our department. No confirmed COVID-19 cases and nosocomial infections were noted. Exclusive breastfeeding rate during the period of January to June 2020 was 44.8%, an increase of 1.3% and 1.5% over the same period in 2019 and 2018, respectively. The rooming-in rate was 7.7%, similar to that (7.5%) of the same period in 2019. Session-specific attendance rates in prenatal parenting classes were 4.4% for second semester and 4.7% for third semester expectant mothers; there was no significant change compared with the 2019 rates (4.5% and 4.6%). The attendance rate of expectant fathers was 1.8% for the second semester and 1.6% for the third semester, a decrease of 0.7% and 1.1%, respectively, compared with the 2019 rates. However, these differences were not statistically significant. Conclusions: The infection control measures implemented for early risk identification, infant exposure reduction, alternative prenatal parenting education, and visitor management were effective as no COVID-19 case occurred and the quality of patient care and treatment was maintained.
• 453-458
• 10.6288/TJPH.202108_40(4).110046