40卷5期

• Link 政策論壇 Policy Forum
• 孕產婦的心理健康Perinatal Mental Health
• 林煜軒、莊海華、羅良明、邱弘毅
  Yu-Hsuan Lin, Hai-Hua Chuang, Liang-Ming Lo, Hung-Yi Chiou
• 心理健康、周產期、產後憂鬱症、孕婦、產婦
  mental health, perinatal period, postpartum depression, pregnant woman, parturient
• 心理健康問題在孕產婦中相當常見，據統計，大約70%的婦女在產後數天會經驗「產後情緒低落」。產後情緒低落會增加發生產後憂鬱症等更嚴重孕產婦情緒疾病的風險，因此早期篩檢，並給予支持與治療對於預防產後憂鬱症十分重要。至於懷孕期間是否可使用精神科藥物則需更多科學實證，孕婦本身的疾病與抗憂鬱藥的種類都會造成不同程度的風險。孕產婦心理健康牽涉層面甚廣，需要跨專業的參與及多面向的著手來防治。
  Mental health problems are pretty common among pregnant women and parturient. According to statistics, about 70% of women experience "baby blue" a few days after delivery. Baby blue can increase the risk of postpartum depression and other more maternal severe mood diseases. Therefore, early screening, support and treatment are essential to prevent postpartum depression. As for whether psychiatric drugs can be used during pregnancy, we need more scientific evidence. The diseases which pregnant women have and the types of antidepressants will cause varying degrees of risk. The mental health of pregnant and parturient involves a wide range of aspects and requires cross-professional participation and multi-faceted actions to address.
• 459-461
• 10.6288/TJPH.202110_40(5).PF05

• Link 公衛論壇 Public Health Forum
• COVID-19疫情停課後中小學之復課策略Reopening strategies for primary and secondary schools after lockdown due to COVID-19
• 盧玉玫、馮嘉玉、陳凱倫、鄭其嘉、陳麗珠、陳富莉
  Yu-Mei Lu, Jia-Yuh Ferng, Kai-Ren Chen, Chi-Chia J. Cheng, Li-Chu Chen, Fu-Li Chen
• 重新開放學校、COVID-19、回到學校、策略、復課
  reopening school, COVID-19, return to school, strategy, resumption of classes
• COVID-19疫情趨緩後，各國政府考慮重新開放學校。學校的重新開放首重提供安全的學習與工作環境，防止病毒在學校中傳播，其次是建置支持學生以及教職員重新回到校園的社會環境，逐步恢復學習氛圍與人際互動。本文從學校行政、教師或教育工作者、學生自身、家長或主要照顧者四個面向來探討，參考他國復課現況、聚焦WHO指引並融合OECD復課步驟概念，提出適用於台灣在最近這波疫情後的復課因應策略與概念。
  After the COVID-19 epidemic eased, governments of various countries considered reopening schools. The reopening of the school first focuses on providing a safe learning and working environment to prevent the spread of the virus in the school, followed by establishing a social environment that supports students and faculty members to return to the campus and gradually restores the learning atmosphere and interpersonal interaction. This article discusses the four aspects: school administration, teachers or educators, students, parents or primary caregivers, referring to the current situation of resumption of classes in other countries, focusing on WHO guidelines, and integrating the concept of OECD resumption steps, and proposes the strategies and concepts which are suitable for Taiwan after the recent outbreak of COVID-19.
• 462-473
• 10.6288/TJPH.202110_40(5).110110

• Link 公衛論壇 Public Health Forum
• 文化能力於公共衛生中之重要性:以新冠肺炎接觸者追蹤為例The significance of cultural competence in public health: COVID-19 contact tracing as an example
• 李柏翰
  Po-Han Lee
• 文化能力、接觸者追蹤、公共衛生、新冠肺炎
  cultural competence, contact tracing, public health, COVID-19
• COVID-19疫情爆發後，不同文化背景族群間的健康不平等更加顯而易見。COVID-19的疫調、篩檢、疫苗推廣等公衛工作涉及專業複雜的資訊，使得少數群體囿於語言、文化阻礙而未參與公衛措施，低估自身所屬群體之疾病風險。公衛服務需注意文化適當性（cultural appropriateness），工作者應培養文化能力，如對文化的基本知識、文化差異的敏感度、開放的態度與意識、以及跨文化溝通。廣義的文化能力包含交織性觀點，意即了解到每個個體的樣貌皆是由性別、年齡、障礙狀況、職業等特徵交織而成。文化能力應用於公衛工作上，既可保護高風險的弱勢群體，亦得以促進整體公共衛生之目標。
  After the outbreak of COVID-19, health inequalities among groups with different cultural backgrounds became more significant. Public health work such as COVID-19 contact tracing, screening, and vaccine promotion involves professional and complex information, makes minority groups limited by language and cultural barriers not participate in public health measures, and underestimate their group's disease risk. Therefore, public health services need to pay attention to cultural appropriateness. Workers should cultivate cultural competence, such as basic cultural knowledge, cultural sensitivity, open attitudes and awareness, and cross-cultural communication. In a broad sense, cultural competence includes a viewpoint of intersectionality, which means that the appearance of each individual is intertwined with characteristics such as gender, age, obstacle status, and occupation. The application of cultural competence in public health work can protect vulnerable groups at high risk and promote the overall public health goal.
• 474-478
• 10.6288/TJPH.202110_40(5).110066

• Link 原著 Original Article
• 台灣成年民眾之室外空氣污染健康識能調查A survey of ambient air pollution health literacy among adult residents of Taiwan
• 黃乙芹、侯文萱、呂芊曄、李岳蓁、李佩珍、陳怡臻、林明彥、王毓正、李中一
  Yi-Chin Huang, Wen-Hsuan Hou, Chien-Yeh Lu, Yueh-Chen Li, Pei-Chen Lee, I-Chen Chen, Ming-Yeng Lin, Yu-Chen Wang, Chung-Yi Li
• 室外空氣污染、健康識能、決策樹、問卷調查、電話訪問
  air pollution, health literacy, decision trees, surveys and questionnaires, telephone interview
• 目標：本研究目的為要探討影響室外空氣污染健康識能的因素並界定出我國低室外空氣污 染健康識能之族群特性。方法：此為一橫斷性研究，以全國20-70歲的成年民眾為研究對象，收案時間自2020年9月11日至10月22日止。使用電腦輔助電話訪問系統蒐集電訪資料，網路收案則採取立意取樣方式為之。本研究使用32題之中文版「室外空氣污染健康識能問卷」進行電話訪問與網路調查。以決策樹模型演算區辨出低室外空氣污染健康識能之族群特性。結果：共有1,588份問卷納入分析，包含：電話訪問（1,297份）以及網路調查（291份）。透過全國性樣本之調查與決策樹模型分類結果，界定出我國民眾低室外空氣污染健康識能之族群特性為：未婚、教育程度為高中、以及居住於南部地區之民眾。結論：教育程度、居住地與婚姻狀態為影響民眾室外空氣污染健康識能程度高低的影響因素。未來可以針對低室外空氣污染健康識能的族群，作為後續衛教介入之目標族群，藉此期望可提升整體民眾對室外空氣污染健康識能的程度，降低室外空氣污染對健康的衝擊。
  Objectives: The purpose of this study was to explore characteristics related to ambient air pollution health literacy (AAPHL) and to identify groups with lower AAPHL. Methods: A national, cross-sectional study of Taiwanese adults aged 20-70 years was conducted. Data were collected from September 11 to October 22, 2020. We conducted the survey through computerassisted telephone interviews. In addition, purposive sampling was used in online surveys. A 32-item Chinese version of the AAPHL assessment tool was used in telephone interviews and online surveys. Decision tree modeling was used to ascertain the characteristics of those with low AAPHL. Results: A total of 1,297 telephone interviews and 291 online surveys were completed, and 1,588 questionnaires were analyzed. The data indicated that having high school education, being unmarried, and living in southern Taiwan were associated with low AAPHL. Conclusions: The education level, area of residence, and marital status were the key risk factors affecting AAPHL. People with the identified characteristics should be regarded as the target population for health education interventions to enhance AAPHL levels in the general population and to reduce the impact of ambient air pollution on public health.
• 479-493
• 10.6288/TJPH.202110_40(5).110070

• Link 原著 Original Article
• 台灣與南韓校園空氣污染防制政策之比較研究Comparison of campus air pollution control policy between Taiwan and South Korea
• 姚澤銘、張弘潔
  Ze-Ming Yao, Hung-Chieh Chang
• 空氣污染、跨國比較研究、兒童健康、政策
  air pollution, cross-national comparison, child health, policy
• 目標：空氣污染是全球兒童最大健康威脅之一。本研究比較台灣與南韓之校園空污防制政策規範，了解差異性與可改善方向。方法：本文從四方面比較我國與南韓校園空污防制政策，包括空品標準、空污監測、校園空污惡化之緊急應對、空污校園防護等。結果：(1)戶外空氣污染物之標準，我國訂定PM2.5、PM10、O3、NO2、SO2、CO和鉛，南韓多增加苯之監測，南韓部分之空品標準也較嚴格。室內空品監測部分，南韓有針對幼兒園和學校場所強制監控，並新增監測之污染物；(2)在室內空品法規方面，南韓專為幼兒族群訂定更高標準之保護措施；而台灣室內空品監測在校園場所仍缺乏全面監測；(3)南韓在空污緊急應對措施之啟動標準對於兒童的保護皆較台灣之標準敏感；南韓近年修法編列預算新增校園保護措施（教室統一安裝空污監測及淨化設備等）。結論：南韓近年對校園空污防制相關之法規頻繁修法，針對兒童族群提供強化之特殊保護，包括空氣品質標準加嚴、新增監控之污染物、空氣污染納入學校衛生法，和編列預算以改善監測與改善校園空氣品質所需之硬體設施，均可作為我國修法之參考。
  Objectives: Air pollution represents a considerable threat to child health worldwide. This study compared Taiwan and South Korea’s air pollution control policies, with a focus on campus regulations. Methods: Taiwan and South Korea’s air pollution control policies were compared with respect to air quality standards, air quality monitoring, emergency response measures to air pollution deterioration, and air quality measures at schools. Results: With regard to outdoor air pollutants, Taiwan has established standards for PM2.5, PM10, O3, NO2, SO2, CO, and Pb, in addition to which South Korea has established a standard for benzene. South Korea’s standards are stricter for some pollutants. In terms of indoor air pollutants, South Korea has mandated compulsory monitoring of specific pollutants and monitored more air pollutants on campus. In terms of indoor air quality, South Korea has established higher standards specifically for kindergartens. By contrast, Taiwan’s Indoor Air Quality Act does not include campuses for air pollution monitoring. South Korea’s emergency response measures to air pollution deterioration prioritize child protection more than do Taiwan’s. South Korea has amended the law and added a budget for protection equipment on campuses, such as air pollution monitoring and purification equipment; this policy should be considered in Taiwan. Conclusions: South Korea has frequently amended the campus air pollution measures to enhance the protection of child health in recent years. The measures include setting higher air quality standards, including air pollution control in the School Health Act, and budgeting for facilities to monitor and improve the air quality of campuses. South Korea’s campus air pollution control policies can serve as reference for policy amendment in Taiwan.
• 494-505
• 10.6288/TJPH.202110_40(5).110085

• Link 原著 Original Article
• 台灣醫院醫療不良事件根本原因分析現況與相關因素探討Status of root cause analysis in medical adverse events and related factors among hospitals in Taiwan
• 洪聖惠、鍾國彪、王拔群
  Sheng-Hui Hung, Kuo-Piao Chung, Pa-Chun Wang
• 根本原因分析、醫療不良事件、人為因素、病人安全
  root cause analysis, medical adverse event, human factor, patient safety
• 目標：本研究欲瞭解台灣醫院內部進行醫療不良事件根因調查分析之現況，進一步探討調查員個人經驗與醫院特性等對調查時人為因素掌握之相關性。方法：採橫斷性調查，以自擬問卷匿名普查全國負責醫療不良事件通報窗口及根因分析調查員，以雙變量分析探討醫院對於醫療不良事件之根因調查分析現況及影響因素間之相關性。結果：共調查122家醫院、590名調查員，平均回收率91.6%。醫院97.5%設有專責單位，89.3%採自主通報。91%設有根因分析小組。調查員18.6%未接受過訓練，35.8%自覺訓練不足，49.1%僅一半甚至更少的信心以現行調查工具能有效掌握根因，94.2%表示調查有障礙，前三位為「事後回溯困難，記憶偏差」、「受訪人員排斥」及「調查員經驗不足」。調查員之個人經驗，不論專業背景、調查年資、件數、是否接受調查訓練及時數、自覺訓練是否足夠等皆會顯著影響調查時對人為因素掌握度。結論：台灣醫院內部通報制度普遍已建立，調查員個人經驗為影響調查結果的重要因素，應更加重視與培訓。
  Objectives: This study explored the status of root cause analysis (RCA) of adverse events in Taiwan’s hospitals. This study also examined the associations between investigator’s personal experience, hospital characteristics with human factors consideration when conducting RCA. Methods: This study adopted a large-scale cross-sectional survey featuring a self-developed questionnaire to investigate the status of the RCA of adverse events and RCA investigators in Taiwanese hospitals. Participants were recruited from institutions responsible for medical adverse event and root cause investigation. Bivariate analysis was applied to analyze the RCA for adverse events and its associated factors. Results: A total of 122 units for hospital patient safety and 590 RCA investigators were surveyed. The questionnaire response rate was 91.6%. Of the hospitals from which participants were recruited, 97.5% had dedicated units to handle reports, 89.3% adopted voluntary reporting system, and 91% established RCA teams. Of the investigators surveyed, 18.6% had not been trained in RCA and 35.8% of the trained investigators still felt insufficiently equipped to engage in RCA. Furthermore, 49.1% of the investigators reported having less confidence to obtain root causes by current investigation tools, and 94.2% of the investigators noted obstacles in adverse event analysis and investigation. The experience of the RCA investigators, including years of participation in the analysis, the number of analysis participated in, whether they received RCA training, total hours of RCA training, and the adequacy of conscious training affected investigators’ consideration of human factors when investigating adverse events. Conclusions: The internal reporting system in Taiwan’s hospitals is well established, and the personal experience of investigators is a key factor affecting the results of RCA investigations. RCA investigators should, therefore, receive attention and high-quality training.
• 508-524
• 10.6288/TJPH.202110_40(5).110052

• Link 原著 Original Article
• 人口結構變動對醫學中心急診部分負擔政策有效性之影響Effect of demographic structural change on copayment policy effectiveness for emergency department visits
• 陳文意、林晏如、楊其璇
  Wen-Yi Chen, Yen-Ju Lin, Chi-Hsuan Yang
• 人口結構、非緊急急診、部分負擔、時間變動向量自我迴歸模型、向量誤差修正模型
  demographic structural change, non-urgent emergency department visit, copayment, time-varying parameter vector autoregressive model, vector error correction models
• 目標：本研究旨在探討台灣地區人口結構變動對醫學中心急診部分負擔政策有效性的影響效果。方法：我們使用時間變動向量自我迴歸以及向量誤差修正模型建構人口結構變動對醫學中心急診部分負擔政策有效性的關聯。結果：部分負擔對急診與非緊急急診醫療利用12個月期間的衝擊反應數值均為負值，增加部分負擔能降低醫學中心急診醫療利用。長期而言，人口老化將降低醫學中心急診部分負擔對所有急診醫療利用負向影響，但是對醫學中心急診部分負擔對非緊急急診醫療利用的關聯性沒有顯著的影響。結論：若以減少整體醫學中心急診利用為政策目標時，高齡化社會所要調高的部分負擔將必須遠高於目前設定的水準。考量急診利用降載的政策工具眾多，未來政府在制定急診利用政策時，除考量人口老化對部份負擔政策的鈍化效果外，仍須搭配其他分級醫療的政策工具，藉以達成緩解醫學中心急診利用的政策目標。
  Objectives: This study investigated the effect of demographic structural change on emergency department (ED) visits in medical centers in Taiwan. Methods: Time-varying parameter vector autoregressive and vector error correction models were adopted to establish the association between demographic structural change and ED visits in medical centers. Results: Our empirical results revealed negative cumulative responses over 12 months of copayments for ED visits and nonurgent ED visits. The negative relationship between copayments and ED visits was reduced in the aging population, but no significant relationship was found between copayments and nonurgent ED visits in this population. Conclusions: Higher copayment adjustment for ED visits should be made for achieving the policy goal of a lower number of total ED visits for the aging society. Various policy instruments other than the copayment policy have been established to reduce the number of ED visits. Considering the ineffectiveness of the copayment policy for ED visit reduction in the aging society, the government should adopt other policy instruments of the hierarchy of medical care together with the copayment policy to achieve the policy goal of total ED visit reduction.
• 525-544
• 10.6288/TJPH.202110_40(5).110051

• Link 原著 Original Article
• 運用德菲法發展台灣婦產科低效益照護清單Use of the Delphi method to develop a list of low-value care practices in obstetrics and gynecology in Taiwan
• 張煜詩、周盈邑、黃文助、楊銘欽、董鈺琪
  Yu-Shih Chang, Ying-Yi Chou, Wen-Chu Huang, Ming-Chin Yang, Yu-Chi Tung
• 婦產科、低效益照護/過度使用、清單、德菲法
  obstetrics and gynecology, low-value care/overuse, lists, Delphi method
• 目標：低效益照護/過度使用漸受關注，如何衡量低效益照護是重要的問題，過去研究發展低效益照護清單多以文獻或臨床醫師凝聚共識，針對台灣婦產科低效益照護清單研究闕如，本研究目的，將以德菲法發展臺灣婦產科低效益照護清單。方法：參考國際明智選擇建議和專家意見，發展婦產科低效益照護問卷。納入醫師為邀請台灣婦產科學會從北中南東醫療院所推薦醫師名單，最終再以德菲法產生低效益照護代表性清單，同意尺度為1分（非常不同意）至9分（非常同意），專家共識定義為中位數≧7且評≧7之比例至少75%，再依評≧7之比例排序以決定前5名清單。結果：本研究共有12名專家參與，兩回合問卷從38項項目中，最終推薦清單共有6項，因排序同名次，7分以上人數比例為91.7%，包括3項檢查（臍動脈都普勒超音波、D-Dimer、紅血球沉降率）、2項處置（催生或剖腹產、子宮切除術）及1項藥品（抗生素）。結論：本研究以德菲法選出6項適合我國國情的清單，政府單位可參考本研究成果發展婦產科臨床指引，能將清單納入且訂出規範；建立資訊整合平台提供低效益照護資訊，不僅有助於醫療人員做出正確決策，也能夠提升民眾對低效益照護之概念。
  Objectives: The problem of low-value care/overuse has become a focal point among the medical community. Determining how to identify and measure low-value care is a central concern. Previous studies have formulated lists of low-value care practices based on earlier literature or the consensus of clinicians, but no study has yet to focus on low-value care in obstetrics and gynecology in Taiwan. We used the Delphi method to compile a list of low-value care practices in obstetrics and gynecology in Taiwan. Methods: By referring to recommendations from international Choosing Wisely lists and expert opinion, we developed a questionnaire about low-value care practices in obstetrics and gynecology. The Taiwan Association of Obstetrics and Gynecology recommended a list of suitable doctors for inclusion from the medical institutions in the northern, central, southern and eastern regions of Taiwan, and the Delphi method was then used to produce a representative list of low-value care practices. The agreement scale ranged from 1 (strongly disagree) to 9 (strongly agree). Expert consensus was defined as a median ≥ 7 with at least 75% scoring ≥ 7. All recommendations were ranked by percentage of score ≥ 7 to determine a list of the top five low-care practices. Results: A total of 12 experts completed in two rounds of questionnaires from which six lists of options were selected from a total of 38 recommendations because the rankings were identical. The lists with 91% scoring ≥ 7 included three examinations (umbilical artery Doppler, D-Dimer, and erythrocyte sedimentation rate), two procedures (elective, non-medically indicated inductions of labor or Cesarean deliveries, hysterectomy), and one drug (antibiotics). Conclusions: In this study, the Delphi method yielded six lists suitable for conditions in Taiwan. Health officials can refer to these research results when developing clinical practice guidelines for obstetrics and gynecology that can incorporate indicators and set standards. Establishing an information integration platform to provide low-value care information will strengthen the decision-making of medical practitioners and enhance public understanding of low-value care.
• 545-555
• 10.6288/TJPH.202110_40(5).110017

• Link 原著 Original Article
• 台灣人工生殖法立法前後五年生殖結果的比較Reproductive outcomes of in vitro fertilisation in the five years before and after the legislation of the Assisted Reproduction Act in Taiwan
• 虞希正、雷文玫、邱淑媞、鄧宗業
  Hsi-Cheng Yu, Wen-May Rei, Shu-Ti Chiou, Chung-Yeh Deng
• 台灣人工生殖法、試管嬰兒、活產、流產
  Assisted Reproduction Act, in vitro fertilization, live-birth, miscarriage
• 目標：利用台灣人工生殖資料庫探進行實證分析，探討2007年台灣人工生殖法頒布前後， 對首次執行試管嬰兒治療成果之影響。方法：擷取人工生殖資料庫中法頒布前與後五年紀錄，利用變異數分析與卡方分析，及廣義線性模型之多變項羅吉斯回歸，比較臨床懷孕、活產、流產、子宮外孕等療程結果。結果：研究共納入2002-2012間83,264次試管嬰兒療程。單變項觀察到立法後五年期間，在著床為胚囊、臨床懷孕及活產率，皆較立法前五年顯著提升；發生子宮外孕、減胎、卵巢過度刺激臨床症候群發生率，則在立法後顯著下降。多變項分析上，在著床為胚囊、臨床懷孕，以及成功誕下活產嬰兒上，立法後較立法前勝算顯著增加31–35%；減胎立法後勝算顯著則降低20%。發現相較於單胚胎植入，選擇植入兩個胚胎活產勝算可顯著增加11%。但若植入3顆或4顆胚胎，則可能同時增加活產與死產勝算。結論：本研究為台灣首篇比較施行胚胎植入限制的前後五年的試管嬰兒生殖結果的差異。研究發現法令限制植入胚胎後，試管嬰兒的活產機率增加及減胎機率減少，相關原因有待後續研究。綜整本研究發現與國內其它實證結果，建議台灣可再下修胚胎植入指引。政府更應持續發展人工生殖技術並擴大補助，特別是單胚胎之植入。
  Objectives: To compare the outcomes of in vitro fertilisation (IVF) treatment before and after the 2007 IVF regulations in Taiwan by accessing data from the national assisted reproduction database. Methods: Clinical pregnancies (those with the foetal heartbeat detected), live births, miscarriage, fetal reduction, and ectopic pregnancy in the five years before and after the assisted reproduction act were assessed from the national assisted reproduction database. Analysis of variance, Chi-square test, and multivariate logistic regression of the generalized linear model were used to compare the outcomes before and after the implementation of the legislation. Results: A total of 83,264 IVF cycles performed between 2002 and 2012 were included in our analysis. After implementing the legislation, fewer embryos were transferred in IVF cycles, but higher percentages of gestational sacs, clinical pregnancies, and live births were achieved. The rates of miscarriages, ectopic pregnancy, and fetal reduction were significantly less in the post-legislation period than in the pre-legislation period. The multivariate analysis found that the odds of embryos reaching the gestational sacs, clinical pregnancies, and live births per cycle significantly increased by 31-35%; the odds of fetal reduction were decreased by 20%. Compared to single embryo transfer, double embryo transfer increases the odds of live births by 11%. Conclusions: This was the first study to focus on the reproductive outcomes of IVF in the five years before and after the legislation of the assisted reproduction act in Taiwan. The Assisted Reproduction Act limited the number of embryo transfers to four would increase the likelihood of live births and reduce the probability of fetal reduction, and there was still a need for further research to prove. We suggest that the legislation be revised to reduce the maximum number of embryo transfers in an IVF cycle from four to less based on our findings and previous studies. The government can encourage the development of IVF technology and deregulate medical allowances for every IVF cycle to promote fertility in Taiwan.
• 556-569
• 10.6288/TJPH.202110_40(5).110076

• Link 原著 Original Article
• 初探低血糖處理行為—立即進食與藥物調整之影響因子Factors associated with immediate food consumption and drug adjustment in hypoglycemia: a preliminary study on hypoglycemia management behaviors
• 黃美娟、洪志秀、黃雅雯
  Mei-Chuan Huang, Chich-Hsiu Hung, Ya-Wen Huang
• 低血糖事件、胰島素治療、第2型糖尿病、立即進食、調整藥物
  hypoglycemia events, insulin therapy, type 2 diabetes, immediate food consumption, drug adjustment
• 目標：低血糖是糖尿病的急性併發症之一，需要病人立即處理。本研究目的在探討接受胰島素治療之第2型糖尿病患者，影響低血糖立即進食和調整藥物行為之重要因子。方法：採用橫斷式調查研究法，以立意取樣收集218位在台灣南部一家醫學中心、一家地區醫院和3家基層醫療門診，接受胰島素治療，而且經歷過低血糖事件之第2型糖尿病患者為研究對象。採用低血糖知識量表、低血糖恐懼量表和社會支持量表收集資料。資料收集自2016年5月至2018年7月。結果：218位研究對象平均年齡為62.3歲；女性佔51.8%、教育程度以高中或以上者佔83.5%。本研究以AMOS檢視性別、規律運動、低血糖知識、半年內發生低血糖事件的次數、教育程度和社會支持與立即進食和藥物調整等項關係和最佳配適模式。結果發現女性（p<0.01）、低血糖知識（p<0.01）和多次發生低血糖事件（p<0.05）與立即進食有顯著相關； 而多次發生低血糖事件（p=0.01）和社會支持（p<0.05）與調整藥物有顯著相關，立即進食的總變異量是10.70%和調整藥物的總變異量是4.80%。結論：性別、低血糖知識和多次發生低血糖事件是立即進食的影響因子，而多次發生低血糖事件和社會支持是調整藥物的影響因子。本研究結果可以提供健康照護人員瞭解接受胰島素治療之第2型糖尿病患者，影響低血糖立即進食和調整藥物之重要因子，以作為強化低血糖照護和低血糖管理之實證指引。
  Objectives: Hypoglycemia is an acute complication of type 2 diabetes (T2D) that requires immediate self-management by the patient. This study explored the key factors determining immediate food consumption and drug administration adjustment when patients with T2D experience an episode of hypoglycemia following insulin treatment. Methods: This cross-sectional survey enrolled 218 patients with T2D receiving treatment in a medical center, a regional hospital, and three primary medical clinics in southern Taiwan. Data were collected from May 2016 to June 2018. Three questionnaires were used: the Knowledge of Hypoglycemia Scale, Fear of Hypoglycemia Scale, and Social Support Scale. Results: This study included 218 patients (mean age: 62.3 years). More than half were women (51.8%), and most had a junior high school education level or below (83.5%). AMOS was conducted to examine the relationships among sex, education, exercise, knowledge of hypoglycemia, multiple hypoglycemia events, social support, immediate food consumption, and drug adjustment and the best fit model. Female sex (p < .01), knowledge of hypoglycemia (p < .01), and multiple hypoglycemia events (p < .05) were significantly correlated with immediate food consumption. In addition, multiple hypoglycemia events (p = .01) and social support (p < .05) were significantly correlated with drug adjustment. The total variance of immediate food consumption and drug adjustment was 10.7% and 4.8%, respectively. Conclusions: Sex, knowledge of hypoglycemia, and multiple hypoglycemia events are crucial factors affecting immediate food consumption, and multiple hypoglycemia events and social support are crucial factors affecting drug adjustment. These findings may help health care professionals understand the factors that can affect the behaviors of patients with T2D in terms of immediate food consumption and drug adjustment after an episode of hypoglycemia. The results may serve as guidelines to improve hypoglycemia care and education.
• 570-579
• 10.6288/TJPH.202110_40(5).110027

• Link 原著 Original Article
• 運用桌上型遊戲提升國小學生對家庭醫師之認知、態度及自我效能的成效研究Assessing the effectiveness of a tabletop game to alter elementary school students’ knowledge, attitudes, and self-efficacy beliefs toward family physician services
• 吳文琪、簡彰蔚、張家臻、張必正、董貞吟
  Wen-Chi Wu, Jang-Wei Jian, Chia-Chen Chang, Bih-Jeng Chang, Chen-Yin Tung
• 家庭醫師、醫療使用、桌上型遊戲、遊戲學習、單組前後測實驗設計
  family physician, medical use, tabletop game, game-based learning, one group pretest-posttest experimental design
• 目標：本研究旨在評價新發展之桌上型遊戲教學模組對提升國小學童的家庭醫師認知、態度及善用家庭醫師資源自我效能之成效，並瞭解此成效在不同的年級、地區和先備知識下是否有差異。方法：本研究運用單組前後測實驗設計的方式，評價國小學童的學習成效，共有479 位學生參與。介入方案為跨界專家共同發展之「健康總動員」桌上型遊戲教學模組。經培訓國小教師後，由其進行教學介入。本研究運用重複測量共變數分析模式進行成效評價。結果：教學介入後，國小學童對家庭醫師之認知、態度及善用家庭醫師資源的自我效能，皆有顯著提升。進一步分析年級、地區、和先備知識對介入成效的影響，發現年級及先備知識越低者，成效越高，且成效不受地區差異的影響。結論：本教學模組可提升四至六年級學童對家庭醫師之認知、態度，及善用家庭醫師資源的自我效能。建議教師、家長及實務工作者，可考慮採用正式遊戲的教育策略，提升學生對家庭醫師的瞭解與認識。
  Objectives: This one-group pretest-posttest study evaluated the effect of a tabletop game-based intervention on elementary school student’s knowledge and understanding of family medicine, attitudes toward family care, and self-efficacy in decision making to utilize family physician services, and to examine whether the effects differed by grade levels, area of residence, and prior knowledge. Methods: A questionnaire (pretest) was administered to an experimental group comprising of fourth to sixth grade students (n = 479) recruited throughout Taiwan to assess preexisting knowledge of family practice, attitudes towards family physicians, and the confidence in their ability to utilize family physician services. The same questionnaire (posttest) was administered to the students after playing a tabletop game (intervention) named Healthy Tales, which was developed by a group of health experts and creative educators with the intent to promote family physician-seeking behaviors through educating, reinforcing, and providing fun. Results: Usage of Healthy Tales was associated with statistically significant increases in the knowledge, attitudes, and self-efficacy beliefs toward family physician services. Results from the post hoc test indicated a greater effect of the game on outcome variables as students’ grade level decreased as well as in students with less knowledge of family medicine. Conclusions: The tabletop game is shown to be effective in increasing knowledge, attitudes, and self-efficacy beliefs among elementary school students in the study. Educators and parents may consider using Healthy Tales to promote understanding of family medicine, persuade students the value of family care, and finally, to encourage students to utilize family physician services.
• 580-594
• 10.6288/TJPH.202110_40(5).110038

• Link 評論 Commentary
• 評論:台灣與南韓校園空氣污染防制政策之比較研究Commentary: comparison of campus air pollution control policy between Taiwan and South Korea
• 黃彬芳
  Bing-Fang Hwang
• 無
  none
• 無
  none
• 506
• 10.6288/TJPH.202110_40(5).11008501

• Link 作者回覆 Authors' response to commentary
• 作者回覆:台灣與南韓校園空氣污染防制政策之比較研究Authors' response to commentary: comparison of campus air pollution control policy between Taiwan and South Korea
• 姚澤銘、張弘潔
  Ze-Ming Yao, Hung-Chieh Chang
• 無
  none
• 無
  none
• 507
• 10.6288/TJPH.202110_40(5).11008502