45卷5期

• Link 政策論壇 Policy Forum
• 認識失智症：風險因子與管理An introduction to dementia: risk factors and management
• 王心妙　楊淵韓
  Hsin-Miao Wang, Yuan-Han Yang
• 無none
  無none
• 無none
  無none
• 363-365
• 10.6288/TJPH.202610_45(5).PF05

• Link 綜論 Review Article
• 台灣高齡者活躍老化之多維度影響因素與 整合實務策略：基於健康老化理論之系統性論述Multidimensional determinants and integrated practice strategies for active aging among older adults in Taiwan: a systematic discourse based on healthy aging theory
• 蕭世榮
  Shih-Jung Hsiao
• 活躍老化、健康老化、多維度因素、整合策略、台灣
  active aging, healthy aging, multidimensional determinants, integrated strategies, Taiwan
• 台灣已於2025年邁入超高齡社會，65歲以上人口占20.06%。本文旨在系統性整合台灣高 齡者活躍老化之多維度影響因素，並提出適合本土脈絡之整合實務策略。採敘事性系統文獻回 顧，整合健康老化理論框架及近期實證研究，涵蓋生理健康、心理認知、社會參與、環境脈絡 及政策制度五大維度。結果發現規律運動與身體活動可顯著延長無失能預期壽命；社會參與 對憂鬱症具緩衝效果，並與認知功能維持密切相關；城鄉差距與性別差異持續影響活躍老化 指標；長照2.0至3.0之政策轉型為預防性健康照顧奠定制度基礎。活躍老化之促進需個體、社 區、系統及政策四層次之整合協作，兼顧實證效益與社會公平，以實現尊嚴、健康、參與之銀 髮新時代。
  In 2025, Taiwan became a superaged society, with 20.06% of the population aged ≥65 years. This study systematically integrated multidimensional determinants of active aging among older adults in Taiwan and proposed context-appropriate integrated practice strategies. A narrative systematic review was conducted. This review integrated healthy aging theoretical frameworks and recent empirical evidence across five dimensions: physical health, mental health and cognitive function, social participation, environmental context, and policy systems. The findings indicate that regular physical activity significantly extends disability-free life expectancy, that social participation buffers against depression and is associated with better maintenance of cognitive function, that rural–urban disparities and gender differences persistently affect active aging indicators, and that transitioning from Long-Term Care 2.0 to 3.0 can establish an institutional foundation for preventive health care. Overall, promoting active aging requires integrated collaboration across individual, community, system, and policy levels and necessitates a balance between evidence-based effectiveness and social equity to realize a dignified, healthy, and participatory aging era.
• 366-377
• 10.6288/TJPH.202610_45(5).115038

• Link 原著 Original Article
• 以健保資料推估現居地演算法正確性驗證比較：以美兆健康資料為例Validation and comparison of residential location estimation algorithms using National Health Insurance data: a case study based on MJ health data
• 馬慶蓉、羅偉成、林先和
  Ching-Jung Ma, Wei-Cheng Lo, Hsien-Ho Lin
• 推估居住地、空間流行病學、地理區位、全民健保資料庫、演算法 比較
  residential location estimation, spatial epidemiology, geographic location, National Health Insurance database, algorithm comparison
• 目標：健保資料庫記錄之地址為投保地及戶籍地，非實際居住地，三者落差限制地理分析 正確性。台灣已有林民浩等人（2011）、古鯉榕等人（2018）、余清祥等人（2020）三種居住 地估算演算法，台灣疾病負擔中心（Taiwan Burden of Disease Center, TBDC）之演算法由古等 人延伸。因余等人僅提供概念性架構，本研究補充未明步驟並比較三者，以找出正確率最高之 方法。方法：以美兆健康資料庫（2005–2017）為參考標準，納入283,286人、309,625筆記錄， 串連健保研究資料庫取得門急診及承保資料後套用三種演算法。推估居住地與美兆自填通訊 地比較，於縣市及鄉鎮市區層級進行整體與次族群分析，並以38分鐘旅運時間及共同行政邊界 定義生活圈評估正確率。結果：縣市層級以TBDC最高（83.21%），林等人次之（82.36%）， 余等人約79%。鄉鎮市區層級亦以TBDC最佳（66.50%），余等人V1次之（62.76%），林等人 最低（54.45%）。生活圈正確率不論以38分鐘（87.32%）或行政邊界（79.90%）定義，均以 TBDC最高。結論：TBDC於各分析面向表現最為一致，鄉鎮市區層級之整體及各次族群正確 率均為最高。因演算法係以整體設計比較，此優勢無法歸因於單一要素，以戶籍地為鄰近參考 點可能為貢獻因素之一。於本研究族群與期間之條件下，TBDC可作為健保資料庫空間流行病 學研究居住地估算之較適預設方法，尤適用於鄉鎮市區層級分析。
  Objectives: Taiwan’s National Health Insurance (NHI) database records enrollment and household registration addresses rather than actual residence, and population mobility creates discrepancies among these addresses that limit the accuracy of spatial epidemiological analyses. Three residential location estimation algorithms have been proposed—Lin et al. (2011), the Taiwan Burden of Disease Center (TBDC, extended from Ku et al., 2018), and Yue et al. (2020)— but Yue et al. provided only a conceptual framework. This study supplements the undefined steps and compares all three to identify the most accurate approach. Methods: Using the MJ Health Database (2005–2017) as the reference standard, 283,286 individuals (309,625 records) were linked to the NHI Research Database (NHIRD) at the individual level using de-identified ID codes. Each algorithm’s estimated residence was compared against the MJ self-reported mailing address at the county/city and township levels, for overall and subgroup analyses. Townshiplevel results were additionally evaluated using two living-circle criteria: a 38-minute travel-time threshold and shared administrative boundaries. Accuracy was estimated with cluster-robust 95% confidence intervals (CIs) to account for repeated measurements. Results: At the county level, TBDC was most accurate (83.21%), followed by Lin et al. (82.36%) and the three Yue et al. versions (78.98–79.15%). At the township level, TBDC again led (66.50%), followed by Yue et al. V1 (62.76%) and Lin et al. (54.45%). Under the travel-time living circle, TBDC (87.32%) and Lin et al. (86.76%) were comparable, both exceeding Yue et al. V1 (80.80%); under the adjacency definition, TBDC (79.90%) led Lin et al. (77.69%) and Yue et al. V1 (61.86%), an 18-percentagepoint gap over Yue et al. Conclusions: TBDC performed most consistently across all analytical dimensions and ranked highest at the township level overall and in every subgroup examined. Because the algorithms were compared as integrated designs, this advantage cannot be attributed to any single component, although TBDC’s use of the household registration address as the proximity reference is a plausible contributor. TBDC appears to be the most defensible default choice for residential location estimation in NHI-based spatial epidemiology, particularly where township-level resolution is required, conditional on the population and period studied.
• 378-391
• 10.6288/TJPH.202510_45(5).115068

• Link 原著 Original Article
• 後疫情時代社區成人COVID-19再感染之 相關因素：健康行為與生活型態之探討Factors associated with COVID-19 reinfection among community-dwelling adults in the postpandemic era: health behaviors and lifestyle
• 吳桂花、李明忠、陳幸宜、林靜芬、馬嘉聯、黃慈柔
  Guey-Hau Wu, Ming-Zhong Lee, Hsing-Yi Chen, Ching-Fen Lin, Jia-Lian Ma, Cih-Rou Huang
• COVID-19、再感染、感染後持續症狀、健康行為、生活型態
  COVID-19, reinfection, persistent post-COVID-19 symptoms, health behavior, lifestyle
• 目標：探討後疫情時代社區成人COVID-19再感染之相關因素。方法：採橫斷式研究設 計，以分層比例抽樣納入513名曾感染COVID-19之20歲以上社區成人，使用結構式問卷蒐集 感染後健康狀態、健康行為、生活型態及健康識能等資料。問卷內容效度指數為0.90。結果： COVID-19再感染率為17.3%。雙變項分析顯示，不同COVID-19感染組別年齡、代謝症候群、 嚼檳榔、每日蔬菜攝取是否達建議量，以及集中注意力困難、思考比以前慢與呼吸道症狀之分 布具有統計上顯著差異；成人健康檢查及癌症篩檢之分布則未達統計顯著差異。多變項分析顯 示，嚼檳榔與較高之COVID-19再感染勝算相關（OR = 10.24，95% CI: 1.72–61.10），有注意力 困難者之再感染勝算較高（OR = 3.38，95% CI: 1.59–7.17），每日蔬菜攝取達建議量者之再感 染勝算較低（OR = 0.56，95% CI: 0.34–0.92）。結論：感染後健康狀態及部分生活型態行為與 社區成人COVID-19再感染相關。社區健康照護人員可於感染後，提供民眾健康管理及衛教服 務，加強檳榔危害防制與均衡飲食指導，並關注民眾感染後持續症狀，以提升社區COVID-19 防治及健康管理成效。
  Objectives: To examine the factors associated with COVID-19 reinfection among community-dwelling adults in the postpandemic era. Methods: A cross-sectional study was conducted involving 513 community-dwelling adults aged 20 years or older with a history of COVID-19 infection. These adults were recruited through proportionate stratified sampling. Data on post-COVID-19 health status, health behaviors, lifestyle factors, and health literacy were collected using a structured questionnaire, which exhibited a content validity index of 0.90. Results: The prevalence of COVID-19 reinfection was 17.3%. Bivariate analyses revealed significant differences between the single-infection and reinfection groups in their distributions of age, metabolic syndrome, betel nut chewing, meeting the recommended daily vegetable intake, difficulty concentrating, slowed thinking, and respiratory symptoms. No significant intergroup differences were discovered in terms of adult preventive health examinations or cancer screening services. Multivariable logistic regression analysis revealed that betel nut chewing was associated with a higher risk of COVID-19 reinfection (odds ratio = 10.24, 95% CI [1.72, 61.10]). The participants reporting difficulty concentrating also had a higher reinfection risk (odds ratio = 3.38, 95% CI [1.59, 7.17]), whereas those meeting the recommended daily vegetable intake had a lower reinfection risk (odds ratio = 0.56, 95% CI [0.34, 0.92]). Conclusions: Post-COVID-19 health status and selected lifestyle behaviors were associated with COVID-19 reinfection among community-dwelling adults. Community health professionals should incorporate betel nut cessation, healthy dietary guidance, and monitoring of persistent post-COVID-19 symptoms into postinfection health management and education to strengthen community-based COVID-19 prevention and health management.
• 392-403
• 10.6288/TJPH.202510_45(5).115026

• Link 原著 Original Article
• 新冠肺炎下無家者交織性經驗與生存策略之研究Intersectional experiences and survival strategies among people experiencing homelessness during the COVID-19 pandemic
• 張凱淳、謝文中
  Kai-Chun Chang, Wen-Chung Hsieh
• 新冠肺炎、無家者、交織性理論、生存策略、地域污名
  COVID-19, homelessness, intersectionality, survival strategies, territorial stigmatization
• 目標：以交織性理論探討新冠疫情、防疫政策與結構不平等對無家者的交織影響及其生存 策略，並檢視場所／地理作為交織軸線之分析價值。方法：於2022年8月至2023年6月，對7名 疫情期間曾於台北市萬華區生活並接觸防疫政策之無家者進行回溯性半結構式深度訪談，資料 採溯因式主題分析。結果：結構性交織性上，防疫資訊、就醫及公共空間關閉預設一般人生活 條件，使無家者落於制度外；表徵性交織性上，萬華破口敘事與無家者污名疊合，導致驅趕、 監視與資源排除；政治性交織性上，紓困、安置與就業措施以標準公民為想像，形成行政負擔 與政策漏接。生存策略則包括迴避人群、隱瞞來自萬華、以生計為優先進行防疫抉擇，及借助 在地中介者與互助網絡。結論：相同防疫措施對無家者產生差異化後果；以戶籍、家戶、勞保 與確診數字為基礎的疫情治理，使無家者可被計數為風險，卻未被辨識為需求者。場所／地理 宜納入交織分析，防疫治理應看見群體內部差異。
  Objectives: Drawing on intersectionality theory, this study examined how the COVID-19 pandemic, prevention policies, and structural inequalities intersected in the lives of people experiencing homelessness (PEH), explored the survival strategies they developed, and assessed the analytical value of place as an axis of intersection. Methods: Between August 2022 and June 2023, retrospective semi-structured in-depth interviews were conducted with seven PEH who had lived in Wanhua District, Taipei, and encountered prevention policies during the pandemic. Thematic analysis followed an abductive strategy, progressing from descriptive and analytic coding to theoretical coding informed by structural, representational, and political intersectionality. Results: Structurally, prevention information, medical care, and publicspace closures were premised on the living conditions of the general population, leaving the needs of PEH unmet. Representationally, the portrayal of Wanhua as an “outbreak hotspot” compounded homelessness stigma, leading to expulsion, surveillance, and exclusion from work and welfare resources. Politically, measures for relief, shelter, and employment were designed around “standard citizens” with labor insurance, household registration, and family ties, creating administrative burdens and policy gaps. Survival strategies included avoiding crowds, concealing ties to Wanhua, making livelihood-first prevention decisions, and drawing on local intermediaries and mutual-aid networks. Conclusions: Identical prevention measures produced divergent consequences for PEH. Pandemic governance that relied on administratively legible units (household registration, family households, labor insurance, and confirmed case counts) rendered PEH countable as risks but unrecognized as people in need. Place should be incorporated as an axis of intersectional analysis, and pandemic governance should attend to intra-group differences.
• 404-422
• 10.6288/TJPH.202510_45(5).115031

• Link 原著 Original Article
• 高績效醫院推動婦女癌症篩檢與陽性個案追蹤之障礙、促進策略及關鍵因素：一項質性研究Barriers to and facilitators of women’s cancer screening and follow-up after positive results in high-performing hospitals: a qualitative study
• 賴思羽、鍾國彪
  Si-Yu Lai, Kuo-Piao Chung
• 婦女癌症篩檢率、癌症篩檢後陽性追蹤率、關鍵成功因素、主題分 析、質性研究
  women cancer screening rate, follow-up rate, key success factors, thematic analysis, qualitative research
• 目標：研究旨在辨識高績效院所在篩檢與陽性追蹤過程中的關鍵成功因素，以提供可供 政策與組織採行的可操作策略。方法：本研究採立意抽樣，邀請及訪談期間為2025年9月至10 月，最終邀請篩檢與追蹤績效優異之醫療院所共五間，訪談對象為獲獎醫院主管及第一線工作 人員，受訪人數19人，最終納入分析人數為17人，進行半結構式訪談。質性資料採主題分析 法，並以社會生態模式（Social-Ecological Model, SEM）分析障礙因素，後結合實施研究綜合 架構（Consolidated Framework for Implementation Research, CFIR）架構歸納跨院所的關鍵成功 因素，再透過聚類分析進行收斂。結果：質性分析發現多層次障礙，包括健康識能不足、恐懼 與疼痛預期、交通與時間限制、院內人力與流程負荷、設備空間與資訊系統不足、申報規定或 誘因設計限制等。而根據院所在克服障礙過程中逐步制度化的經驗中，歸納出高績效院所普遍 展現三項關鍵成功因素：(1)資訊支援與永續人力；(2)流程優化與資源彈性；(3)健康識能與心 理支持策略。結論：透過歸納高績效院所共同之策略及特點，補足過往研究多聚焦於障礙層 面，提出各醫療院所之策略，同時有助於強化癌症防治政策的設計，以促進婦癌篩檢與陽性追 蹤服務的品質及效率。
  Objectives: This study identified the key strategies adopted by high-performing institutions during cancer screening and follow-up in women. It sought to inform actionable strategies for both policy development and organizational implementation. Methods: Through purposive sampling, eligible individuals were recruited from hospitals with excellent screening and follow-up performance. Semistructured interviews were conducted. Data were subjected to thematic analysis. Barriers were analyzed using the Social Ecological Model, and cross-institutional key factors were synthesized using the Consolidated Framework for Implementation Research, along with a cluster analysis. Results: Multilevel barriers included low health literacy, fear and anticipated pain, transportation and time constraints, workforce and workflow burdens in hospitals, limited space or equipment, inadequate information systems, and regulatory or incentive-related constraints. Three key success factors were identified in high-performing hospitals seeking to overcome these challenges: robust information support and sustainable workforce capacity, streamlined workflows and flexible resource allocation, and health-literacy-oriented and psychologically supportive patient engagement strategies. Conclusions: This study provides an integrated perspective that links policy implementation, resource distribution, and organizational processes and addresses gaps in research focusing predominantly on barriers. By highlighting replicable key factors from high-performing hospitals, the findings provide evidence-informed guidance for enhancing cancer prevention policies and supporting health-care organizations in optimizing workflows, strengthening team coordination, and improving patient-centered support. These insights can help improve the quality and efficiency of women’s cancer screening and follow-up services in Taiwan.
• 423-441
• 10.6288/TJPH.202510_45(5).115033

• Link 原著 Original Article
• 彈性工作情境下的就業控制：以居家照顧服務員為對象的量表發展與心理計量驗證Employment control in flexible work arrangements: scale development and psychometric validation among home care aides
• 曾逸軒、陳雅美、鄭婉汝、鄭雅文
  I-Hsuan Tseng, Ya-Mei Chen, Wan-Ju Cheng, Yawen Cheng
• 就業控制、居家照顧服務員、職場社會心理特質、量表發展、心理 計量驗證
  employment control, home care aides, psychosocial work conditions, scale development, psychometric validation
• 目標：彈性工作安排受部分工作者歡迎，但可能未真正符合工作者需求，且時常有就業保 障不足等問題。本研究以長期照顧體系中之居家照顧服務員作為研究對象，發展並驗證就業控 制量表。方法：採橫斷性調查法，參考文獻並透過專家審查編制就業控制量表，涵蓋工時主控 權、薪資主控權、經濟保障、請假權益等題項。於2025年10月至12月間招募《長期照顧服務 法》規範之居家照顧服務員486人參與紙本問卷調查，並透過理論分析與心理計量評估檢視量 表之信效度。結果：就業控制量表涵蓋「請假權益」（3題）、「經濟保障」（2題）與「工時 薪資主控權」（2題）三個構面，累積解釋變異量為67.11%。驗證性因素分析支持相關因素模 型，模型適配度佳（χ2 = 10.87，df = 11，χ2/df = 0.99，GFI = 0.98，NNFI = 0.99，CFI = 0.99， RMSEA = 0.02，SRMR = 0.03），並具可接受之收斂效度與區辨效度。測量不變性分析顯示， 北、中、南部樣本達截距不變性。各構面與既有職場社會心理特質之關聯方向大致符合預期， 可提供初步的同時效度證據。三構面之Cronbach’s α分別為0.86、0.90與0.65，內在一致性介於 尚可至良好。結論：面對日益彈性的就業趨勢，評估與監測工作者多元層面的就業控制有其必 要。本研究針對居家照顧服務員發展就業控制量表，可作為後續評估就業處境及探討相關職業 健康議題之初步測量基礎。
  Objectives: Flexible work arrangements are favored by certain workers but may not fully meet workers’ needs and are often accompanied by inadequate employment security. This study focused on home care aides (HCAs) within the long-term care system and aimed to develop and validate an employment control scale. Methods: A cross-sectional survey design was adopted. The proposed scale was developed on the basis of a literature review and expert review and covered control over work hours and wages, economic security, and access to leave. Between October and December 2025, 486 HCAs regulated under the Long-Term Care Services Act completed a paper-based questionnaire. Scale validity and reliability were assessed through theoretical analysis and psychometric evaluation. Results: The proposed scale comprised three dimensions, namely access to leave (three items), economic security (two items), and control over scheduling and wages (two items), explaining 67.11% of the total variance. Confirmatory factor analysis supported a correlated three-factor model with good model fit (χ2 = 10.87, df = 11, χ2/df = 0.99, goodness-of-fit index = 0.98, non-normed fit index = 0.99, comparative fit index = 0.99, root mean square error of approximation = 0.02, and standardized root mean square residual = 0.03), with acceptable convergent and discriminant validity. Measurement invariance analysis revealed scalar invariance across northern, central, and southern Taiwan. The associations observed between the three dimensions and established psychosocial work conditions were generally in the expected directions, which provided preliminary evidence of concurrent validity. Cronbach’s α values for access to leave, economic security, and control over scheduling and wages were 0.86, 0.90, and 0.65, respectively, indicating fair to good internal consistency. Conclusions: In response to the current increasingly flexible employment trends, assessing and monitoring workers’ employment control across multiple dimensions are essential. The proposed employment control scale provides a preliminary measurement basis for future assessments of the employment conditions of HCAs and related occupational health research.
• 442-459
• 10.6288/TJPH.202510_45(5).115060

• Link 實務 Public Health Practice
• 台北市西醫基層診所廁所物理可近性之調查研究Toilet physical accessibility in western medicine primary care clinics: a survey in Taipei, Taiwan
• 黃詩樺、葉明叡、謝雨純
  Shih-Hua Huang, Ming-Jui Yeh, Yu-Chun Hsieh
• 物理可近性、基層診所、身心障礙者權利公約、調查
  physical accessibility, primary health care clinics, Convention on the Rights of Persons with Disabilities, survey
• 目標：本研究旨在描述台北市全民健康保險特約西醫基層診所的廁所物理可近性（physical accessibility）之分布。方法：本研究以台北市12行政區分層進行隨機抽樣，實地調查全市111 間健保特約西醫基層診所。透過「基層診所廁所可近性檢核表」測量樣本診所的廁所「物理可 近性」，將其區分為「診所出入口」、「診所通道」、「升降設備」與「診所廁所」等四大類 別共20題項，初步建構「廁所可近性分數」。結果：依行政區觀之，可近性總分之分布界於 0.50至0.78之間。依類別觀之，較不可近之處，在「診所出入口」類別為超過三公分之門檻高 低差，在「診所通道」類別為缺乏友善通道至廁所，在「診所廁所」類別中為缺乏馬桶兩側扶 手，以及廁所門口有超過三公分之門檻高低差；「升降設備」類別可近性整體較高。結論：西 醫診所之廁所可近性於台北市之分布呈現差異，建議政府應強化診所之廁所可近性，積極推動 《醫療機構設置標準》修訂，並進一步補助診所更新設施，促進醫療環境的包容性與公平性。
  Objectives: Using the toilet is a basic physiological need in daily life and is common in clinic-related settings. This study explored they physical accessibility of toilets in Western medicine primary care clinics operating under the National Health Insurance program in Taipei, Taiwan. Methods: A field survey was conducted across 111 Western medicine primary care clinics in Taipei, with random sampling stratified by the 12 administrative districts of Taipei. Physical accessibility to toilets in the sample clinics was measured using the Primary Care Clinic Toilet Accessibility Checklist. Through this checklist, a toilet accessibility score is obtained by considering 4 assessment categories, namely, clinic entrances, clinic corridors, elevators, and clinic toilets, distributed across 20 items. Results: The mean scores ranged from 0.50 to 0.78 among the 12 administrative districts. The presence of gaps at the thresholds of the clinic’s gate and toilet door, the lack of an accessible pathway from the gate to the toilet, and the lack of grab bars on both sides of the toilet were identified as factors associated with lower physical accessibility to toilets, whereas the presence of elevators and platform lifts was identified as a factor associated with greater accessibility. Conclusions: Physical accessibility to toilets varies between Western medicine primary care clinics in Taipei. To address this variability, the government should promote the amendment of the Establishment Standards of Medical Care Institutions regulations and provide subsidies for clinics to renovate their facilities.
• 460-476
• 10.6288/TJPH.202510_45(5).115028