41卷5期

• Link 政策論壇 Policy Forum
• 消除C型肝炎最關鍵的一哩路：注射藥物族群的防治現況與建議The most critical mile to eliminate hepatitis C: Current status and recommendations for the prevention and treatment of people who inject drugs
• 王聲昌、林佩萱、鍾安妮、鍾宇筑、陳為堅
  Sheng-Chang Wang, Pei-Hsuan Lin, An-Nie Chung, Yu-Ju Ella Chung, Wei J. Chen
• 無
  none
• 無
  none
• 479-482
• 10.6288/TJPH.202210_41(5).PF05

• Link 綜論 Review Article
• 醫療照護適當性：概念性定義、測量與國際倡議Appropriateness of medical care: conceptualization, measurement, and international initiative review
• 林志遠、李玉春
  Chih-Yuan Lin, Yue-Chune Lee
• 醫療照護適當性、醫療品質、健康服務研究
  appropriateness of medical care, medical care quality, health services research
• 醫療照護適當性為醫療品質的面向之一，概念性定義為正確的病人、正確的治療地點、正確的照護提供者、正確的時間，提供或使用正確照護的組合。測量方法包括內隱指標、明確指標及混合指標，國際醫療照護適當性倡議與實踐可分為概念建構期、指標建立期、減少浪費及避免低價值服務期、政策結合期。本文簡要回顧醫療照護適當性之定義、測量及國際倡議經驗，並討論研究與政策發展意涵，供後續學術與政策之應用。
  Appropriateness of medical care is a crucial dimension of medical quality. The most common conceptual definition is the provision of the right care for the right patient, the right setting, the right service provider, and the right time. Measurement methods include implicit, explicit, and combined criteria. International initiatives and practices of appropriateness in medical care can be divided into the concept construction period, the indicator establishment period, the waste reduction and low-value care reduction period, and the policy implementation period. This narrative review reports the conceptual definition, measurement methods, and international initiatives of appropriateness of medical care. Implications for future research and policy development are discussed.
• 483-499
• 10.6288/TJPH.202210_41(5).111002

• Link 原著 Original Article
• 青少年於新冠肺炎疫情期間維持社交距離之動機與行為的相關探討：以同理心為中介變項Adolescents’ motivation and behavior to maintain social distancing during the COVID-19 pandemic: the mediating role of empathy
• 趙敏安、程景琳
  Min-An Chao, Ching-Ling Cheng
• 維持社交距離、內在性動機、外在性動機、同理心、新冠肺炎疫情
  social distancing, intrinsic motivation, extrinsic motivation, empathy, COVID-19 pandemic
• 目標：本研究旨在探討於新冠肺炎疫情期間，台灣青少年維持社交距離的情況，與青少年對於維持社交距離的動機和行為的關聯、及其是否受到同理心之中介影響。方法：本研究使用問卷調查法，研究參與者為來自台灣北、南及東部的889名國、高中學生（男生37%，高中生 77%）。以結構方程模型之統計方法檢驗同理心在動機與維持社交距離間的中介途徑。結果： 在疫情緊張的三級警戒期間，大約八成以上的青少年會在生活中落實維持社交距離行為；青 少年的內在性動機會透過同理心進而影響維持社交距離行為（β = .04, p < .01, 95 % CI = [.034, .169]），但外在性動機與維持社交距離間並沒有顯著關聯（β = -.01, p = .42, 95 % CI = [-.051, .016]）。結論：青少年對於維持社交距離的內在性動機與同理心，都明顯與其表現出維持社交距離的行為有關。建議學校教師及衛教相關人員在進行防疫之公共衛生宣導時，若能關照到青少年的內在性動機及引發其同理心，將有助於提升青少年之防疫行為的展現與落實。
  Objectives: This study investigated the social distancing behavior of Taiwanese adolescents during the COVID-19 pandemic. It examined the influence of adolescents’ motivation and empathy on their social distancing behavior and the mediating role of empathy. Methods: The participants were 889 adolescent students recruited from four public schools in northern, southern, and eastern Taiwan (boys: 37%, senior-high-school students: 77%). The study used structural equation modeling to test the hypothesis that empathy mediates the relationship between motivation (intrinsic and extrinsic) and social distancing. Results: During the COVID-19 pandemic, nearly 80% of Taiwanese adolescents followed the guidelines of maintaining social distancing in their daily lives. A significant mediating path between adolescents’ intrinsic motivation and their social distancing behavior through their empathy was observed (β = .04, p < .01, 95% confidence interval CI = [ .034, .169]). However, no significant association between adolescents’ extrinsic motivation and their social distancing behavior was observed (β = −.01, p = .42, 95% CI = [−.051, .016]). Conclusions: Adolescents who exhibit intrinsic motivation and high empathy are more likely to engage in social distancing. These findings suggest that prevention strategies relying on students’ intrinsic motivation and empathetic concern can help to increase their practice of social distancing during the pandemic.
• 500-511
• 10.6288/TJPH.202210_41(5).111024

• Link 原著 Original Article
• 生活技能健康教學策略提升教保服務人員視力保健教學能力之介入研究An intervention effect study on improving preschool educators ability on eye care programs by adopting life skill based strategies
• 陳慧玲、黃煒翔、劉潔心
  Hui-Ling Chen, Wei-Hsiang Huang, Chieh-Hsing Liu
• 視力保健、生活技能、教保服務人員
  vision care, life skill, educator
• 目標：本研究旨在探討生活技能健康教學策略提升教保服務人員健康教學能力之介入成效。方法：本研究為前、後測並追蹤延宕效果的準實驗研究設計，採便利取樣，選取北部地區教保服務人員共77人為研究對象，根據意願分成實驗組及對照組，以「幼兒視力保健課程之生 活技能健康教學策略方案」進行6堂共計12小時的實驗介入，運用自編的「健康教學能力評估 量表」為測量工具，以廣義估計方程式進行分析，藉此評值方案的介入成效。結果：分析結果顯示，在控制了組別與時間後，生活技能健康教學策略融入幼兒視力保健課程對於教保服務人員的健康教學認知、健康教學態度，以及健康教學信心皆有正向成效；其中健康教學態度更具 有8週的延宕效果。結論：本研究發展之生活技能健康教學策略方案能顯著提升教保服務人員在視力保健教學上的健康教學認知、健康教學態度及健康教學信心，可提供未來相關單位或政府機關提升教保服務人員健康教學能力課程設計之參考。
  Objectives: This study aims to investigate the effectiveness of interventions to enhance the health instruction ability of preschool educators by adopting life skills-based strategies. Methods: This study was designed as a quasi-experimental study with pre- and post-testing control group design as well as tracking of delayed effects. An aggregate of 77 preschool educators from the northern region were selected as the study subjects and were divided into experimental and control groups according to their preference. A total of 12 hours of experimental intervention was conducted in six sessions of the “Life Skills-Based Health Instruction Strategic Program for Early Childhood Eye Care Course.” The self-formulated “Health Instruction Ability Assessment Scale” was adopted as a measurement tool and analyzed with a generalized estimating equations (GEE) to evaluate the effectiveness of this intervention program. Results: The analysis findings indicated that after controlling for group and time, the integration of life skills-based health instruction strategies into the early childhood eye care course had positive effects on the health instruction awareness, attitudes, and confidence of preschool educators. Moreover, the program exhibited an eight-week delayed effect on the health instruction attitude of preschool educators. Conclusions: The life skills-based health instruction strategic program developed in this study significantly improved the health instruction awareness, attitude, and confidence of preschool educators regarding eye care instruction, and can serve as a reference for entities or government agencies concerned to design courses on enhancing preschool educators’ health instruction competency in the future.
• 512-523
• 10.6288/TJPH.202210_41(5).111043

• Link 原著 Original Article
• 台灣社區營養推廣中心服務現況、挑戰與契機之質性研究A qualitative exploration of progress, challenges, and opportunities in community nutrition services in Taiwan
• 王澤強、李佳融、潘昕榆、張鳳琴、梁桂嘉、秦義華、羅素英、吳昭軍
  Tse-Chyang Wang, Chia-Jung Lee, Hsin-Yu Pan, Fong-Ching Chang, Kuei-Chia Liang, Yi-Hua Chin, Shu-Ying Lo, Chao-Chun Wu
• 營養、服務、設計思考、挑戰、契機
  nutrition, services, design thinking, challenges, opportunities
• 目標：國民健康署自2018年補助縣市辦理延緩失能社區營養示範據點，本研究旨在探討社區營養推廣中心服務的現況、挑戰與契機。方法：本研究訪談14個縣市17名「社區營養推廣中心」營養師，及5名專家學者，並進行設計思考增能與評價。結果：(一)現況：營養師表示「社區營養推廣中心」服務包括：營養風險篩檢及調查、營養教育推廣、輔導餐飲業者及長者據 點、社區營養行銷及人員培訓等。(二)困難：人力有限、缺乏具信效度長者營養調查問卷、不 同區域長者營養需求與資源差異大、營養教育深度與廣度不足、社區營養行銷成效難量化、跨單位合作機制不完備、社區營養師招募不易、新冠肺炎疫情影響介入執行。(三)契機：專家學 者建議強化社區營養社會行銷、營養教育體驗學習、社區營養中心成果展現、跨單位合作等。 設計思考增能有助於提升社區健康工作人員運用設計思考認知、態度、效能、使用意願與應用。結論：我國「社區營養推廣中心」在增進長者健康飲食型態扮演重要角色，本研究有助於 了解社區營養服務推動困難與優化服務契機。
  Objectives: In 2018, Taiwan’s Health Promotion Administration funded the establishment of community nutrition centers in various cities and counties to prevent frailty among community older adults. This study investigated the current suite of community nutrition services and the challenges and opportunities therein. Methods: In total, 17 community dietitians from 14 counties/cities and 5 professional community health workers were interviewed. These community dietitians and community health workers underwent design thinking training, and its effects were evaluated. Results: (1) Services: The community dietitians reported that the current services provided by the community nutrition centers include older adult nutrition screening and surveys, nutrition education, consultations aimed at helping community centers and restaurants to establish healthy food environments, nutrition promotion, and the recruitment of dietitians and other personnel. (2) Challenges: The community dietitians reported that the challenges included a lack of human resources, a lack of reliable and valid dietary questionnaires, overly large variations in older adult–related nutrition needs and resources across multiple areas, difficulties in implementing nutrition education at an intensive and large-scale level, difficulties in evaluating the effects of nutrition education, obstacles in collaborations with other sectors, low uptake in dietitian recruitment, and difficulties in coping with the COVID-19 pandemic. (3) Opportunities: The professional community health workers suggested strengthening community nutrition promotion, providing nutrition-related experiential learning opportunities, establishing collaborations among multiple sectors, presenting and promoting the community nutrition achievements of the centers, and applying design thinking to promote community nutrition services. The evaluation of the design thinking training intervention revealed its positive effects on increasing the knowledge, attitudes, and performance of community health workers and their intention to apply design thinking. Conclusions: Taiwan’s community nutrition centers play a key role in reinforcing healthy eating habits among older adults. This study provided insights regarding the challenges and opportunities pertaining to the promotion of community nutrition services.
• 524-537
• 10.6288/TJPH.202210_41(5).111050

• Link 原著 Original Article
• 基因與運動與台灣民眾痛風得病風險的關聯性Relationship of genes and exercise with risk of gout in a Taiwanese population
• 陳延安、謝璦如、陳培君、周子傑
  Yen-An Chen, Ai-Ru Hsieh, Pei-Chun Chen, Tzu-Chieh Chou
• 痛風、基因風險分數、運動、台灣人體生物資料庫
  gout, genetic risk score, exercise, Taiwan Biobank
• 目標：痛風是尿酸累積所導致的關節炎，影響痛風發生的因素可分為環境及個體差異，環 境包含生活習慣、運動、飲食等，個體差異包含共病症的有無以及基因差異，以上因素皆可能 影響痛風得病風險。先前研究中基因的影響及基因和環境之間的關聯仍未完全解析。本研究目 的為探討痛風、基因風險與運動之關聯。方法：本研究為橫斷性研究，運用台灣人體生物資料 庫，納入11,865位基因資料與問卷資料兩者皆有資料之受試者。爾後進行運動問卷資料與受試 者自述是否有經醫生診斷之痛風作為判定是否罹患痛風之狀況。依據上述研究流程，最後本研 究納入1,727位受試者（其中痛風者為353人，非痛風者為1,374人）進行相關分析研究。另外以 基因數據篩選遺傳變異位點後估計基因風險分數，並由問卷中的運動類型與頻率等資訊估計運 動消耗熱量進行分組分析。結果：本研究結果顯示運動消耗熱量與痛風發生有關聯性。相較於 運動量低的民眾，進行適當運動量的民眾可觀察到較低的痛風得病風險，但如果在過度運動的 情況下，痛風得病風險則可能有提高的情形（p = 0.031）。上述現象在低基因風險組仍發現相 同趨勢（p = 0.034）。結論：運動與基因風險可能與台灣民眾痛風的發生風險有關，未來將可 進一步進行前瞻性長期追蹤與預防性研究。
  Objectives: Gout is a type of arthritis caused by abnormal purine metabolism and uric acid accumulation. Various environmental factors (e.g., living habits, exercise, diet, and individual differences) and individual factors (the presence or absence of comorbidities and genetic differences) are associated with the occurrence and severity of gout. Epidemiological studies have extensively examined the influence of exercise, diet, and comorbidities; however, the influence of genes on gout and the relationship between genes and the environment require further verification. Therefore, this study aimed to evaluate the association of gout with genetic variation and exercise in a Taiwanese population. Methods: We collected genetic and questionnaire data from Taiwan Biobank, conducted a data analysis after screening for genetic mutation sites, and obtained genetic risk scores. Results: Moderate exercise (not too high or low) was associated with decreased gout incidence. A genetic risk stratification analysis yielded similar results only among individuals with low and not high genetic risk. Conclusions: Our findings suggest that exercise has a greater effect on gout in individuals with low genetic risk than in those with high genetic risk.
• 538-547
• 10.6288/TJPH.202210_41(5).110128

• Link 原著 Original Article
• 大氣空氣品質和腎臟透析病人的死亡相關：系統性文獻回顧Association between ambient air quality and the mortality risk of dialysis patients: a systematic review
• 張佑瑄、郭素娥、許翠華、劉嘉玲
  Yu-Hsuan Chang, Su-Er Guo, Tsui-Hua Hsu, Chia-Ling Liu..
• 血液透析、空氣品質、死亡率、系統性文獻回顧、懸浮微粒
  hemodialysis, air quality, mortality, systematic review, particulate matter
• 目標：過去的研究顯示長期暴露於空氣中懸浮微粒和罹病與死亡危險有關，包括腎臟疾病 的惡化，但少有相關研究統整大氣空氣品質與腎臟疾病死亡的關聯，希冀藉由此系統性文獻回 顧及整合，探討空氣品質和洗腎病人健康的相關，提供未來相關研究的實證參考。方法：建立 關鍵字並搭配自然語言及Mesh term於五個資料庫進行搜尋2022年6月前的中英文資料庫，總共 發現163篇，經排除重複、納入及排除條件篩選後，最終納入5篇符合文章主題之文獻，並以 CAPS（Critical Appraisal Skills Programme, CAPS）世代研究評讀工具及Oxford CEBM檢測文章 品質及證據等級。結果：共納入5篇研究，結果發現長期暴露於NO2 7年的洗腎病人的死亡危險 增加1.33-3.78倍；暴露於高濃度PM2.5 7年的老年洗腎病人可能會與死亡有關。結論：長期暴露 於大氣NO2、PM2.5可能和洗腎患者的死亡危險有關；SO2與PM10因有發表偏差問題，可能需要 日後更多研究針對此議題再加以探討證實。另受限於目前研究多是探討室外空氣品質和洗腎病 人健康的相關，因此日後應針對室內空氣污染做更進一步的臨床試驗實證研究，以提供更全面 與系統性的探討與分析。
  Objectives: Studies have associated the long-term exposure to ambient particulates with mortality from various types of disease, including kidney disease. However, few studies integrating the relationship between ambient air quality and the mortality risk from kidney disease. The objective of this study is to evaluate this association using systematic literature review to provide empirical references for future research. Methods: Mesh term and free-text words were used for literature search. Articles were retrieved from electronic databases including PubMed, Cochrane Library, ProQuest, EMBASE, and Airiti Library. A total of 163 articles published before June 2022 met the search criteria. After screening the abstract, title, and main text of the studies to delete repetitions, we identified five studies eligible for the qualitative synthesis. Each study was appraised using the CASP-Cohort checklist and Oxford CEBM. Results: We examined the data in these five studies and found that the hazard ratio of mortality from dialysis ranged 1.33-3.78 for population with long-term exposure to NO2. A study also found that the elderly patients with dialysis exposing to high levels of PM2.5 for 7 years were also at an elevated hazard of deaths. Conclusions: These studies showed that long-term exposure to NO2 and PM2.5 might associate with an increased hazard of deaths from dialysis. However, these studies were conducted based on the outdoor air quality. Research based on indoor air quality and experimental study are required to verify the association with the mortality risk.
• 551-563
• 10.6288/TJPH.202210_41(5).111038

• Link 其他 Others
• 讀者來函：福利體系中的世代衝突與世代團結Letters to the editor: intergenerational conflicts and intergenerational solidarity in welfare systems
• 葉明叡
  Ming-Jui Yeh
• 無
  none
• 無
  none
• 564-565
• 10.6288/TJPH.202210_41(5).Letter202201

• Link 作者回覆 Authors' response to commentary
• 作者回覆：快速高齡化與代間衝突Author's response to letters to the editor: rapid aging and intergenerational conflicts
• 陳端容、陸子初、吳冠穎
  Duan-Rung Chen, Tzu-Chu Lu, Kuan-Ying Wu
• 無
  none
• 無
  none
• 566
• 10.6288/TJPH.202210_Letter202201R

• Link 評論 Commentary
• 評論：基因與運動與台灣民眾痛風得病風險的關聯性Commentary: relationship of genes and exercise with risk of gout in a Taiwanese population
• 林明薇
  Ming-Wei Lin
• 無
  none
• 無
  none
• 548-549
• 10.6288/TJPH.202210_41(5).11012801

• Link 作者回覆 Authors' response to commentary
• 作者回覆：基因與運動與台灣民眾痛風得病風險的關聯性Authors' response to commentary: relationship of genes and exercise with risk of gout in a Taiwanese population
• 陳延安、謝璦如、陳培君、周子傑
  Yen-An Chen, Ai-Ru Hsieh, Pei-Chun Chen, Tzu-Chieh Chou
• 無
  none
• 無
  none
• 550
• 10.6288/TJPH.202210_41(5).11012802