41卷2期

• Link 政策論壇 Policy Forum
• 台灣面臨超高齡社會的挑戰與因應The challenges and strategies for coping with super-aged society in Taiwan
• 許志成
  Chih-Cheng Hsu
• 無
  none
• 無
  none
• 109-111
• 10.6288/TJPH.202204_41(2).PF02

• Link 公衛今與昔 Public Health Now and Then
• 哲人雖已遠，典型在夙昔：追憶全球衛生先行者保羅．法默爾博士In memory of global health pioneer Dr. Paul Farmer
• 黃傳景、林先和
  Chuan-Chin Huang, Hsien-Ho Lin
• 無
  none
• 無
  none
• 112-114
• 10.6288/TJPH.202204_41(2).PHNT01

• Link 公衛論壇 Public Health Forum
• 數位時代建立以實證為導向的毒品防制政策：健全公務資料庫基礎建設 Strengthening data infrastructure for evidence-oriented drug policy in the digital era
• 陳娟瑜、雷文玫
  Chuan-Yu Chen, Wenmay Rei
• 無
  none
• 無
  none
• 115-127
• 10.6288/TJPH.202204_41(2).110151

• Link 綜論 Review Article
• 檢視我國均衡區域病床資源之發展政策Development policy of balancing the number of hospital beds among regional area in Taiwan
• 吳肖琪、葉馨婷
  Shiao-Chi Wu, Shin-Ting Yeh
• 醫療網計畫、區域病床、醫療區域、分級醫療
  Medical Care Network Plan, regional hospital bed, medical areas, the hierarchy of medical care policy
• 醫療網計畫為均衡區域醫療資源分布，減少民眾就醫距離之障礙，因此將台灣地區劃分為17個醫療區域。本文系統性回顧政府推動醫療網計畫以來在均衡區域醫療資源政策之脈絡；研究結果發現，我國二級醫療區內每萬人口總病床數之最高值與最低值差距比有縮小，一級醫療區內之醫學中心家數、及二級醫療區域內之區域醫院家數多已超過醫療網設定，自2010年公告發布「醫院設立或擴充許可辦法」，僅保留對醫療資源過剩區之絕對擴建限制，三級醫療之病床目標值逐步放寬致更難落實分級醫療。未來50年我國總人口數將持續減少，除將使每萬人口病床數持續增加，都市化效應亦將使農業縣市人口加速流失，恐造成農業縣市之基層健康照護單位及人力難以續留，建議未來仍需持續管控區域級以上醫院之床數變化，並強化農業縣市基 層健康照護單位及人力之量能，以避免影響民眾就醫可近性。
  The Medical Care Network Plan divided Taiwan into 17 medical areas to balance medical resources and reduce distance-related barriers to access. This paper presents a systematic review of how regional medical resources have been balanced since the Medical Care Network Plan was established. The gap between the highest and lowest total number of beds per 10,000 people in secondary medical areas has narrowed. The number of medical centers in the primary medical areas and the number of regional hospitals in secondary medical areas have exceeded plan targets. The “Permission for Hospital Establishment or the Expansion of Licensing” measures announced in 2010 only retain absolute expansion restrictions with excess medical resources. As the target number of tertiary medical beds is gradually relaxed, the implementation of a hierarchical medical care policy becomes more difficult. In the next 50 years, the total population of Taiwan is expected to continue to decrease. In addition to the continual increase in the number of hospital beds per 10,000 population, urbanization effects will accelerate population losses in agricultural counties and less-populated cities, making it difficult for primary health care units and personnel to remain there. Changes in the number of beds in hospitals above the regional level must continue to be controlled, and the capacity of grassroots health-care units and human resources in agricultural counties and less-populated cities must be increased to avoid reducing the public’s medical treatment accessibility.
• 128-141
• 10.6288/TJPH.202204_41(2).110143

• Link 綜論 Review Article
• 健康促進相關行動應用程式的使用性概念分析Usability of mobile applications: a concept analysis in health promotion
• 龔柏仁、陳靜敏
  Po-Jen Kung, Ching-Min Chen
• 概念分析、使用性、行動應用程式、健康促進
  concept analysis, usability, mobile applications, health promotion
• 伴隨現代社會健康意識的抬頭，健康促進觀念逐漸備受學術及產業界的重視，同時，在資訊科技高度發展的現今，健康促進相關的行動應用程式亦雨後春筍般地開發。然仍諸多健康促進行動應用程式的設計，未能提供用戶擁有順暢的使用經驗，進而導致用戶無法透過健康促進行動應用程式達成健康促進目標；有鑑於此，釐清行動應用程式的使用性定義屬性，並嘗試應用於健康促進領域，期能協助程式設計者瞭解用戶角度之使用性屬性，終能滿足用戶擁有流暢的使用經驗。本文採用Walker及Avant所提出之概念分析方法，進行「行動應用程式使用性」 概念分析，步驟依序為(1)瞭解概念範疇(2)釐清概念定義屬性(3)建構典型案例(4)建構相反、邊緣與相關案例(5)確認概念前因與後果(6)確認實證參考指標。基於健康促進觀點的概念分析結 果，本文歸納出行動應用程式之使用性定義屬性包括：(1)產品具效率的、(2)用戶滿意的、(3)易於學習的。良好的健康促進行動應用程式，可提高用戶對行動應用程式的忠誠度與黏著度，亦能協助其達成健康促進目標，並樂見用戶勇於分享健康促進行動用程式。
  With the rise of health awareness in modern societies, health promotion has attracted increased attention in both academia and industry. This, along with the evolution of information and communication technologies, has stimulated the development of mobile applications for health promotion. However, users of the applications do not necessarily achieve their goals because many applications do not provide a smooth user experience. In this study, we identified the defining attributes of app usability in the context of health promotion to guide app design for improved user experience. We first explored app usability by applying Walker and Avant’s concept analysis method, which involves the following steps: (a) identifying the use of the concept; (b) determining the defining attributes; (c) considering a model case; (d) considering contrary, borderline, and related cases; (e) identifying antecedents and consequences; and (f) defining empirical referents. We subsequently derived a unified definition of usability. From the healthcare perspective, the defining attributes of usability of mobile application are efficiency, user satisfaction, and learnability. Apps with these attributes can achieve their designed goals and reach maximal efficacy because users would continue using the app on a regular basis and recommend it to others.
• 142-155
• 10.6288/TJPH.202204_41(2).110113

• Link 原著 Original Article
• 台灣非戶籍所在縣市自殺死亡的區域社經因素分析Suicides away from county of residence and their socioeconomic correlates in Taiwan
• 陳宜明、李明濱、陳俊鶯、廖士程
  I-Ming Chen, Ming-Been Lee, Chung-Ying Chen, Shih -Cheng Liao
• 外地自殺、社會經濟與地理因素、健康不均、內部遷移
  suicide away from home, socio-economic and geographic factors, health inequity, internal migration
• 目標：探討非戶籍地自殺死亡之人口學、社會經濟、與地理因素之影響。方法：橫斷面研 究設計，利用2011至2013年全國死因登記，取得戶籍地、死亡地，以及人口學資訊，統計外地 自殺人口之特徵與地理分布，並進行縣市社會經濟指標與外地自殺之相關性分析，以及個體與 區域二階層變數的多層次模式分析。結果：共有10,474名自殺身亡個案，1,538人（14.7%）死 亡地點在原戶籍縣市外，自殺方式吊死或窒息占32.1%。離島（33.3%）、北北基宜（20.4%） 與花東地區（15.8%）之自殺死亡於非戶籍縣市之占比較高。自殺身亡族群年齡24歲以下（OR = 1.31, p < .05）、單身（OR = 1.83, p < .001）或離婚（OR = 1.55, p < .001）、原戶籍地的勞動 參與率越低（OR =.87, p < .05），或扶養比越高時（OR = 1.10, p < .05），死於外地的風險越 高。性別、年齡、與婚姻狀態與大部分社會經濟指標具有交互作用。結論：非戶籍地自殺死亡 凸顯就業機會、高齡人口照顧與居住議題對於心理健康的重要性。
  Objectives: To investigate the influences of demographic, socioeconomic, and geographic factors on nonresident suicides. Methods: In this cross-sectional study, data on demographics, geographical locations of residence, and places of death for 2011–2013 were retrieved from the Taiwanese National Cause-of-Death Register. The odds ratios for nonresident suicides associated with each risk factor were calculated. The correlations of county-level socioeconomic indicators with nonresident suicide data obtained from public government databases were analyzed. Multilevel modeling was used to examine the cross-level interaction effects between individuallevel and county-level variables. Results: A total of 10,474 suicide deaths occurred during 2011–2013, of which 1,538 (14.7%) deaths occurred away from the area of residence. The most common suicide methods used were hanging and asphyxiation (32.1%). Among the regions of Taiwan, the offshore islands (33.3%), Taipei and the surrounding area (20.4%), and the Hualien– Taitung area (15.8%) had the highest proportions of nonresident suicides. Age of <25 years (OR = 1.31, p < .05), single and divorced marital status (single: OR = 1.83, p < .001; divorced: OR = 1.55, p < .001), and a lower labor force participation rate (OR = .87, p < .05) and higher dependency ratio (OR = 1.10, p < .05) in the resident area were associated with increased odds of nonresident suicides. Gender, age, and marital status interacted with most of the socioeconomic indicators. Conclusions: Nonresident suicides highlight the effects of employment opportunity, elderly care, and housing issues on public mental health.
• 156-168
• 10.6288/TJPH.202204_41(2).110116

• Link 原著 Original Article
• 長照2.0核定專業服務與退出居家復能服務使用者特性之探討Exploring the characteristics of care recipients approving professional services and discontinuing home-based reablement under long-term care 2.0
• 黃亭穎、劉立凡、張玲慧、林佩欣、郭佳吟
  Ting-Ying Huang, Li-Fan Liu, Ling-Hui Chang, Pay-Shin Lin, Chia-Yin Kuo
• 長期照護、居家復能、復能服務利用、使用者特性、安德森健康服務利用行為模式
  long-term care, reablement, utilization, user characteristics, Andersen’s Behavioral Model of Health Services Use
• 目標：本研究目的為了解現行長照體制下專業服務與居家復能使用者特性。方法：本研究採用次級資料庫分析，以安德森健康服務利用行為模式為架構，資料來源為長照2.0制度下南 部某都市照顧管理資訊平台資料庫。以描述性及多元羅吉斯迴歸分析探討使用者特性與服務利用之關係。結果：研究結果分為兩大面向，分別為：(一)核定專業服務之使用者特性：居住區 域為都會核心、A個管類型為醫事個管單位、個案年齡較輕、教育程度較高、家屬照顧負荷較 低、有聘請看護、個案失能等級越高等因素與專業服務核定顯著相關。(二)退出居家復能服務個案之特性：年齡越高、與照顧者同住、無聘請看護、失能等級輕中度以及其他長照資源越多之個案較有退出居家復能服務可能性。結論：本研究針對個案特性實證結果可以作為未來專業服務輸送之參考，希望藉由了解目專業服務推動與服務使用現況，提升制度端對於專業服務的決策制定並有助針對民眾推廣復能服務的效益。
  Objectives: This study explored care recipients’ characteristics in relation to Taiwan’s “Professional Services and Home-Based Reablement Under Long-Term Care 2.0” plan. Methods: Data were extracted from the care management information database of the long-term care system in Taiwan, and secondary data analysis was performed. Descriptive statistics and multiple logistic regression were used to analyze the factors affecting outcomes. Results: The study revealed the following two main results: (1) Factors significantly influencing care recipients’ approval of the relevant professional services were residential area, type of A care management unit, a younger age, a higher level of education, a lower level of caregiver burden, having a foreign care worker, and a higher dependency level. (2) The characteristics of care recipients who were likely to discontinue their participation in home-based reablement plans were age, living with family caregivers, not having a foreign live-in caregiver, having mild to moderate disabilities (long-term care CMS level), and greater long-term care resource availability. Conclusions: Policy makers can use the care recipient characteristics identified in this study as a reference for developing an effective intervention model for the long-term care of care recipient groups in the community to meet the needs of both care recipients and their caregivers.
• 170-188
• 10.6288/TJPH.202204_41(2).110135

• Link 原著 Original Article
• 乾洗作業環境有機溶劑濃度分布特性調查Distribution profile of organic solvents in dry cleaning workplaces
• 徐櫻芳、羅金翔、莊啓佑、洪粕宸、黃筱茜、黃小林、楊心豪、劉暐廷
  Ying-Fang Hsu, Chin-Hsiang Luo, Chi-Yu Chuang, Po-Chen Hung, Hsiao-Chien Huang, Hsiao-Lin Huang, Shinhao Yang, Wei-Ting Liu
• 乾洗、作業環境、石油系乾洗油、苯、正壬烷
  dry cleaning, operating environment, stoddard solvent, benzene, n-nonane
• 目標：我國乾洗作業場所主要使用石油系乾洗油作為乾洗溶劑，在作業過程中乾洗油溶劑 會因相關作業逸散至作業環境中，作業人員會暴露於揮發性有機物污染中，本研究目的即是在瞭解使用石油系乾洗油之作業環境中有機溶劑污染空間分布之特性，藉以瞭解作業人員可能暴露之危害。方法：本研究選取四間使用使用石油系乾洗油之作業環境，進行有機污染空間濃度分布特性調查，針對作業環境中主要可能逸散之揮發性有機物正辛烷、正壬烷、苯與甲苯進行 採樣分析。採樣規劃上，按前置作業區、清洗與溶劑脫除區、晾乾區、整燙區等4區作業區域進行採樣，並以勞動部建議之標準方法進行採樣。結果：本研究檢測之作業環境中，主要檢出之揮發性有機物為苯與正壬烷，甲苯僅在一處檢出，正辛烷則是均低於偵測極限。揮發性有機物濃度分布主要檢出在前置作業區前置作業區以及清洗與溶劑脫除區，清洗與溶劑脫除區檢出濃度高於前置作業區。苯濃度分布與風速呈顯著負相關；其與二氧化碳呈顯著正相關。結論： 乾洗作業場所環境中通風條件不佳，可能造成揮發性有機物污染累積，建議應加強通風，同時作業人員應確實配戴活性碳口罩以及手套，藉以減少暴露。另，乾洗作業場所多在住宅區內， 除應加強通風外，應有適當之處理單元，避免環境污染產生。
  Objectives: This study investigated the distribution characteristics of the Stoddard solvent used in dry cleaners to assess workers’ exposure to hazardous solvents. Methods: Four dry cleaners using the Stoddard solvent were selected as the sampling sites for air sample collection to measure the levels of volatile organic solvents, including n-octane, n-nonane, benzene, and toluene. Samples were collected from the preparation, cleaning and solvent removal, drying, and ironing areas and were handled in accordance with official Taiwanese guidelines. Results: Benzene and n-nonane were the main volatile organic compounds detected. Toluene was detected in one cleaning and solvent removal area, and n-octane was not detected. The target volatile organic compounds were detected mainly in the preparation area and cleaning and solvent removal area. Benzene concentrations were significantly negatively correlated with wind speeds and significantly positively correlated with carbon dioxide concentrations. Conclusions: Ventilation should be strengthened to reduce the accumulation of volatile organic compounds caused by poor ventilation in dry cleaning workplaces. Operators should wear activated carbon masks and gloves to reduce exposure to solvents. In addition, dry cleaners are located predominantly in residential areas, and appropriate processing units should be provided to avoid environmental pollution.
• 189-199
• 10.6288/TJPH.202204_41(2).110062

• Link 原著 Original Article
• 區域醫院及醫學中心醫療人員使用安全針具扎傷之經驗 Experience in using of safety-engineered medical devices and related needlestick injuries in healthcare workers in regional hospitals and medical centers
• 歐育珊、吳雪菁、郭育良、蕭淑銖
  Yu-Shan Ou, Hsueh-Ching Wu, Yue Leon Guo, Judith Shu-Chu Shiao
• 醫療法第56條、安全針具、使用經驗
  Needlestick Safety and Prevention Act, safety-engineered medical devices, user experience
• 目標：台灣醫療法規範醫療院所應提供安全針具後，醫療人員之扎傷率已有下降趨勢；但在台灣EPINet通報系統的扎傷事件統計中，仍可看到有工作人員沒有適時選用安全針具，或是安全針具未能避免扎傷事件的情形。本研究目的為探索台灣區域醫院與醫學中心之醫療人員使用安全針具仍發生扎傷的狀況與困境。方法：本研究對象為曾被安全針具扎傷之醫療人員，訪談內容以遭安全針具扎傷之事件經過以及安全針具使用之心得為主，並透過質性內容分析法歸納出核心主題。結果：共有25位醫療人員接受訪談，訪談後歸納出醫療人員認為安全針具使用 上不夠便利與安全針具替代範圍不全面兩個主題，其中包含沒有真正好用的安全針具、未上過教育訓練、缺乏便於使用安全針具的環境以及醫師的治療項目沒有安全針具共四個次主題。結論：台灣在安全針具的使用上仍有進步的空間。建議針具製造商應持續改善現存安全針具的設計並拓展更多安全針具種類，也建議醫療院所配合所引進之安全針具，調整安全針具教育時機 以及調整尖銳物回收桶、工作車等工作環境配置。
  Objectives: The incidence of sharps injury in Taiwan has declined after the enactment of the Needlestick Safety and Prevention Act. However, some healthcare workers still use conventional devices in high-risk procedures, and some safety-engineered medical device (SEMD) users experience sharps injury. In this study, we explored the problems of using SEMDs in regional hospitals and medical centers in Taiwan. Methods: We included healthcare workers who had sharps injury due to the use of SEMDs. The interviews focused on the process of sharps injury and participants’ experience of using SEMDs. We analyzed the interview data by using the qualitative content analysis method. Results: Twenty-five healthcare workers were interviewed. We noted that the participants did not find the use of SEMDs to be sufficiently convenient. This indicated that SEMDs were not easy to use and that improper training and unfavorable work environment further reduced their use. Our findings also revealed that replacement of SEMDs were not comprehensive, especially in the procedure of the physicians. Conclusions: We recommend the manufacturers to improve the existing SEMDs and introduce more types of SEMDs. Healthcare facilities should involve the users in the purchase process, provide appropriate training, and establish a more convenient work environment for promoting the use of SEMDs.
• 200-210
• 10.6288/TJPH.202204_41(2).110087

• Link 實務 Public Health Practice
• 科學博物館協力公眾參與科學之實踐－以沃爾巴克氏菌防治登革熱展示為例Science museums as a platform for public engagement: exhibiting the Wolbachia dengue fever prevention method
• 郭世文、吳佩修、王裕宏、王雅芳、劉韋良、陳佳靖
  Shih-Wen Kuo, Pei-Hsiu Wu, Yu-Hung Wang, Ya-Fang Wang, Wei-Liang Liu, Chia-Ching Chen
• 科學博物館、公眾參與科學、上游參與、沃爾巴克氏菌生物防治法
  science museum, public engagement with science, upstream public engagement, Wolbachia method
• 目標：「公眾參與科學」為新興科技政策制定前的重要工作，本研究旨在探究科學博物館 如何作為公眾參與科學之平台，及其功能。方法：以研究者與國家蚊媒中心研究員合作，親身參與科學博物館的沃爾巴克氏菌防治登革熱展示的策展經驗為案例，經過展覽形成、展出、修正三階段，將研究員研究成果轉譯成為科普展示教育活動，在導覽後請觀眾留言，從留言中蒐集觀眾對此防治法的問題及疑慮，經編碼彙整為三大類面向，10個主題，並將研究員對該些問 題的回應轉譯成為新單元補充於展示中。結果：分兩部分記錄實踐成果，第一部分介紹「沃爾巴克氏菌防治登革熱展示」的展示架構、學習目標及所設計的互動手法及教育活動；第二部分說明如何將觀眾留言及研究員回應製作成新的展示單元，以落實雙向互動的對話溝通。結論： 經過實踐，驗證科學博物館可作為公眾參與公衛新興科技之平台，協助民眾與研究員雙向溝通、相互學習；本研究所收集的觀眾留言問題可提供沃爾巴克氏菌生物防治法未來研究方向及 制定溝通策略之參考。
  Objectives: Public engagement is essential when developing policies involving new technologies. This study explored the function of science museums as a platform for engaging the general public. Methods: In collaboration with the scientists at the National MosquitoBorne Diseases Control Research Center, the researchers participated in curating, exhibiting, and modifying an exhibition showcasing the Wolbachia dengue fever prevention method. For this exhibition, the scientific research results were translated into educational activities and popular science displays. Questions from visitors were consolidated into ten subjects within three categories. These questions and the answers provided by scientists were incorporated into the exhibition. Results: The study results were recorded in two parts. The first part included the framework, interfacing design, and educational activities of the exhibition. The second part explained how the questions and answers were included in the modified exhibition to enhance dialog. Conclusions: Our results demonstrate that science museums can be a platform for engaging with the general public on new technologies for public health and aid bidirectional communication between scientists and the public. The questions from the exhibition visitors provided pointers for future research and references for policy making.
• 211-225
• 10.6288/TJPH.202204_41(2).110126

• Link 研究紀要 Research Brief
• 末期醫療抉擇的家庭會議溝通模式之回溯性分析 Family conference communication patterns for end-stage patients
• 宋聖芬、陳煌麒、楊婉萍
  Sheng-Fen Sung, Huang-Chi Chen, Wan-Ping Yang
• 病人自主、家庭會議、醫療抉擇、內容分析
  patient autonomy, family conference, medical decision, content analysis
• 目標：家庭會議是促進醫療端與病家端的重要開放性溝通方式，藉此確認病人的意願，整合家屬意見，討論共識出適切的醫療抉擇。本研究目的為了解末期醫療抉擇的家庭會議中醫療 端與病家端間的溝通模式。方法：以台灣南部一區域教學醫院，收集2009-2014年108位病人共 125份的癌末醫療抉擇的家庭會議紀錄，進行病歷之回溯性分析。採內容分析歸納臨床上進行末期醫療抉擇家庭會議的常見溝通模式。結果：發現召開的家庭會議中，雖然有部分討論到以 病人的意願與自主為最重要之考量，但實際上有病人參與共同討論的家庭會議為數不多，甚至有的會議家屬拒絕病人參與決策。質性分析歸納出家庭會議溝通模式包括了三主題九大類別： 1.病主－尊重依循病人的自主決定；2.家主－由家屬代表發聲並代做決定；3.醫主－希望以醫師 的經驗與建議為之。結論：期能以此研究結果為基礎，發展符合文化民情但具有效能的末期醫療抉擇與家庭會議溝通模式，進而深耕推動未來更尊重病人自主的醫病共享決策模式。
  Objectives: Family conferences constitute a vital medium for facilitating open communication between a medical team, a patient, and the patient’s family. Confirming the patient’s wishes and incorporating their family’s views during the formulation of decisions for end-stage medical care are crucial. The objective of this study was to determine the communication patterns arising between the health-care team, the patient, and the patient’s family during a family conference for making decisions about end-stage medical care. Methods: This 5-year retrospective analysis reviewed charts for 125 family conference minutes concerning decisions for end-stage medical care; the charts were sourced from 108 patients residing in a regional teaching hospital in Southern Taiwan between 2009 and 2014. Content analysis was conducted to observe the common communication patterns during these family conferences. Results: Although some family conferences reached an agreement that patient willingness and autonomy should be prioritized, few conferences actually involved the patients. Some conferences were even held on the condition of no patient involvement. Our qualitative research identified several family conference communication patterns as follows: (a) patient-oriented patterns, where the patient’s thoughts were considered to deliberate the medical decisions; (b) family-oriented patterns, where family members made decisions on behalf of the patient; and (c) medical-oriented patterns, where physicians were trusted to make decisions. Conclusions: The results of this study can serve as a reference for developing effective family conference communication patterns in which patient autonomy in making decisions concerning end-stage medical care is respected, thus promoting shared decision-making.
• 226-233
• 10.6288/TJPH.202204_41(2).110147

• Link 評論 Commentary
• 評論：台灣非戶籍所在縣市自殺死亡的區域社經因素分析Commentary: suicides away from county of residence and their socioeconomic correlates in Taiwan
• 陳澂毅
  Cheng-Yi Chen
• 無
  none
• 無
  none
• 169
• 10.6288/TJPH.202204_41(2).11011601