41卷3期

• Link 其他 Others
• 新冠肺炎與形塑全球公共衛生的力量:在下一個全球大流行來臨前公共衛生學界所面對的挑戰(第四屆陳拱北教授公共衛生紀念講座)COVID-19 and forces shaping global public health: challenges for academic public health before the next pandemic
• John R. Finnegan Jr
  John R. Finnegan Jr
• 新冠肺炎、全球公共衛生、大流行、公共衛生學界的挑戰
  COVID-19, global public health, pandemic, challenges for academic public health
• 本演講回顧並探討我們從新冠肺炎全球大流行當中學到的某些關鍵教訓，以及它們對全球公共衛生的衝擊。做為公共衛生學界的我們，將如何藉由我們的研究、教學， 以及與決策者和社會大眾的合作，對因應這些重大挑戰做出貢獻？我們將一切如常、照章行事，或是能夠自我提升？如果是後者， 我們的目標為何？同時我們該如何重塑、重新定義，與提升我們的三項使命（研究、教學，與社區服務）以達成這些目標？重要的是，全球公衛學界應該如何連結起來、共同因應即將來臨的公衛挑戰？
  This presentation is a review and discussion of some of the crucial lessons we are learning from the COVID-19 pandemic and its impact on global public health. How will we in the public health academic community contribute to addressing these challenges through our research, our teaching, and our engagement with policymakers and the public? Is it business as usual or do we “step up our game?” If the latter, what are our goals, and how should we reshape, re-frame and re-energize our three missions (research, education, community engagement) to achieve them? Importantly, what can we in academic public health do to connect ourselves better globally for coming public health challenges?
• 235-248
• 10.6288/TJPH.202206_41(3).AL202201

• Link 政策論壇 Policy Forum
• 台灣牙周病概況、預防及展望The introduction, prevention, and prospect of periodontal disease in Taiwan
• 陳彥均、胡愷芳、黃炯霖、鄭景暉、周郁翔
  Yen-Chun Chen, Kai-Fang Hu, Chiung-Lin Huang, Jiiang-Huei Jeng, Yu-Hsiang Chou
• 牙周病、口腔健康、台灣
  periodontal disease, oral health, Taiwan
• 牙周病泛指發生在牙齒周圍組織因細菌感染的疾病，使得牙齦發炎與支撐牙齒的齒槽骨萎縮，進而產生牙齒動搖，甚至導致牙齒脫落。台灣成年人有一半以上患有牙周病。日常清潔照護、定期回診追蹤、戒除菸酒等不良成癮因子、加強牙科植體照護是牙周病最基本，最有效的預防方式。推動早期診斷與治療、開發分子標的檢測、加強系統性疾病和牙周病之間的照護與相關性研究都是未來重要的發展方向。
  Periodontal disease generally refers to a disease that occurs in the tissues around the teeth due to bacterial infection, which causes inflammation of the gums and atrophy of the alveolar bone that supports the teeth, resulting in tooth shake and even tooth loss. More than half of Taiwanese adults suffer from periodontal disease. Daily cleaning and care, regular follow-up visits, quitting smoking and alcohol and other adverse addiction factors, and strengthening dental implant care are the most basic and most effective ways to prevent periodontal disease. Therefore, the promotion of early diagnosis and treatment, the development of molecular target detection, and the strengthening of care and correlation research between systemic diseases and periodontal disease are all critical development directions in the future.
• 249-251
• 10.6288/TJPH.202206_41(3).PF03

• Link 公衛論壇 Public Health Forum
• 學校衛生法修法之芻議:以健康飲食教育與基因改造食品議題為中心Comments on the School Health Act amendment: focusing on the issues of healthy eating education and genetically modified foods
• 李銘杰
  Ming-Chieh Li
• 學校衛生法、營養教育、健康飲食教育、基因改造食品
  School Health Act, nutrition education, healthy eating education, genetically modified food
• 2015年《學校衛生法》修正公布8條條文。第16條與第23-1條中「營養教育」一詞修正為「健康飲食教育」，理由為營養教育一詞無法涵括正確飲食習慣、生命教育、環境倫理、飲食文化等內涵。事實上從美國CDC、FAO、我國公共衛生營養學教科書等各方文獻資料中，可見營養教育一詞本身即包含了健康飲食教育之概念。第15條將「健康教育」一詞修正為「健康飲食教育」，限縮了學校場域對於社區健康促進之義務，曲解立法原意。第23條新增「禁止使用含基因改造生鮮食材及其初級加工品」，但基改食品對健康的影響仍有爭論，強制基改食品標示，讓民眾或學校場域自由選擇是否採購為較權宜的做法。
  In 2015, the "School Health Law" was amended with eight articles. First, "nutrition education" in Articles 16 and 23-1 was amended to "healthy eating education" because the legislators thought nutrition education didn't have the connotations of good eating habits, life education, environmental ethics, and food culture. Actually, from the public health nutrition textbooks and the documents of the US CDC, FAO, etc., we can see that nutrition education includes the concept of healthy eating education. Second, the amendment that "health education" was replaced by "healthy eating education" in Article 15 limited the obligation of schools to promote community health, which distorted the legislation's original intent. Lastly, "forbidding the use of genetically modified fresh ingredients and their primary processed products" was added in Article 23. However, the impact of genetically modified food on health is still controversial. Therefore, mandating genetically modified food labeling and giving the public or schools the right to choose whether to purchase or not are more reasonable approaches.
• 252-257
• 10.6288/TJPH.202206_41(3).110146

• Link 公衛論壇 Public Health Forum
• 從建議到指引:世界衛生組織2010年與2020年身體活動與靜態行為版本之比較From recommendation to guideline: a comparison between the versions of World Health Organization published in 2010 and 2020
• 連又旻、林倩宇、廖 邕
  Yu-Min Lien, Chien-Yu Lin, Yung Liao
• 身體活動、靜態行為、世界衛生組織
  physical activity, sedentary behavior, World Health Organization
• 適當的身體活動量能增進個人全體健康，而非僅是避免疾病。WHO於2010年發布了第一版針對三大族群的身體活動建議，然而身體活動量不足持續為造成全球死亡的主要危險因子之一，因此WHO於2020年提出更新的身體活動指引。本文彙整兩份身體活動建議（2010）與指引（2020）中的要點與異同處：新指引強調多元的目標族群、身體活動的短暫累積、避免過量身體活動、以低強度身體活動中斷或取代靜態行為對於健康成效的重要性。此外，新指引的建立過程更為系統性，且具備標準的評核流程及工具，更具實證力。
  Appropriate physical activity can improve an individual's overall health, not just prevent disease. Therefore, WHO released "Global Recommendations on Physical Activity for Health" in 2010. However, physical inactivity continues to be one of the main risk factors for global mortality. Consequently, "WHO Guidelines on Physical Activity and Sedentary Behaviour" was proposed in 2020. This article summarizes the key points, similarities, and differences between the two physical activity recommendations (2010) and the guidelines (2020). The new guidelines emphasize diverse target groups, accumulating short-term physical activity, avoiding excessive physical activity, and interrupting or replacing sedentary behavior with low-intensity physical activity are crucial to health outcomes. In addition, the establishment of the new guidelines is more systematic, with standard assessment processes and tools, which makes it more evidence-based.
• 258-264
• 10.6288/TJPH.202206_41(3).111005

• Link 公衛論壇 Public Health Forum
• 從社會團結原則談健保的納保規範Reflections on social solidarity in Taiwan’s health care insurance: principle and practice
• 白裕彬
  Yuh-Bin Bai
• 全民健保、社會團結、健康保險
  National Health Insurance, social solidarity, health care insurance
• 依全民健保而來的就醫身份是形塑台灣國民「想像的共同體」的重要元素。雖然全民健保以「社會保險」自詡，但實務上被保險人不具備自主性與實質話語權，多由政府部門強力主導，背離社會團結原則。現行的納保資格規範基於國民的社會公民權納入長期旅居國外的僑民，保費卻僅由受薪階級的雇傭雙方承擔，即使延長旅外國人的等待期仍不足以解決世代不正義的問題。本文就納保資格規範提出建議，尚有待各方利益相關者進一步討論協商以臻完備。
  Access to National Health Insurance is an important element in shaping the "imagined community" of the Taiwanese people. Although National Health Insurance claims to be "social insurance," the insured does not have the autonomy and substantive right to speak. The system is strongly dominated by government departments, which deviates from the principle of social solidarity. The current eligibility criteria for insurers include overseas compatriots considering social citizenship, but the salaried employees only bear insurance premiums. Even extending the waiting period for overseas compatriots is still not enough to solve the problem of generational injustice. This article puts forward suggestions on the eligibility criteria for inclusion of the insurance, and these suggestions need further discussion and negotiation among stakeholders of all parties to complete it.
• 265-269
• 10.6288/TJPH.202206_41(3).111012

• Link 公衛論壇 Public Health Forum
• 防疫邊際群體之健康權益保障Rethinking health right for the underprivileged people from the infectious disease prevention and control perspective
• 陳再晉、鐘珮純、陳冠文
  Tzay-Jinn Chen, Pei-Chunn Chung, Kuan-Wen Chen
• 邊際群體、健康權益、防疫
  underprivileged people, health right, infectious disease prevention
• 邊際群體係指沒享受適當權益或服務不完備的人。就過去SARS與新冠肺炎疫情的防制經驗，防疫邊際群體包含合法之產業移工及社福移工、失聯移工、特種行業人員、街友。周延邊際群體的照顧，不但保障其健康權，亦是全民健康的保障。建議政府藉由：保障邊際群體如同一般國民享有必要的免費公共衛生服務，包含非法居留者可出面就醫、接種疫苗且不被查處；建立八大行業從業人員及業者自主登錄機制；鼓勵能接受必要之公共衛生服務的街友享有較優惠之社會福利等措施來落實防疫邊際群體之健康權益保障與公共健康安全之維護。
  The underprivileged people are those who do not enjoy appropriate rights or are underserved. Based on experience in the prevention and control of SARS and the COVID-19 pandemic this time, the underprivileged people, which are viewed from the infectious disease prevention and control perspective, include legal industrial migrant workers and social welfare migrant workers, lost migrant workers, nightlife industry personnel, and homeless people. Taking good care of underprivileged people not only protects their right to health but also protects the health of others. Therefore, we suggest that the government should: ensure that underprivileged people access necessary and free public health services like citizens, including illegal residents who can get medical treatment and vaccination without being arrested; establish a self-registration mechanism for nightlife industries; award homeless people preferential social welfare if they are willing to accept necessary public health services. By doing this, we indeed protect the health rights of underprivileged people and all people.
• 270-275
• 10.6288/TJPH.202206_41(3).111011

• Link 綜論 Review Article
• 新冠肺炎疫情下之學童近視問題衝擊與因應Myopia related impacts and responses among school children during Covid-19
• 張麗春、廖梨伶
  Li-Chun Chang, Li-Ling Liao
• 新冠肺炎、封城、學童近視、近視進展、近距離活動
  Covid-19, Lockdown, schoolchildren’s myopia, myopia progression, near work
• 新冠肺炎對人類生活方式與健康帶來重大影響，各國政府為避免疫情傳播採取不同程度的校園防疫措施，除了限制戶外活動外，部分國家也停止實體上課，改為線上學習，有鑑於此， 國外學者紛紛以研究證實因疫情限制措施導致學童近視問題惡化的情勢。而台灣在2020年5月首次停止各級學校的實體課程、社團活動與課後輔導、安親班等，更讓健康專家對疫情時期學童視力問題感到憂心。依據文獻整理得知，在疫情前後，學童視力盛行率顯著上升、每天戶外活動時間不到1小時、每日線上課程至少1小時以上、近距離活動與螢幕使用時間顯著增加，而手機是其線上課程學習的主要載具。此外，疫情期間，學童近視屈光度數年增長約為>0.5D~0.98D，眼軸年增長速度>0.2 mm。有鑑於國內外尚未具體提出因應後疫情時代之近視防治策略，本文依文獻統整之結果，提出以下建議：(一)強化學童與家長因應近距離用眼的生活技能；(二)為教師採行線上教學做好規劃與準備；(三)落實3C載具的使用與控管原則；(四)運用科技輔助監測與追蹤產品；期望能以此四項因應策略，預防因防疫限制措施所造成的學童視力惡化問題。
  The Covid-19 pandemic has affected lifestyles and health worldwide, forcing countries to adopt different levels of epidemic prevention. In addition to restricting outdoor activities, some governments have suspended in-person classes, switching to online learning. Multiple scholars have conducted studies confirming that the prevalence of myopia among school children has worsened due to the implementation of pandemic restrictions. Since May 2020, the Taiwanese government has suspended all in-person classes, club activities, after-school tutoring, and parenting classes at schools, further escalating health experts’ concerns about myopia. A literature review suggests that since the beginning of the pandemic, the prevalence of myopia increased considerably among school children, as they spent less than 1 hour in outdoor activities and at least 1 hour in online classes per day, often relying on mobile phones to complete coursework. Children also spent substantially more time engaged in close visual work and other screen-related activities. During the pandemic, annual growth of diopter and axial length in school children were approximately >0.5–0.98 D and >0.2 mm, respectively. However, neither foreign nor domestic studies have proposed specific strategies for myopia prevention in the postpandemic era. Therefore, based on the literature review, this study proposes the following solutions: (1) strengthen life skills of children and parents in limiting close visual work; (2) assist teachers in adapting curriculum for online learning; (3) implement guidelines for the use and management of 3C products; and (4) introduce technological monitoring and tracking products. These 4 responses may prevent eyesight deterioration in school children due to pandemic restrictions.
• 276-285
• 10.6288/TJPH.202206_41(3).111032

• Link 原著 Original Article
• 我國醫療服務提升計畫對醫療資源不足地區的政策效果評估Policy impact of medical quality improvement project on medically underserved areas
• 簡毓寧、林俐吟、黃勢璋、陳亭安、鍾和益、洪敬宜、邱弘毅
  Yu-Ning Chien, Li-Yin Lin, Shih-Chang Huang, Ting-An Chen, Ho-Yi Chung, Ching-I Hung, Hung-Yi Chiou
• 醫療資源、偏鄉地區、醫療服務提升計畫
  medical resources, rural areas, medical quality improvement project
• 目標：近年我國積極推動各項偏鄉醫療照護計畫，投注預算數逐年提升，為探究政策是否有具體成效，本研究以「全民健康保險醫療資源不足地區之醫療服務提升計畫」（簡稱「醫療服務提升計畫」）為例，評估其政策效益。方法：本研究利用我國2011年與2013年全民健康保險資料庫，採用「綜合特質型居住地估計方法」定義偏鄉長住居民，並將有無參與醫療服務提升計畫醫院之周邊偏鄉分為實驗組與對照組，透過差異中差異法（difference-in-differences, DD）進行實證分析，探討偏鄉醫療照護計畫對醫療資源不足地區之影響。結果：研究結果指出，以門診為基礎的評估指標呈現顯著的政策效果，其門診跨區就醫分率顯著成長5.33%。以急診為基礎的評估指標雖可觀察到政策介入效果，如急診跨區就醫分率成長1.14%，可避免急診率降低0.20%，但皆未達統計上顯著。惟可避免住院率呈現逆勢發展成長0.26%，但同樣未達統計上顯著。結論：以跨區域醫療資源而非行政區來整合醫療資源之政策概念，將有助於改善偏鄉民眾醫療服務需求。
  Objectives: Taiwan has implemented numerous healthcare projects in rural areas, and the number of bidding budgets has increased yearly. The aim of this study is to evaluate the policy effect of medical quality improvement projects in medically underserved areas. Methods: This study used 2011–2013 data from Taiwan’s National Health Insurance Database to analyze the effect of the national medical quality improvement policies have on the medically underserved areas. The experimental group comprised of hospitals participating in the projects, while the control group comprised of non-participating hospitals. We examined the effect of projects implemented to improve healthcare services by performing an empirical analysis using the DD method. Results: The outpatient-based evaluation indicators suggested the projects had considerable effect, such as increasing the outpatient cross-boundary medical care rate by 5.33%, increasing the interregional medical treatment rate of emergency departments by 1.14%, and decreasing preventable emergency department visits by 0.20%. Among these results, the outpatient cross-boundary medical care rate reached a statistical significance, while the other two indicators did not. The preventable hospitalization rate showed a contrarian growth of 0.26%, which was also not statistically significant. Conclusions: Policies to provide regional medical services across jurisdictional boundaries will help medical care needs of rural populations.
• 286-298
• 10.6288/TJPH.202206_41(3).110131

• Link 原著 Original Article
• 工作與生命意義的實踐:急重症護理師的疫起挑戰Meaningful work and life: challenges faced by acute- and critical-care nurses
• 李美秀、許欽津
  Mei-Hsiu Lee, Chin-Chin Hsu
• COVID-19、急重症單位、護理師、工作意義、生命意義
  COVID-19, acute and critical care unit, nurse practitioner, job meaning, meaning in life
• 目標：台灣2021年COVID-19疫情嚴峻，造成第一線急重症護理師工作量倍增且染疫風險增加，了解護理師在此情境下的工作意義與生命意義，以便未來醫院有相應的輔助措施。方法：以質性研究深度訪談十五位急重症單位的護理師。結果：疫情下的「工作意義」有三個主題，分別為：1.讓生活安定；2.因使命固守崗位；3.看見自己的價值；「生命意義」有四主題， 分別為：1.照顧家人；2.生死無常；3.行善；4.把握當下。結論：在COVID-19疫情嚴重期間， 台灣急重症單位的護理師對工作不逃避，而是以正向的態度面對工作所帶來的挑戰，且能從工作中體現自己不凡的生命意義，在有限的生命歷程，留下偉大捍衛國人健康的歷史軌跡。本研究提供台灣疫情警戒期間，急重症單位的護理師對工作意義與生命意義的見解，讓政策制定者在未來大流行時能有應對的相關計劃。
  Objectives: The severity of the COVID-19 epidemic in 2021 in Taiwan doubled the workload of first-line acute- and critical-care nurses and increased their risk of infection. This study explored such nurses’ work and personal lives to help hospitals develop auxiliary measures. Methods: This qualitative study interviewed fifteen nurses working in acute- and critical-care units. Results: Three themes were regarding the meaning of the nurses’ work during the pandemic were identified: (a) keeping life stable, (b) fulfilling duties, and (c) recognizing self-worth. Four themes regarding the meaning of the nurses’ personal lives were identified: (a) caring for families, (b) the impermanence of life and death, (c) doing good, and (d) seizing the day. Conclusions: During the pandemic, the nurses faced challenges at with a positive attitude, which helped them find meaning in their lives. In the limited life course, he left behind a great historical track of defending the health of the Chinese people. This study provides insight into the professional and personal lives of nurses in acute- and critical-care units during the pandemic in Taiwan, and the findings can help policymakers plan for future pandemics.
• 301-311
• 10.6288/TJPH.202206_41(3).111022

• Link 原著 Original Article
• 台灣不同類型大專校院之大學生健康促進生活型態及其影響因素Health-promoting lifestyle and influencing factors among students from different types of universities in Taiwan
• 趙丹平
  Dan-Ping Chao
• 大學類型、健康促進生活型態、性別、自覺健康狀況、健康概念
  university types, health-promoting lifestyle, gender, perceived health status, health conception
• 目標：大學是青少年邁入成年的關鍵，此時養成促進健康的生活方式（HPL）將有助於遠離慢性疾病。本研究欲探討不同類型大學學生的HPL現況及影響因素。方法：以台灣大學生為對象，採二階段抽樣進行自填問卷，先依學校區域、公私立、定向，分層隨機抽出37所學校， 再於各校依學號隨機抽出受試學生，共回收1,062份有效問卷。結果：大學生的健康促進生活型態量表（HPLP-S）得分在中等程度之上，但營養、運動和健康責任得分較低。多元逐步迴歸分析顯示，女性、自覺健康狀況低分、健康概念之角色功能性、安寧幸福性或臨床性低分，為所有大學生HPLP-S相對消極的重要因素；而可支配金額較低、有進食宵夜可做為公立大學的參考因素，運動時間不足為私立大學的參考因素，有進食宵夜為一般大學的參考因素，運動時間不足、外食次數過多為技職校院的參考因素。結論：本研究建議各類型大學現階段亟需針對前述學生，積極規劃正確飲食搭配規律運動的衛教方案，並灌輸對自身健康負責的正確觀念。
  Objectives: University sees the transition from adolescence to adulthood and the development of habits. A health-promoting lifestyle (HPL) developed during this period may help individuals avoid chronic diseases in adulthood. This study discussed HPL and its influencing factors among students from different types of universities. Methods: Two-stage sampling was adopted. Firstly, universities were stratified and randomly selected according to the region, ownership, and orientation in Taiwan. Students were then randomly selected according to their respective school ID numbers, and completed self-administered questionnaires that covered personal factors, health-promoting lifestyle profile (HPLP-S), perceived health status (PHS), and health conception (HC). A total of 1,062 valid questionnaires were collected from 37 universities. Results: The score for students’ HPLP-S was 3.34, above the midpoint. However, the scores for nutrition, exercise, and health responsibility subscales of HPLP-S were relatively low. Additionally, female students, low PHS scores, and low scores for the functional/role performance, eudaimonistic, and clinical subscales of HC were each associated with a negative HPLP-S of students from all types of universities. Low disposable income and night-snacking were factors that could be considered by public universities. Inadequate physical activity was factor that could be considered by private universities. Night-snacking was factor that could be considered by general universities. And inadequate physical activity and excessive dining-out were factors that could be considered by vocational colleges. Conclusions: We believe that it is vital to provide plans featuring correct diet combined with regular exercise to students with poor health-promoting behaviours to promote responsibility for their own health.
• 312-330
• 10.6288/TJPH.202206_41(3).110153

• Link 原著 Original Article
• 老人是珍寶或是負擔?亞洲青壯世代對老年人的態度Older adults: a treasure or a burden? Attitudes among Asian youth
• 陳端容、陸子初、吳冠穎
  Duan-Rung Chen, Tzu-Chu Lu, Kuan-Ying Wu
• 亞洲國家、高齡化、老年歧視、價值觀
  Asia, aging, ageism, value orientation
• 目標：本研究聚焦於同時承受少子化及高齡化問題的亞洲國家如台灣、中國、日本、南韓及新加坡，從世代差異、資源競爭及個人價值三種面向，探討青壯年對老年人的態度。方法： 使用2010-2012年《世界價值觀調查》第六波資料，分別從「老年人政經資源使用過多」、「對老人有好感」兩個面向，比較亞洲社會青壯年對於老年人態度的差異。結果：愈重視「個人自主與成就」價值觀的亞洲青壯年愈傾向認同老年人政經資源使用過多，而與華人文化較有關的台灣、中國及新加坡，自評社經劣勢愈強，愈傾向認為老年人政經資源使用過多（如中國），或對老人沒有好感（如台灣、中國及新加坡）。日本、南韓及新加坡青壯年生活控制感愈高，愈不易有老年人政經資源使用過多的負面想法。多數國家和台灣相同，愈重視「社會規範與合群」價值觀的青壯年對老人較有好感，也較易降低其對老年人政經資源使用過多的敵意（台灣為主）。在台灣及新加坡，教育程度能緩和青壯世代對於老年人政經資源使用過多的敵意，卻不會增加其對老年人有好感。「資源衝突論」與「個人價值」論可部分解釋亞洲青壯年對老年人的刻版印象。結論：亞洲國家在快速高齡化過程中，代間資源競爭是一個重要的社會議題，而愈趨向個人主義價值觀也愈增加對年長者的負面想法。如何促進世代間彼此了解，創造跨世代的社會支持環境是未來努力方向。
  Objectives: Many Asian countries are facing the challenges of low birth rates and rapid aging. This study examines the attitudes of young people in 5 such countries toward older adults from 3 perspectives: 1) intergenerational differences, 2) resource competition, and 3) personal value orientation. Methods: We used data from the World Values Survey Wave 6 (2010–2012) to examine the attitudes of young people toward older adults. Age-related stereotypes comprised two domains: 1) “disproportionate political and economic power of older adults,” and 2) “positive views of older adults.” Results: Young people who valued “autonomy and achievement” viewed older adults as having disproportionate political and economic power (mainly in China). Socioeconomically disadvantaged youth also held negative views of older adults (mainly in Taiwan, China, and Singapore). Young people who perceived a sense of control over their lives held positive views of older adults and disagreed with the stereotype that older adults “have disproportionate political and economic power.” In most of the Asian countries studied, young people who valued “social norms and community” had favorable views of older adults. The attitudes of young people toward older adults can be attributed to resource competition and personal values. Education significantly reduced prejudice against older adults (mainly in Taiwan and Singapore). Conclusions: As populations in Asian countries rapidly age, intergenerational resource competition and growing individualism may increase prejudice toward older adults. Education and policy intervention are needed to improve intergenerational communication and create a healthier social environment.
• 331-346
• 10.6288/TJPH.202206_41(3).111016

• Link 研究紀要 Research Brief
• 台灣中老年族群失能率趨勢:以中老年身心社會生活狀況長期追蹤調查重新驗證Disability trends among middle-aged and older adults in Taiwan: validation using the Taiwanese Longitudinal Study of Aging
• 鐘子婷、吳世權、黃瑋絜、杜裕康、陳雅美
  Zi-Ting Zhong, Shih-Cyuan Wu, Wei-Chieh Huang, Yu-Kang Tu, Ya-Mei Chen
• 「≧50歲」中老年失能率、「≧65歲」長者失能率、中老年身心社會生活狀況長期追蹤調查、國民長期照護需要調查、行政院人口及住宅普查報告
  disability rates (DRs) among the 50-year-old age bracket, disability rates (DRs) among the 65-year-old age bracket, Taiwanese Longitudinal Study of Aging (TLSA), LTC Needs of an Aging Population of Taiwan surveys (LTCNAPTS), General Report of Population and Housing Census
• 目標：隨長者與失能人數上升，長照需求將隨之增加。2010年「國民長期照護需要調查（Long-Term Care Needs of an Aging Population of Taiwan surveys, LTCNAPTS）」長者失能率14.95%，高於行政院人口及住宅普查12.67%，現有失能率推估存在落差，本研究利用「中老年身心社會生活狀況長期追蹤調查(Taiwanese Longitudinal Study of Aging, TLSA)」再估計與驗證失能率及趨勢。方法：分析TLSA 1996、1999、2003、2007、2011年五波資料，「≧50歲、≧65歲」長者「粗失能率」、「加權後失能率」、「以2003/2007/2011年為參考組調整後之失能率」、「依性別及年齡層區分之失能率」，並與兩份資料比較。結果：2007年TLSA失能率落在12.14~18.59%，2011年落在16.50~22.91%，數值較接近LTCNAPTS，失能率逐年增加，女性高於男性，2010-2011年「≧50歲」失能率增幅較「≧65歲」長者高，其餘年份兩族群失能率變化幅度相近。結論：本研究驗證TLSA為有效第三種資料庫，其推估接近LTCNAPTS，失能人數在20年間成長2~4倍。相對國際失能率緩和，台灣面對失能率攀升，未來可採用不同資料來源依失能程度，及使用更精準模型估計長照需求人數，且在中老年族群失能率增幅比長者大，應加強中老年族群失能預防。
  Objectives: Population aging and disabilities are associated with long-term care (LTC) needs in Taiwan, but current estimates of disability rates (DRs) are inconsistent. The LTC Needs of an Aging Population of Taiwan survey (LTCNAPTS) reported a DR of 14.95% in 2010, whereas the Taiwan Census estimate was 12.67%. The present study analyzed the Taiwan Longitudinal Study of Aging (TLSA) to verify which survey provides the most accurate DR. Methods: This study used TLSA results from 1996, 1999, 2003, 2007, and 2011 to estimate the DRs and trends among older adults (aged 50 years and older), including the crude, weighted, and adjusted DRs for the reference groups from 2003, 2007, and 2011, stratified by sex and age. Results: The TLSA DRs were 12.14%–18.59% and 16.50%–22.91% in 2007 and 2011, respectively. These rates most closely resemble those of the LTCNAPTS. Women had higher DRs than men, and DRs increased annually. In 2010–2011, DRs among the 50-year-old age bracket increased more drastically than those of the 65-year-old age bracket, and this trend held true for other years as well. The number of Taiwanese older adults with disabilities increased 2–4-fold over the past 20 years, whereas DRs in foreign countries plateaued. Conclusions: This study validates the TLSA as an effective third database and corroborates the DR reported by the LTCNAPTS. New datasets and precise models can be used to predict DRs based on disability levels after LTC 2.0. Preventing disability, especially among the middle-aged population, should be a priority.
• 331-346
• 10.6288/TJPH.202206_41(3).111017

• Link 評論 Commentary
• 評論:我國醫療服務提升計畫對醫療資源不足地區的政策效果評估Commentary: policy impact of medical quality improvement project on medically underserved areas
• 洪錦墩
  Chin-Tun Hung
• 無
  none
• 無
  none
• 299
• 10.6288/TJPH.202206_41(3).11013101

• Link 作者回覆 Authors' response to commentary
• 作者回覆:我國醫療服務提升計畫對醫療資源不足地區的政策效果評估Authors' response to commentary: policy impact of medical quality improvement project on medically underserved areas
• 簡毓寧、林俐吟、黃勢璋、陳亭安、鍾和益、洪敬宜、邱弘毅
  Yu-Ning Chien, Li-Yin Lin, Shih-Chang Huang, Ting-An Chen, Ho-Yi Chung, Ching-I Hung, Hung-Yi Chiou
• 無
  none
• 無
  none
• 300
• 10.6288/TJPH.202206_41(3).11013102