40卷6期

• Link 政策論壇 Policy Forum
• 妳如何能不憂鬱?從產前到產後心理健康照護How could you not be depressed? supporting women’s wellbeing from prenatal to postnatal care in Taiwan
• 施麗雯
  Li-Wen Shih
• 心理健康、產前產後照護、產後憂鬱、政策
  mental health, prenatal to postnatal care, postpartum depression, policy
• 台灣在國際比較上屬於產後憂鬱高盛行率的國家，孕產照護政策長期以來側重生物性醫學的預防措施,對於孕產婦心理健康與需求較為缺乏。理解台灣社會文化、醫學實作和女性在孕產週期間的需求,方能發展出全方位支持女性的孕產政策與措施。
  Taiwan has a higher prevalence of postpartum depression than most countries worldwide. The maternal care policy has long focused on preventive measures of biological medicine and lacked concern for maternal mental health and needs. Only by understanding Taiwan's social culture, medical practice, and women's needs during the pregnancy and maternity period can we develop comprehensive maternal care policies and measures to support women.
• 595-599
• 10.6288/TJPH.202112_40(6).PF06

• Link 公衛今與昔 Public Health Now and Then
• 美援對台灣二戰後醫療衛生發展影響The influences of American aids to health care development in post-WWII Taiwan
• 蔡篤堅、李孟智
  Duu-Jian Tsai, Meng-Chih Lee
• 臨床培訓、公共衛生、家庭計畫、醫療專業主義、科學研究
  clinical training, public health, family planning, medical professionalism, scientific research
• 有鑑於美援對台灣醫療衛生的貢獻，本文透過二手資料收集，結合口述歷史檔案資料，嘗試以臨床人員培訓制度的轉變、克服疾病的挑戰、公共衛生制度的改變、家庭計畫的推行，以及美國海軍第二研究所所代表研究的進展，來勾勒美援對戰後台灣醫療衛生發展的影響。研究發現，戰後台灣醫療專業主義和科學研究的精神，透過來自中國和本地頂尖人才合作之落實，採取務實創新克服困難的醫療衛生水平提升的方法，成就嶄新的醫療體系，這當中美援扮演著非常關鍵的催化角色，可說是當代國際醫療衛生援助的典範。
  To evident the contributions of American aids to the health care development in Taiwan, this paper adopts literature reviews with oral history archives to reconfigure this post-WWII time period through the lens of institutional changes in clinical personnel training, significant challenges from infectious diseases, organizational reform in public health, formulating strategies for family planning, and facilitating research with support from the U. S. Naval Medical Research Unit No. 2. This research finds that ethos along with medical professionalism and scientific research have been contextualized through the cooperation between Chinese and Native leading figures. Comprehensive brand-new health care system has been developed with problem-oriented innovative pragmatic approaches to enhance the health status for general population since then. American-Aid-to-Taiwan is the most critical catalyst facilitating aforementioned positive changes and, as a result, has become a well-known paradigm of international medical and health aids.
• 600-610
• 10.6288/TJPH.202112_40(6).110026

• Link 公衛論壇 Public Health Forum
• 台灣自付醫療費用估計:困境與機會Challenges and opportunities for estimating out-of-pocket medical spending in Taiwan
• 葉育華、李妙純、蔡淑鈴、蒲正筠
  Yu-Hua Yeh, Miaw-Chwen Lee, Shu-Ling Tsai, Christy Pu
• 全民健康保險、自費醫療、部分負擔
  National Health Insurance, out-of-pocket (OOP), copayment
• 台灣自1995年起實施全民健康保險以分擔國民就醫的財務風險,避免落入因病而貧的困境。健保支出逐年上升，為控制醫療支出和維護健保的永續經營，支付制度與部分負擔的調整使民眾的自付費用漸增。本研究討論估計我國自費醫療(out-of-pocket, OOP)應考量的一些議題，盼藉此獲得可信賴的數值，來檢視自付醫療費用上升是否增加民眾就醫時的財務負擔。
  Taiwan has implemented National Health Insurance since 1995 to share people's financial risks of medical treatment, avoiding falling into the plight of poverty due to illness. However, health care expenditures have been increasing recently. In order to control medical expenditures and maintain the sustainable operation of NHI, the adjustment of the payment system and copayment made the out-of-pocket medical spending increase. This study discusses some issues that should be considered in estimating Taiwan's out-of-pocket (OOP), hoping to obtain reliable values ​​to examine whether the growth in OOP increases people's financial burden when they seek medical care.
• 611-614
• 10.6288/TJPH.202112_40(6).110053

• Link 綜論 Review Article
• 時間敏感性狀況:分類、測量及對可避免急診與住院之意涵Time-sensitive conditions: classification, measurement, and implications of preventable emergency department visits and hospitalizations
• 林志遠、鄭鳳翔、李玉春
  Chih-Yuan Lin, Feng-Shiang Cheng, Yue-Chune Lee
• 時間敏感性狀況、時間敏感性疾病、醫院緊急醫療能力分級、可避免急診指標、可避免住院指標
  time-sensitive conditions, time-sensitive diseases, categorization of hospital emergency capability, preventable emergent department visit, preventable hospitalization
• 時間敏感性狀況是具時間急迫性且需及時診斷與特定治療之疾病或狀況，對醫病雙方均產生高度影響。急診壅塞研究中，是否為緊急醫療狀況或時間敏感性狀況常為討論議題，本文回顧時間敏感性狀況概念性定義、分類、測量指標及其對研究與政策之意涵。時間敏感性狀況分為門診照護敏感狀況、特定緊急醫療處置手術及重大時間敏感性疾病；時間敏感性狀況可由民眾觀點及專家觀點來測量，本文也探討其對醫師緊急醫療行為、可避免急診、可避免住院及可避免死亡之可能應用。本文增補時間敏感性狀況之國際疾病分類碼，希望時間敏感性狀況成為學術與政策的研究議題。
  Time-sensitive conditions are often urgent and require timely diagnoses and specific treatments, implicating both patients and medical providers. Emergency care research often focuses on the difference between an emergency medical condition and time-sensitive disease. This study reviewed the definition, classification, measurement indicators, and research and policy implications of time-sensitive conditions, which are classified into ambulatory care-sensitive conditions, referral-sensitive surgeries, and critical time-sensitive diseases. This study formulated a measure of a time-sensitive condition based on the perspectives of both laypeople and experts; this study also discussed implications for emergency care medical providers and regarding preventable emergency department visits, hospitalizations, and deaths. Finally, this article provides the International Classification of Diseases codes for time-sensitive conditions, with the anticipation that they will become more common topics of academic and policy-focused research.
• 615-630
• 10.6288/TJPH.202112_40(6).110101

• Link 原著 Original Article
• 探討72小時內非預期重返急診之風險因子Exploring the risk factors of unexpected return to the emergency department within 72 hours
• 莊旺川、葉淑娟、黃竫棻
  Wang-Chuan Juang, Shu-Chuan Jennifer Yeh, Ching-Fen Huang
• 非預期重返、急診、人格特質、風險因子、工作疲勞
  unexpected return visit, emergency department, personality, risk factor, work fatigue
• 目標：非計劃性重返急診是病患照護警訊，本研究藉由探討病患72小時內重返急診因子， 作為改善重返急診現況之依據。方法：合併某醫院2019年病患72小時內重返急診回溯性資料及2020年7月結構式問卷收集急診醫師資料，依病患是否重返急診，以年齡、性別及身份別經傾向分數予1：2配對，並以卡方及t檢定、邏輯式迴歸進行72小時內重返急診風險因子分析。結果：2019年急診病患返診率4.47%，病患性別、檢傷分類、就診時間、急診壅塞程度、醫師年齡及年資對於病患72小時內重返急診之影響不顯著；病患年齡、身分別(重大傷病)、離院方式、急診滯留時間(6-48小時)、醫師人格特質(神經質)與工作疲勞顯著影響是否重返急診。結論：針對影響病患72小時重返急診之病人、醫院相關風險因子，建議將年老者、重大傷病身份、自行離院、自動出院患者列為衛生教育的重點族群，提前加強出院衛教與溝通；而醫師因素部分可藉由改善醫師人力調派、提供緩解工作疲勞的措施或政策來減輕醫師工作疲勞程度。
  Objectives: Unexpected revisits to the emergency department (ED) may indicate poor patient care and quality issue. This study investigated factors related to unexpected revisit to the ED within 72 hours of discharge. Methods: This study retrospectively analyzed patient data from an ED system in 2019. Additionally, a structured questionnaire was designed to collect data on physicians’ personality and work fatigue. The combined data were matched by age, sex, and type of insurance cover by using propensity score matching with a ratio of 1:2. The risk factors of unexpected return to the ED within 72 hours were evaluated using the chi-square test, independent t-test, and logistic regression. Results: Of the 91,582 included patients, 4,086 patients returned, yielding an unexpected revisit rate of 4.47%. The results found that patients’ sex, triage level, arrival shift, ED crowding, physician age, and seniority were not significant indicators of ED revisits within 72 hours. Patients’ age, type of insurance cover (severe illness), mode of leaving, a length of stay in the ED (6-48 hours), and the physician’s neuroticism and work fatigue were significant predictors of ED revisit. Conclusions: For patient and hospital related factors, patients with advanced age, severe disease, and those likely to leave without notice or against advice should be prioritized for outpatient education. For physician related factors, reforms to reduce the workload of physicians are essential. Further studies should continue to identify risk factors for hospitals to effectively reduce unexpected revisits to the ED within 72 hours.
• 631-641
• 10.6288/TJPH.202112_40(6).110109

• Link 原著 Original Article
• 新型移位機之技術商品化探討:以職業健康作為價值主張An analysis of the technology commercialization of a new lifting device: taking occupational health as the value proposition
• 尤素芬、林聰益、張哲豪、趙品淳、曾明基
  Su-Fen You, Tsung-Yi Lin, Jer-Hao Chang, Pin-Chun Chao, Ming-Ji Tzeng
• 職業健康、移位機、技術商品化、價值主張畫布、創新
  occupational health, lifting device, technology commercialization, value proposition canvas, innovation
• 目標：本文針對一台新型移位機的技術商品化，探討如何藉由預期使用者的參與，帶來進一步的創新，促成輔具研發結果更被市場接受，並能回饋到照顧工作者的職場健康保護。方法：採取個案研究法，個案為南部一家小型老人養護機構，透過參與式觀察及深度訪談蒐集質性的資料。進一步藉由「顧客價值主張畫布」的概念，針對新型移位機的研發應用與商業模式發展進行探討分析。結果：移位機團隊以「職業健康」與「案主增能」作為商品訴求的核心價值，針對顧客的痛點與需求進行溝通，的確有助於新型移位發展出有模仿障礙的阻隔機制，包括提供客製化的配件與服務以及小型、雙向的教育訓練方案等。結論：本文主張職業健康的價值可以作為推廣移位輔具商品的利基，但移位機能否被廣泛接受尚需考量機構面管理創新的能量以及政府的政策。面對「不徒手搬運」的國際趨勢，政府的長照政策需考量相關的輔具補助措施，並將移位機的使用納入照服人員的教育訓練之中。
  Objectives: This article focuses on the technology commercialization of a new lifter and discusses how to bring further innovation through the participation of prospective users. It is expected that the new lifter will be more accepted by the market and will be rewarded to the workplace health protection of care workers. Methods: This research is based on a case study, in terms of a small elderly care institution in the southern Taiwan. It adopts the approach of qualitative research in that participatory observation and in-depth interviews were conducted. Furthermore, the concept of “Value Proposition Canvas” is used to analyze the technology commercialization of the new lifter and the development of its business model. Results: “Occupational health” and “client reablement” is taken as the core value of the product appeal. In terms of that, the research team communicate on the customers’ pains and gains, which really helps the R&D group to develop an isolating mechanism with imitation barriers, including the provision of customized accessories and services, and small, two-way education and training programs. Conclusions: The value proposition of occupational health can be used as a niche for the promotion of transferring device, but whether the new lifter can be widely accepted still needs to consider the energy of institutional management innovation and government policies. In the face of the international trend of “No-lift Policy”, the government’s long-term care policy needs to consider relevant assistive device subsidies and incorporate the use of lifters into the education and training of caregivers.
• 642-659
• 10.6288/TJPH.202112_40(6).110111

• Link 原著 Original Article
• 照護失智患者飲食能力量表發展與驗證Development and validation of the scale of the ability to care for the diet of patients with dementia
• 蕭華岑、陳乃菁、楊雅萍、趙慧珍
  Hua-Tsen Hsiao, Nai-Ching Chen, Ya-Ping Yang, Hui-Chen Chao
• 失智、照顧者、飲食、能力、量表發展
  dementia, caregiver, diet, ability, instrument development
• 目標：發展與驗證照護失智患者飲食能力量表之信效度，以評價家庭照顧者照護失智患者飲食的能力。方法：第一階段為量表題項建構，以立意取樣邀請29位失智家屬進行焦點團體、專家內容效度檢定，初擬失智飲食照護能力題項。第二階段為量表信效度檢測，以探索性及驗證性因素分析檢定量表建構效度，內在一致性檢定量表信度。運用橫斷式調查、方便取樣於臺灣北、中、南地區之失智症共同照護中心、失智症門診、社區失智症服務據點招募418 位失智家屬為研究對象，運用IBM SPSS 26 Amos 27版程式進行資料分析。結果：6個焦點團體共12次訪談達資料飽和，初擬73個題項經專家效度檢定後修訂為50題，CVI值達0.97。經因素分析，量表第一部分「失智飲食照護概念」萃取出三因素8題，模式適配度指標GFI=0.97、CFI=0.97、TLI=0.95、AGFI=0.94、NFI=0.93、RMSEA=0.05、SRMR=0.04；8題SMC均高於0.25；除「因素三地中海食材選擇」CR值為0.49，其他皆高於0.6；「因素二營養與認知功能」AVE為0.4、「因素三地中海食材選擇」AVE為0.33，其餘題目AVE均高於0.5；三個因素的AVE 皆高於其他兩兩因素的積差相關係數平方；信度KR-20值為0.70。第二部分「自覺失智飲食照護能力」萃取出四因素17題，模式適配度指標GFI=0.88、CFI=0.94、TLI=0.93、AGFI=0.83、NFI=0.92、RMSEA=0.08、SRMR=0.04；SMC值均高於0.25、CR值高於0.6、AVE值均高於0.5；四個因素的AVE皆高於其他兩兩因素的積差相關係數平方；信度Cronbach’s α值為0.94， 量表兩部分SEM模式檢定達良好適配度且具收斂效度與區辨效度。結論：本量表具有良好信效度，可作為家庭照顧者其照護失智患者飲食能力的評估工具。
  Objectives: To develop and verify the reliability and validity of the Scale of the Ability to Care for the Diet of Patients with Dementia to assess the family caregivers’ ability to care for the diet of such patients. Methods: The first stage involved constructing the items for the scale. Through purposive sampling, 29 family members of patients with dementia were invited to conduct focus group interviews and to conduct expert content validity verification, thereby drafting the items of the ability to care for the diet of patients with dementia. The second stage involved verifying the reliability and validity of the scale. Exploratory and confirmatory factor analyses were conducted to assess the construct validity of the scale. Internal consistency was used to assess the reliability of the scale. A cross-sectional survey was adopted. Through convenience sampling, 418 family members of patients with dementia from a center for integrated dementia care, dementia outpatient clinics, and community-based support sites for dementia care in northern, central, and southern Taiwan were recruited. IBM SPSS 26.0 and AMOS 27.0 were used for data analysis. Results: After conducting 12 interviews with 6 focus groups, data reached saturation. We drafted 73 items, which were revised into 50 items after expert validity verification, reaching a content validity index value of 0.97. After factor analysis, 3 factors and 8 items in the first part of the scale, “Dementia Diet Care Concepts,” were extracted. The model goodness of fit indices were as follows: goodness of fit index = 0.97, comparative fit index = 0.97, Tucker–Lewis index = 0.95, adjusted goodness of fit index = 0.94, normed fit index = 0.93, mean square error of approximation = 0.05, and standardized root mean squared residual = 0.04. The square multiple correlation values of all 8 items were greater than 0.25. With the exception of Factor 3 (Choosing Mediterranean ingredients), whose critical ratio (CR) value was 0.49, the CR values of all the other factors were greater than 0.6. The average variance extracted (AVE) of Factor 2 (Nutrient and cognitive function) was 0.4, and that of Factor 3 (Choosing Mediterranean ingredients) was 0.33. The AVE of the rest of the factors were greater than 0.5. The AVE of 3 factors were all greater than the squared value of the product–moment correlation coefficient of any 2 factors. The Kuder–Richardson Formula 20 reliability was 0.70. In the second part of the scale, Self-reported Ability of Dementia Diet Care, 4 factors and 17 items were extracted. The model goodness of fit indices were as follows: goodness of fit index = 0.88, comparative fit index = 0.94, Tucker– Lewis index = 0.93, adjusted goodness of fit index = 0.83, normed fit index = 0.92, mean square error of approximation = 0.08, and standardized root mean squared residual = 0.04. The square multiple correlation values of all items were greater than 0.25. The CR values were all greater than 0.6, and the AVE values were all greater than 0.5. The AVE of 4 factors were all greater than the squared value of the product–moment correlation coefficient of any 2 factors. The reliability Cronbach’s α was 0.94. The structural equation modeling model verification of the 2 parts of the scale revealed favorable goodness of fit, and they exhibited convergent validity and discriminant validity. Conclusions: This scale had favorable reliability and validity, and it can be used as an assessment tool for assessing family caregivers’ ability to care for the diet of patients with dementia.
• 660-679
• 10.6288/TJPH.202112_40(6).110071

• Link 原著 Original Article
• 青少年時期家庭脈絡與成年初期睡眠行為:離家過渡的角色Family context during adolescence and sleep behavior during young adulthood: the role of leaving home transition
• 吳孟軒、林文旭、喬 芷
  Meng-Hsuan Wu, Wen-Hsu Lin, Chi Chiao
• 睡眠行為、家庭脈絡、離家過度、縱向研究
  sleep behavior, family context, leaving home transition, longitudinal study
• 目標：本研究旨以縱向視野探索青少年時期家庭脈絡（包括，家庭結構、親子關係、父母監管）與成年初期睡眠行為間之關聯，及離家過渡在這之間的潛在調節機制．方法：納入台灣青少年成長歷程研究（簡稱TYP）中完整參與高二至大二時期之受訪者（N=2,123，共兩世代：2005年至2007年的國一世代和2003年至2004年的國三世代），並以多元邏輯斯迴歸分析睡眠時間（短、建議〔7h-9h〕、長）；負二項迴歸分析失眠症狀（三種症狀加總）。結果：青少年時期生於單親家庭者，其成年初期有較高可能睡眠時間相對長（相對風險比 [Relative Risk Ratio] RRR 1.52，95% CI 1.02-2.25）；與父母關係較佳或受父母較多監管者，日後則較低可能睡眠時間相對短（RRR 0.75，95% CI 0.61-0.92；RRR 0.91，95% CI 0.85-0.97）。此外，親子關係較佳者，日後失眠症狀風險也相對低（發生率比 [Incidence Rate Ratio] IRR 0.90，95% CI 0.83-0.98）。進一步探究於成年初期離家者，可見親子關係和父母監管與睡眠行為仍存顯著相關。結論：青少年時期所處家庭脈絡與成年初期睡眠行為間存在縱向關聯．為預防後續出現不建議睡眠時數和失眠症狀，青少年時期親子關係和父母監管為建議優先介入措施。
  Objectives: This study seeks to delineate the effects of family context during adolescence, namely family structure, parent-child relationship, and parental monitoring, and their longitudinal associations with sleep behaviors during young adulthood, with a focus on a possible moderating effect of leaving home transition. Methods: Data were retrieved from the Taiwan Youth Project (TYP) (N=2,123, and consisted of a two-cohort sample from 12th grade at school up to an age of around 20 years, these cohorts consisted of a 7th-grade one from 2005 to 2007 and a 9th-grade one from 2003 to 2004). Sleep duration (short, recommended [7h-9h], and long) was analyzed by multinomial logistic regression, while insomnia symptoms were analyzed by negative binomial regression. Results: Youth living in a one-parent family during adolescence had an increased risk of long sleep duration during young adulthood (Relative Risk Ratio [RRR] 1.52, 95% CI 1.02- 2.25); whereas those with a more positive relationship with parents, or receiving more parental monitoring, were less likely to experience short sleep duration (RRR 0.75 95% CI 0.61-0.92; RRR 0.91, 95% CI 0.85-0.97). Moreover, youth with a more positive parent-child relationship were also found to be at lower risk of insomnia symptoms (Incidence Rate Ratio [IRR] 0.90, 95% CI 0.83-0.98). Furthermore, when the sample was restricted to those who had left home during young adulthood, the effects of a positive parent-child relationship and parental monitoring remain significant and had the same effect on the various sleep behaviors. Conclusions: Our results suggest that the importance of family context and its longitudinal association with sleep behaviors. To prevent an unrecommended sleep duration and the development of insomnia symptoms during young adulthood, early intervention that targets parent-child relationships and parental monitoring are suggested as a priority.
• 680-698
• 10.6288/TJPH.202112_40(6).110097

• Link 原著 Original Article
• 生命自主方案對輕度認知障礙者與其家庭照顧者參與預立醫療照護諮商及末期維生醫療抉擇意向之影響Effect of life autonomy programs on engaging in advance care planning and end-of-life care decisions for people with mild cognitive impairment and their family caregiver
• 呂偉如、黃秀梨、劉建良
  Wei-Ru Lu, Hsiu-Li Huang, Chien-Liang Liu
• 認知障礙、家庭照顧者、預立醫療照護諮商、預立醫療決定、生命末期
  cognitive impairment, family caregiver, advance care planning, advance directives, end-of-life
• 目標：探討生命自主方案對輕度認知障礙者或失智者與其家庭照顧者參與正式預立醫療照 護諮商（ACP）及末期維生醫療抉擇意向之影響。方法：採單組前後測之前實驗法，招募55歲以上、診斷為輕度認知障礙或輕度失智症、未參與過正式ACP，且其家庭照顧者亦同意參加者納入本研究。由受過ACP訓練且有失智症照顧經驗的護理師進行介入。以結構性問卷進行資料收集，並以成對樣本t檢定及組內相關係數比較介入前後差異與一致性。結果：共44對參與者完成本研究，介入後參與者在失智末期治療及ACP認知均顯著提升（p < .01），認知障礙者簽署「預立安寧緩和醫療暨維生醫療抉擇意願書」（p < .05）及「醫療委任代理人委任書」（p < .05）可能性顯著增加，家庭照顧者為認知障礙親人簽署「不施行心肺復甦急救同意書」可能性顯著提升（p < .05），二者對於末期照護維生醫療抉擇一致性亦增加。結論：生命自主方案對輕度認知障礙者或失智者與其家庭照顧者末期維生醫療抉擇意向與一致性有顯著正向影響。建議照護團隊正視此群體接受ACP的平等性與可近性，儘早進行ACP溝通與討論，改善其末期照護品質。
  Objectives: Exploring the effect of a life autonomy program on the engagement in advance care planning (ACP) and end-of-life (EoL) care decisions among people with mild cognitive impairment (PWCIs) or mild dementia and among their family caregivers (FCGs). Methods: A one-group, pretest–posttest design was applied. The inclusion criteria for PWCIs were: aged >55 years, had a diagnosis of mild dementia or mild cognitive impairment, and had never participated in a formal ACP consultation. Their FCGs also must have agreed to participate in the study. The intervention was provided by an ACP-trained registered nurse. A structured questionnaire was used for data collection, and paired t tests and the intraclass correlation coefficient were used to compare the differences between pre-intervention and post-intervention. Results: A total of 44 dyads of participants completed this study. After the intervention, both PWCIs and their FCGs had significantly greater knowledge of end-stage dementia treatment and ACP (p <.01). PWCIs were significantly more likely to sign advance directives for palliative care (p < .05) and for a health care agent (p < .05). FCGs were also significantly more likely to sign do not resuscitate consent forms for PWCIs (p < .05). The consistency of EoL care decisions also increased between PWCIs and FCGs after intervention. Conclusions: Life autonomy programs significantly and positively affect the PWCIs’ and FCGs’ consideration of EoL care decisions. We suggest for care teams to recognize the equality of and accessibility to ACP for this PWCIs, promote the communication and discussion of ACP as soon as possible, and improve the quality of EoL care for PWCIs.
• 699-712
• 10.6288/TJPH.202112_40(6).110059

• Link 原著 Original Article
• 台灣高雄市堪薩斯分枝桿菌之空間分析Spatial cluster analysis of Mycobacterium kansasii infection in Kaohsiung, Taiwan
• 劉柏辰、黃虹綾、詹大千、李欣蓉、林俊農、李禎祥、王振源、盧柏樑、林先和
  Bo-Chen Liu, Hung-Ling Huang, Ta-Chien Chan, Shin-Jung Lee, Jiun-Nong Lin, Chen-Hsiang Lee, Jann-Yuan Wang, Po-Liang Lu, Hsien-Ho Lin
• 非結核分枝桿菌、堪薩斯分枝桿菌、莫蘭指數、空間相對風險函數、核密度估計
  Nontuberculous mycobacterium, Mycobacterium kansasii, Moran’s I, spatial relative risk function, adaptive kernel density estimation
• 目標：由於堪薩斯分枝桿菌的高致病性及高雄逐年上升的發生率，本研究旨在探討高雄堪薩斯分枝桿菌感染者之空間分佈及該菌種之感染熱區範圍。方法：利用高雄市2015至2017年間堪薩斯分枝桿菌感染者之地理資訊，以最小統計區為空間單位，藉莫蘭指數分析發生率之空間分佈型態及顯著的群聚核心。並隨機抽樣門牌地址以代表空間上均質的感染分佈，再透過空間相對風險函數比較感染者與隨機感染之座標來計算感染熱區的確切範圍。結果：發生率於最小統計區下之空間自相關呈顯著正相關（呈群聚趨勢），且顯著地圖指出群聚核心位於小港區內。空間相對風險分析亦得出兩感染熱區，分別位於前金、鹽埕區的交界及小港區內部（空間相對風險落在1.54至2.27之間）。結論：高雄市堪薩斯分枝桿菌感染者的分布並非均質，且存在感染熱區。然而感染來源與易感染人群的空間分布均可能有其特定的群聚趨勢，故本研究的結果應解讀為可能影響此感染症的所有因素在空間上的綜合表現。未來仍須更多生物與環境上的證據以佐證本研究之結論。
  Objectives: Owing to the high virulence of mycobacterium kansasii and the increasing incidence in Kaohsiung, the present study aimed to analyze the spatial pattern of mycobacterium kansasii infection in Kaohsiung. Methods: We applied the Moran’s I to estimate the spatial pattern of incidence risk and to identify the cluster core. The core of the cluster was confirmed by the spatial relative risk function with contouring an infection hotspot that the location of the comparative group were randomly sampled from the address database. Results: The positive and significant spatial autocorrelation based on the incidence risk of the basic statistical area was illustrated by the significance map with the cluster core locating in Xiaogang district. The spatial relative risk function indicated two hotspots, one located across Qianjin district and Yancheng district, and the other mainly sat in Xiaogang district. All the significant spatial relative risk ranged from 1.54 to 2.27. Conclusions: Two hotspots indicated that the mycobacterium kansasii infection not homogeneously distributes in Kaohsiung City. Infection sources may have specific spatial patterns, yet the susceptible host probably has other tendencies too. Therefore, our results should be interpreted as a combination of all factors related to this infection.
• 713-723
• 10.6288/TJPH.202112_40(6).110098

• Link 實務 Public Health Practice
• 以台灣健保申報資料進行糖尿病相關研究個案定義作法之差異Variations in case definition algorithms in diabetes-related studies using Taiwan National Health Insurance claims data
• 顧芳萍、李昇暾、李中一、呂宗學
  Fang-Ping Ku, Sheng-Tun Li, Chung-Yi Li, Tsung-Hsueh Lu
• 糖尿病、台灣健保申報資料、個案定義作法
  diabetes mellitus, Taiwan National Health Insurance claims data, case definition algorithm
• 目標：本描述性研究探討以台灣健保申報資料進行糖尿病相關研究個案定義作法之差異。方法：搜尋文獻資料庫找出2001至2020年發表的相關論文，整理出每一篇研究使用的個案定義作法。個案定義作法的組成包括：1)診斷編碼，2)使用資料（譬如門診，住院或藥物處方紀錄），3)診斷碼最少就診次數，4)是否有時間間隔要求。本研究參考已發表準確度研究的陽性預測值高低將不同作法進行分類。結果：本研究找出611篇相關研究，整理出8類30種不同個案定義作法。陽性預測值第1類最低，第8類最高。數目最多的作法依序是第8類「診斷碼且有藥物處方」194篇（32%），第1類「1次門診診斷碼」119篇（20%）與第3類「2次以上門診診斷碼」111篇（18%）。第7,8類「有使用藥物處方為個案定義條件」的研究論文篇數顯著增加，由2001-2011年的18篇增加到2018-2020年的89篇，而且86篇是用較嚴格的「有診斷碼且有藥物處方」。反之，第1,2類「1次門診或住院診斷碼」的比例由2001-2011年的31%，下降到2018-2020年的14%。結論：近二十年來，越來越多研究使用較嚴格（高陽性預測值）的個案定義作法。未來應該有研究進一步產出台灣不同個案定義作法的準確度指標數據，提供後續研究者引用，以符合國際學術期刊對於使用例行收集行政資料研究的報告規範要求。
  Objectives: This descriptive study examined the variations in case definition algorithms in diabetes-related studies using Taiwan National Health Insurance claims data. Methods: We searched the PubMed database to retrieve relevant papers published between 2001 and 2020. The components of a case definition algorithm included 1) diagnostic codes, 2) data used, 3) minimum number of visits with diagnostic codes, and 4) time intervals required. We grouped the algorithms according to their positive predictive value (PPV) derived from a published validity study. Results: We identified 611 studies with 30 distinct case definition algorithms and classified them into 8 groups. The PPV was lowest in Group 1 and highest in Group 8. The three most frequently used algorithm appeared in Group 8, (“diagnostic code AND antidiabetic drugs prescribed,” 194 papers, 32%), followed by Group 1 (“at least one outpatient diagnostic code,” 119 papers, 20%) and Group 3, (“at least two outpatient diagnostic codes,” 111 papers, 18%). The number of papers in Groups 7 and 8 that used antidiabetic drugs as a condition for case definition increased prominently, from 18 between 2001 and 2011 to 89 between 2018 and 2020. Furthermore, 86 papers used the more rigorous definition “diagnostic codes AND medications.” However, the proportion of papers in Groups 1 and 2 decreased from 31% between 2001 and 2011 to 14% between 2018 and 2020. Conclusions: The number of diabetes-related studies using more rigorous (higher PPV) case definition algorithms increased between 2001 and 2020. Additional studies, which are requested through the reporting of studies conducted using observational routinely collected health data (RECORD), on the validity of these algorithms are required.
• 725-733
• 10.6288/TJPH.202112_40(6).110120

• Link 評論 Commentary
• 評論:台灣高雄市堪薩斯分枝桿菌之空間分析Commentary: spatial cluster analysis of Mycobacterium kansasii infection in Kaohsiung, Taiwan
• 郭書辰
  Shu-Chen Kuo
• 無
  none
• 無
  none
• 724
• 10.6288/TJPH.202112_40(6).11009801