41卷1期

• Link 政策論壇 Policy Forum
• 老年衰弱症(Frailty)的防治Prevention and intervention of frailty in the elderly
• 李怡萱、盧佳文、余忠仁、黃國晉
  Yi-Hsuan Lee, Chia-Wen Lu, Chong-Jen Yu, Kuo-Chin Huang
• 無
  none
• 無
  none
• 1-3
• 10.6288/TJPH.202202_41(1).PF01

• Link 公衛論壇 Public Health Forum
• 兒童公共衛生的新目標:將兒童納入所有政策The new goals of child public health: children in all policies
• 張弘潔
  Hung-Chieh Chang
• 無
  none
• 無
  none
• 4-6
• 10.6288/TJPH.202202_41(1).111006

• Link 綜論 Review Article
• 2021年國際健康數據治理概況Overview of international health data governance in 2021
• 葉咨甫、林 澂
  Tzu-Fu Yeh, Chen Lin
• 健康數據、數據治理、數據共享、隱私保護、數據民主化
  health data, data governance, data sharing, privacy protection, data democratization
• COVID-19不僅威脅生命，而且對全球經濟造成巨大危害。健康數據推動21世紀衛生部門在治療和護理的變革。國際組織呼籲加強健康數據治理，實現數據安全共享和隱私保護。本文摘錄Jillian Oderkirk在經濟合作暨發展組織(OECD)衛生工作文件第127號的國際統計調查，介紹國際健康數據整合、治理、隱私和共享的發展概況。本文發現大多數國家都了解健康數據治理的重要性，但在現實中仍面臨諸多挑戰，僅有少數國家在健康數據治理方面表現突出，但距離健康數據「民主化」還很遙遠。最後是台灣健康數據發展概況，並簡要介紹目前全球數據治理的主流方案。
  The COVID-19 pandemic has endangered human life and damaged the global economy. The development of artificial intelligence and medical technology depends on the continuous supply of high-quality health data. With the wide availability of health data, the importance of data governance cannot be understated. Health data have enabled reforms in medical diagnosis and treatment. International organizations call for strengthened health data governance to achieve data security and privacy protection. This paper, which is an excerpt from an international statistical survey in OECD Health Working Paper No. 127, provides an international governance–based overview of the integration, governance, privacy, and sharing of international health data. This study revealed that the governments of most countries understand the importance of health data governance but face many related challenges. Only a few countries have outstanding performance in health data governance, and they have not achieved the democratization of health data. Finally, this paper provides an overview of Taiwan’s health data development and introduces current mainstream data governance solutions.
• 7-15
• 10.6288/TJPH.202202_41(1).110141

• Link 綜論 Review Article
• 中醫居家醫療之現況與展望Role of traditional Chinese medicine in home-based medical care in Taiwan: current status and prospects
• 陳品璇、曾育慧、許中華
  Pin-Shuan Chen, Yu-Hwei Tseng, Chung-Hua Hsu
• 中醫居家醫療、居家醫療、失能者、老年照護、整合照護
  traditional Chinese medicine in home-based medical care, home health care, disability, elder care, integrated care
• 本文藉由分析統整中醫居家醫療相關實證醫學及研究文獻，初探中醫於「居家醫療」的發展。近年來老年以及失能人口帶來醫療需求增加，政府整合並提升因失能或疾病特性外出就醫不便患者的醫療照護，自1995年陸續推動多項計畫，並於2016年正式實施「居家醫療整合照護計畫」，由整合性照護團隊提供「居家醫療」、「重度居家醫療」及「安寧療護」三階段的連續性照護。中醫雖為傳統醫學但有其獨特的醫療價值，以全人的觀點診治患者，也相當重視「預防醫學」，可應用在老年人口的預防失能、減緩失能加重程度、改善中重度失能個案健康問題上，也能協助提高整體照護品質。政府在2019年6月1日正式將中醫納入「居家醫療整合照護計畫」，有中醫照護需求之患者可申請中醫師至家中給予治療。本文以文獻回顧的方式，從中醫居家醫療及中醫治療老年與失能者常見疾病之實證經驗的角度出發，探討中醫在居家醫療團隊中的角色與貢獻，並回顧台灣健保居家醫療推動之歷史演進。
  Recently, the demand for home health care has increased in Taiwan, which has an aged society. The Taiwanese government has introduced several programs since 1995 to integrate and improve the medical care of patients who face difficulties visiting health-care facilities due to disability, illness or frailty. The Home-Based Integrated Care Program, which took effect in 2016, is a three-stage holistic program that incorporates home-based medical care, severe home-based medical care, and home-based palliative care. Traditional Chinese medicine (TCM) can be used for home-based medical care. In TCM, patients are treated with a special focus on preventive medicine; related treatments can be used to prevent disability, to slow the progression of disability, and to improve the health of older adults with moderate-to-severe disability. By improving individual health, TCM can also help improve the overall quality of health care. The Taiwanese government included TCM in the Home-based Integrated Care Program in June 2019. Patients who require TCM care can apply to receive such care at home. On the basis of our literature review, this paper examines the role and contribution of TCM in home health care with the support of empirical experience. The evolution of home health-care programs in Taiwan is also reviewed herein.
• 16-35
• 10.6288/TJPH.202202_41(1).110130

• Link 原著 Original Article
• 嬰幼兒母親對食品安全相關之政府信任及風險感知與其採用避險行為之路徑分析:以台北市某教學醫院為例Path analysis of trust in government, risk perception, and risk avoidance behavior regarding food safety among mothers at a teaching hospital in Taipei City
• 丁心恬、簡伶朱、江椿彬、陳怡樺、賈培娟、莊媖智
  Hsin-Tien Ting, Ling-Chu Chien, Chuen-Bin Jiang, Yi-Hua Chen, Pei-Chuan Chia , Ying-Chih Chuang
• 政府信任、食安風險感知、母親食安避險行為、社會經濟地位、修飾因子
  trust in government, risk perception about food safety, mothers’ risk avoidance behavior, socioeconomic status, moderator
• 目標：本研究目的是探討有六歲以下嬰幼兒之母親政府信任、食安風險感知以及食安避險行為之間的關係，以及探討社經地位是否為三者關係之修飾因子。方法：研究樣本來自台北某一教學醫院439位有六歲以下嬰幼兒的母親，以一對一面訪的方式收集資料，其食安避險行為包括購買當季蔬菜和注意食品添加物。分析方法使用路徑分析進行多變項分析。結果：母親對於政府的信任提高會降低對食安的擔憂程度、嚴重程度以及採取食安避險行為的機率，而擔憂程度提高則會提高採取食安避險行為的機率，但自覺障礙提高反而會減少採取食安避險行為的機率。多群組分析結果顯示，社經地位中的教育程度指標為政府信任、食安風險感知以及食安避險行為三者關係之修飾因子。結論：在面對食安風險時，母親的政府信任確實會影響食安風險感知與食安避險行為。建議未來政府在處理食安風險時，應更注重治理方式以增進民眾對政府的信任與針對不同族群採取不同的風險溝通方式。
  Objectives: This study examined the relationships among trust in food safety, risk perception, and risk avoidance behaviors among mothers with children younger than 6 years of age and determined whether socioeconomic status moderates those relationships. Methods: The study participants were recruited from a teaching hospital in Taipei, and face-to-face interviews were conducted with 439 mothers. Path analysis was used to analyze the relationships among trust in the government, risk perception, and risk avoidance behaviors regarding food safety. Risk avoidance behaviors included buying seasonal vegetables and paying attention to food additives. A multigroup analysis was used to assess whether socioeconomic status was a moderating variable. Results: The results of the path analysis indicated that the mothers’ trust in the government reduced their worry about food safety risks, perceived severity of food safety risks, and the probability of adopting risk avoidance behaviors. The perception of barriers by the mothers also reduced their probability of adopting risk avoidance behaviors. The results of this multigroup analysis demonstrated that an individual’s education level moderates the relationships among trust in government, risk perception, and risk avoidance behavior. Conclusions: Our results indicated that mothers’ trust in the government affected their perception of risk and risk avoidance behaviors. In the future, the Taiwanese government must enhance risk governance to increase people’s trust, strengthen its communication capacity about food safety risks, and design tailored programs for individuals of various socioeconomic statuses.
• 36-50
• 10.6288/TJPH.202202_41(1).110056

• Link 原著 Original Article
• 新冠肺炎謠言內容分析之探究Content analysis of COVID-19 rumors
• 歐昱傑、楊淑晴、宋庭瑋、羅藝方
  Yu-Jie Ou, Shu-Ching Yang, Ting-Wei Song, Yi-Fang Luo
• 內容分析法、新冠肺炎、謠言
  content characteristics, COVID-19, rumors
• 目標：本研究期能在這波COVID-19疫情期間，提供民眾判讀眾多訊息來源的依據，並避免將錯誤訊息一再轉傳與分享而造成更多誤解。方法：本研究採用內容分析法，以網路上所散布的新冠肺炎(COVID-19)謠言為標的。從「TFC台灣事實查核中心」網站所收集的113則COVID-19謠言作為分析樣本，探討其謠言之內容要素特徵。結果：COVID-19謠言常見的類型以「分化性」謠言最多，謠言所述對象主要是「某一特定行為」及「某種食品/用品」，且大多沒有明確描述發生日期，但一半以上有描述精確地點。謠言主要目的為「注意/警惕」以及「分享新知」，託稱的主要來源則是網路轉載，並且主要以「照片/圖示/影片」及「專家說法」佐證。結論：COVID-19謠言內容分析結果，可作為民眾辨識COVID-19謠言的基本認知，以強化一般公民辨識假訊息的能力，教導社群媒體使用者，能對訊息傳染病具更正面的態度及回應。
  Objectives: This study provided a basis for the public to evaluate numerous sources of COVID-19 information to mitigate the harm caused by the repeated dissemination and sharing of misinformation. Methods: Content analysis was used to examine the spread of COVID-19 rumors on the Internet. The content characteristics and expressions of 113 COVID-19 rumors collected from the “Taiwan Fact Checking Center” website were used as samples for analysis. Results: The most common type of COVID-19 rumor was “aggressive,” and “a particular behavior” and “specific type of food or appliance” were the most common objects of the rumors. The dates of occurrence were not clearly noted, but the contents of more than half of the rumors were accurately described. The main purposes were primarily “attention/warning” and “sharing new knowledge.” These rumors mostly originated from the Internet, and the rumors were corroborated primarily by “photos/icons/videos” and “experts.” Conclusions: The content analysis results of the COVID-19 rumors could enhance the public’s basic awareness and ability to identify false COVID-19 rumors and to encourage social media users to be more vigilant against the spread of disinformation.
• 51-68
• DOI:10.6288/TJPH.202202_41(1).110112

• Link 原著 Original Article
• 缺血性腦中風病人出院後照護連續性與照護結果及醫療費用之關係Associations of continuity of postdischarge care with healthcare outcomes and expenses among patients with ischemic stroke
• 林映萱、董鈺琪
  Ying-Hsuan Lin, Yu-Chi Tung
• 缺血性腦中風、照護連續性、照護結果、醫療費用
  ischemic stroke, continuity of care, outcomes of care, medical expense
• 目標：腦中風病患出院後死亡率、再住院率高，醫療費用亦高，病人出院後接受片段式照護導致住院率及醫療費用增加。過去研究指出腦中風病人照護連續性越高，出院後死亡率越低，然而照護連續性與住院次數及醫療費用之關係仍未明瞭。本研究針對缺血性腦中風病人，探討照護連續性與照護結果及費用之相關性。方法：使用衛生福利部衛生福利資料科學中心代表性全國樣本，以缺血性腦中風住院之病人納為研究對象。依出院後一年門診申報資料計算照護連續性指標(continuity of care index, COCI)，將樣本分為低、中、高三組，利用羅吉斯迴歸、負二項迴歸及伽瑪迴歸，分析門診照護連續性對出院後一年內的死亡風險、住院次數、總醫療費用之相關性。結果：共納入2,447位研究對象。缺血性腦中風病人出院後高照護連續性與低死亡率及低住院次數相關，亦與低醫療費用相關。結論：缺血性腦中風病人照護連續性高與降低住院次數及死亡風險相關。因此建議衛生主管機關可提升病人照護連續性改善照護結果，達到降低總醫療費用之目的。
  Objectives: The mortality and readmission rates of patients with stroke after discharge are high, and the associated medical costs are high. Patients receiving fragmented care after discharge have an increased hospitalization rate and higher medical expenses than other patients. Studies have indicated that the better is the continuity of care among patients with stroke, the lower is their mortality rate after discharge. However, the relationship between the continuity of care and hospitalizations and medical expenses is unclear. This study explored the associations of the continuity of postdischarge care with healthcare outcomes and expenses among patients with ischemic stroke. Methods: Patients hospitalized for ischemic stroke were included in a nationally representative sample using data from the Health and Welfare Data Science Center, Ministry of Health and Welfare. The continuity of care index (COCI) was calculated using outpatient data after discharge. The patients were divided into low, medium, and high COCI groups. Logistic regression, negative binomial regression, and gamma regression were used to explore the associations of care continuity with mortality, hospitalizations, and medical expenses. Results: A total of 2,447 patients were included. High continuity of care was related to low mortality, low hospitalizations, and low medical expenses. Conclusions: High continuity of care among patients with ischemic stroke is associated with a reduction in hospitalizations and a low risk of death. Therefore, healthcare authorities can increase the continuity of care to improve patient outcomes and reduce medical expenses.
• 69-80
• 10.6288/TJPH.202202_41(1).110091

• Link 原著 Original Article
• 身心障礙鑑定與需求評估分析—分立?或整合?Disability evaluation and needs assessment of International Classification of Functioning, Disability and Health in Taiwan: separated or integrated?
• 姚奮志
  Fen Zhi Yao
• 關鍵詞:身心障礙功能鑑定、身心障礙需求評估、身心障礙鑑定
  functioning disability evaluation scale, Taiwan ICF needs assessment scale, disability evaluation
• 目標：本研究主要了解身心障礙鑑定評估兩階段工具，「身心障礙鑑定功能量表」與「福利與服務需求評估訪談表」的關聯性與差異性，並討論對身心障礙者評估結果的影響。方法：運用衛生福利部身心障礙功能鑑定資料庫與需求評估資料庫2015年至2019年的有效資料共59,787筆，針對兩份工具的評估結果運用等級相關、卡方適合度考驗與單因子變異數分析進行比對。結果：根據各項數據，兩份工具是同一個ICF理念但各自表述;身障者社會參與環境因素在整體鑑定過程中難以評量;身障者的障礙認定有受到區域性的差異對待。結論：制度規劃應整合鑑定評估流程、加強環境因素的考量與應用、強化以身障者為核心的互動和參與。整體鑑定評估流程呈現分立式、區隔化、差異性的特徵，影響身障者評估權益。
  Objectives: This study was conducted to understand the correlation and differences between the two-stage tools for disability evaluation – the Functioning Scale of the Disability Evaluation System and the Needs Assessment of Welfare Services for Persons with Disabilities – and to discuss their impact on disability evaluation result. Methods: A total of 59,787 pieces of valid data from the disability evaluation database and needs assessment database of the Ministry of Health and Welfare (MOHW) for the period from 2015 to 2019 were used for the analysis. The results of the two tools were compared through rank correlation, chi-square distribution, and one-way analysis of variance. Results: The data indicated that the two tools were expressed separately by the same ICF ideal. The evaluation of environmental factors was difficult in the overall system. The evaluation of the disabled was subject to regional differences. Conclusions: The system should integrate the evaluation process, reinforce the consideration and application of environmental factors, and facilitate the interaction with and participation of the disabled. The overall evaluation process is characterized by a separated, compartmentalized, and difference approach that undermines the implementation of disability evaluation rights.
• 81-95
• 10.6288/TJPH.202202_41(1).110136

• Link 研究紀要 Research Brief
• 台灣新冠肺炎疫情下的家庭收入損失與兒童健康不平等Family income loss and child health inequality during the COVID-19 pandemic in Taiwan
• 江宛霖、林宇旋、江東亮
  Wan-Lin Chiang, Yu-Hsuan Lin, Tung-liang Chiang
• 新冠肺炎、家庭收入損失、兒童健康不平等、台灣出生世代研究
  COVID-19, family income loss, child health inequality, Taiwan Birth Cohort Study
• 目標：本研究旨在探討新冠肺炎疫情下，家庭收入損失與兒童健康的關係。方法：資料來源為台灣出生世代研究，其乃針對2005年全國出生嬰兒為母群體進行追蹤調查，本研究主要使用這些兒童15歲時，對其主要照顧者所蒐集的資料共18,042名。首先，以描述統計檢視兒童社經背景與家庭收入損失之關係。接著，利用Cochran-Armitage趨勢檢定，評估家庭收入損失與兒童健康是否呈現梯度相關。最後，以多變項邏輯斯迴歸模型，分析家庭收入損失對兒童健康的影響。結果：本研究發現：(1)社經背景較弱勢的家庭，家庭收入損失的風險較大；(2)家庭收入損失越嚴重、兒童健康越差，但此梯度關係在高收入的家庭沒有顯著；(3)控制社經背景後，家庭收入有嚴重損失（OR: 1.3, 95% CI 1.2-1.5）與輕微損失（OR: 1.2, 95% CI 1.1-1.3）的兒童，健康普通/不好的風險都顯著較沒有損失的兒童高。結論：新冠肺炎疫情下家庭收入損失與兒童健康不平等息息相關。為避免健康差距擴大，必須預防並幫助家庭收入因疫情遭受衝擊的兒童，特別是社經背景弱勢族群。
  Objectives: This study aimed to examine the relationship between family income loss and child health during the COVID-19 pandemic. Methods: Data for the analysis were obtained from the Taiwan Birth Cohort Study, a nationally representative sample of babies born in 2005, and 18,024 caregivers participated in the survey as their children aged 15. In analysis, we first conducted descriptive analyses to test the correlation between socioeconomic variables and family income loss. We next assessed whether there was a gradient relationship between family income loss and child health using Cochran–Armitage trend test. Finally, multiple logistic regression was used to estimate the relationship between family income loss and child health. Results: Our findings indicated that (1) lower socioeconomic families were at a greater risk of suffering income loss during COVID-19; (2) children in the families experiencing a more severe loss of income had worse health, but the gradient relationship was not significant for those in higher income families; and (3) significantly higher risk of fair/poor health of children was found in the severe (OR: 1.3, 95% CI 1.2–1.5) and mild (OR: 1.2, 95% CI 1.1–1.3) income loss groups than in the no income loss group after adjustment for socioeconomic variables. Conclusions: Family income loss due to COVID-19 was significantly associated with child health inequality. To avoid widening the health gap, children in families experiencing financial impacts during the COVID-19 pandemic should be protected and supported, particularly those in lower socioeconomic groups.
• 96-104
• 10.6288/TJPH.202202_41(1).110133

• Link 評論 Commentary
• 評論:台灣新冠肺炎疫情下的家庭收入損失與兒童健康不平等Commentary: Family income loss and child health inequality during the COVID-19 pandemic in Taiwan
• 李妙純
  Miaw-Chen Lee
• 無
  none
• 無
  none
• 105-106
• 10.6288/TJPH.202202_41(1).11013301

• Link 作者回覆 Authors' response to commentary
• 作者回覆:台灣新冠肺炎疫情下的家庭收入損失與兒童健康不平等Authors' response to commentary: family income loss and child health inequality during the COVID-19 pandemic in Taiwan
• 江宛霖、林宇旋、江東亮
  Wan-Lin Chiang, Yu-Hsuan Lin, Tung-liang Chiang
• 無
  none
• 無
  none
• 107
• 10.6288/TJPH.202202_41(1).11013302