41卷6期

• Link 政策論壇 Policy Forum
• 滾動調整2025年C肝消除治療目標數Towards HCV elimination by 2025: rolling update of the estimated number of persons with chronic HCV infection
• 楊雯雯、吳慧敏、盧勝男、劉嘉玲、鄭國本、蒲若芳
  Wen-Wen Yang, Grace Hui-Min Wu, Sheng-Nan Lu, Chia-Ling Liu, Kuo-Pen Cheng, Raoh-Fang Pwu
• 無none
  無none
• 無none
  無none
• 567-571
• 10.6288/TJPH.202212_41(6).PF06

• Link 公衛論壇 Public Health Forum
• 新冠狀疫情下新住民小組的成立與運作之觀察與反思The reflection on the establishment and operation of the new immigrant taskforce during the COVID-19 pandemic
• 林庚酉、林佳靖
  Keng-Yu Lin, Chia-Ching Lin
• 無none
  無none
• 無none
  無none
• 572-574
• 10.6288/TJPH.202212_41(6).111089

• Link 綜論 Review Article
• 簡介價值基礎的健康照護及其對台灣的啟示Implications of value-based healthcare for Taiwan
• 莊智鈞、林青青、鄭守夏
  Chih-Chun Chuang, Ching-Ching Claire Lin, Shou-Hsia Cheng
• 全民健保、價值基礎、健康照護、醫療給付、醫療改革
  National Health Insurance, value-based payment, value-based healthcare, medical payment, healthcare reform
• 隨著醫療科技、藥品、醫材與醫療技術的精進與普及，人類平均餘命延長，各國政府健康保險福利服務支出劇增，已成嚴重的財務負擔。因此相繼尋求因應之道以紓解財務危機。美國政府部門以及私人健康保險公司為擺脫傳統論服務量計酬的醫療支付模式所造成的財務負擔， 自2010年起開始嘗試導入價值基礎的健康照護模式（Value-based healthcare）；因能提升醫療照護服務品質並降低醫療支出而逐漸受到世界各國的青睞。本文將簡述價值基礎健康照護的緣起、介紹不同的價值基礎模式、列舉世界各國施行價值基礎健康照護模式的實例，並討論價值基礎健康照護模式可提供台灣醫療與健保體系改革的借鏡之處。
  With the advancement of technology, innovative therapies, and prolonged life expectancy, healthcare expenditures have risen dramatically in recent decades. To improve the quality of healthcare and reduce associated medical expenses, the United States government and private health insurance companies replaced traditional fee-for-services models with value-based healthcare in 2010. Subsequently, value-based healthcare model has gradually become a subject of interest for health care providers around the world. This study described concepts related to value-based healthcare and introduced several successful cases of the implementation of value-based healthcare model worldwide. In addition, this study discussed the implications and provided recommendations for the implementation of value-based healthcare model in the National Health Insurance system in Taiwan.
• 575-589
• 10.6288/TJPH.202212_41(6).111067

• Link 原著 Original Article
• 台灣勞工發生急性心肌梗塞後工作狀態與影響因素探討The employment status and related factors of Taiwanese workers after acute myocardial infarction
• 江宜蓁、王亮懿
  Yi-Chen Chiang, Liang-Yi Wang
• 急性心肌梗塞、勞工、工作維持、工作狀態、重返工作
  acute myocardial infarction, workers, work maintenance, employment status, return to work
• 目標：台灣急性心肌梗塞的發生率攀升與年輕化，可能對勞動市場帶來衝擊，但罹病後對工作變動的長期影響，卻不清楚。本研究透過30-59歲新發急性心肌梗塞的勞工，探討急性心肌梗塞發病後的工作變動與影響因素。方法：採回溯性世代研究，根據2011-2017年全民健康保險資料庫、勞工保險資料庫、死因統計檔及戶籍檔，篩選個案為2013到2014年間首次因急性心肌梗塞住院就醫之30至59歲勞工。觀察存活者於發病後第6、12、24及36個月之工作趨勢， 並探討影響工作的因素與效應。結果：納入本研究的新發急性心肌梗塞勞工個案共2,659人。存活者之工作比例從發病後第六個月的94.1%下降至第36個月的86.4%。雖然整體工作比例表現尚可，但高齡、低薪、多共病者越容易沒有工作，以第36個月無工作的風險為例，50-59歲較30-39歲高2.63倍（95%CI: 1.57-4.41），薪資不滿2萬較6萬以上高2.86倍（95%CI: 1.67-4.92）， 查爾森共病指數（Charlson Comorbidity Index, CCI）3分以上相較無共病者高1.57倍（95%CI: 1.07-2.31）。而性別、都市化程度及教育程度對工作的影響無統計顯著差異。結論：本研究為台灣第一篇探討急性心肌梗塞對工作趨勢影響的研究，除了死亡造成的勞動力損失，應注意高齡、低薪、共病多者較容易在發病後轉變為無工作。未來應進一步了解這些族群在發生急性心肌梗塞後的工作困境，並推動友善罹病者的職場環境。
  Objectives: In Taiwan, the rising incidence of acute myocardial infarction and younger patients with the infarction may have implications for the labor market. However, the long-term effects of the illness on the labor market remain unclear. Therefore, we explored the changes in the employment status and factors influencing the employment of patients with acute myocardial infarction. Methods: This cohort study used data from the National Health Insurance Research Database, Labor Insurance Database, Cause of Death Statistics, and household registration records from 2011 to 2017. Patients aged 30-59 years who were hospitalized for acute myocardial infarction for the first time between 2013 and 2014 were enrolled in this study. We observed the employment rate of the survivors at 6, 12, 24, and 36 months after the onset of the disease and the factors influencing their employment status. Results: We enrolled 2,659 workers with acute myocardial infarction. The proportion of employed survivors decreased from 94.1% at 6 months to 86.4% at 36 months after the onset. The likelihood of not being employed was higher among patients who were older, with lower salary, and with more comorbidities. In terms of the risk of unemployment at 36 months after the onset, patients aged 50–59 years had a 2.63 times higher risk than those aged 30–39 years (95% CI: 1.57–4.41); patients with a salary of less than NT$20,000 had a 2.86 times higher risk than those earning more than NT$60,000 (95% CI: 1.67–4.92); and patients with Charlson Comorbidity Index of more than 3 points had a 1.57 times higher risk than those without comorbidities (95% CI: 1.07–2.31). The difference in the effects of gender, urbanization, and education level on employment did not reach statistical significance. Conclusions: In Taiwan, this study is the first to explore the effects of acute myocardial infarction on the employment status. Patients who are older, with low salary, and multiple comorbidities are more likely to become unemployed after the onset of the disease, in addition to unemployment cause by death. Understanding the difficulties related to employment of such patients with acute myocardial infarction is necessary in promoting a patient-friendly workplace environment.
• 590-599
• 10.6288/TJPH.202212_41(6).111097

• Link 原著 Original Article
• 誤導資訊介入對電子煙態度之影響:台灣吸菸族群之隨機分派實驗Effects of misinformation on smokers’ attitudes toward e-cigarettes: a randomized control trial in Taiwan
• 許子濰
  Zih-Wei Hsu
• 誤導資訊、錯誤資訊、電子煙、吸菸族群、實驗研究
  misleading information, misinformation, e-cigarette, smoker, experimental research
• 目標：鑑於近年網際網路發達且資訊傳播快速，其中也包含誤導資訊之流傳，尤其與健康相關的誤導資訊議題更為重要，其可能對人體產生長期危害。本研究之目的為了解誤導資訊是否會影響吸菸族群對於電子煙之態度。方法：本研究為一隨機分派實驗研究，以網路問卷招募吸菸族群作為參與者，以2015年英國公共衛生局（Public Health England）發布之研究報告中所述「電子煙比香菸安全95%」資訊作為實驗組誤導資訊介入，對照組則提供與電子煙無關之資訊，以網頁的形式呈現內容，以檢測誤導資訊是否會影響台灣吸菸族群對於電子煙之態度， 並估計其影響程度。結果：實驗組於誤導資訊介入後，對於電子煙之態度更正向。吸菸族群對於電子煙的態度與是否使用電子煙、教育程度、自覺經濟狀況、自覺健康狀態等因素有關。結論：誤導資訊會造成吸菸者改變對電子煙態度，建議電子煙政策應積極宣導電子煙正確資訊， 以降低未來民眾因誤導資訊而造成之負面健康結果。
  Objectives: The pace of information dissemination has been increasing rapidly with the advancement of information technology and increased Internet use. Thus, attention should be paid to the dissemination of health-related misinformation to avoid harm. In the present study, we investigated whether misinformation affects smokers’ attitudes toward electronic cigarettes (e-cigarettes). Methods: In this randomized control trial, Taiwanese adult smokers were recruited through online questionnaires. The participants were randomly allocated to experimental and control groups. The experimental group received misinformation from a study web page, which contained information presented in the 2015 Public Health England Report; such information indicated that e-cigarettes are less harmful than tobacco. Results: After the intervention, the experimental group had a more positive attitude toward e-cigarettes than did the control group. Furthermore, e-cigarette use, education level, perceived economic status, and perceived health status were found to be associated with smokers’ attitudes toward e-cigarettes. Conclusions: Misinformation may influence smokers’ attitude towards e-cigarettes. Public health policies should focus on actively promoting accurate information on e-cigarettes to alleviate the negative health effects of misinformation.
• 600-610
• 10.6288/TJPH.202212_41(6).111091

• Link 原著 Original Article
• 比較靜態與動態人口資料應用於新冠肺炎熱區之預測能力Comparing the performance between static and dynamic populations in COVID-19 hotspot prediction
• 周敬棋、林先和、陳正誠、陳潤秋、詹大千
  Ching-Chi Chou, Hsien-Ho Lin, Kevin J. Chen, Ran-Chou Chen, Ta-Chien Chan
• 新冠肺炎、手機信令、人流、預警模式
  COVID-19, mobile phone signal, human mobility, early warning
• 目標：本研究探討運用戶籍人口資料與電信人流資料進行臺北市、新北市新冠肺炎熱區預警的建構，比較其預測準確度與應用上的限制，期提供未來疫情防治參考。方法：研究的時空範圍為2021年5月之雙北市村里，分別使用靜態、動態兩種資料建構人流網絡。前者以重力模型模擬人流，後者以電信數據測量人流變化，透過網絡空間的結構等位特性估計人流足跡相似度，進而計算村里感染風險，並以ROC曲線、羅吉斯迴歸檢驗在不同確診門檻值下的模型表現。結果：在研究區間內，電信人流之平均曲線下面積較高（AUC為0.75，重力模型之AUC為0.69），且傾向預測距離疫情爆發中心較遠的村里，適合用於預測空間上的傳染趨勢。羅吉斯迴歸的結果也顯示，使用電信人流資料所計算的未來一周確診人數是否高於門檻值的平均風險之勝算比為1.45；重力模型之平均勝算比為1.10。結論：在評估地區的感染風險時，除了參考疫情調查與累積病例數外，人流網絡的資訊可以協助辨識潛在的高風險區域並進行及早預警。
  Objectives: This study aimed to set up the prediction model of COVID-19 hotspot areas by using the census data and human mobility from telecommunication data in Taipei and New Taipei City. The comparison between their accuracy and limitations can provide the relevant insights for future epidemic control. Methods: The spatio-temporal resolution is fixed at the village level in two cities in May 2021. The static and dynamic data are used to construct the mobility network. The former applies gravity model to mimic human flow, and the latter uses telecommunication data as the measure of mobility. We propose the footprints similarity by structural equivalence of spatial networks and integrate it with the number of confirmed cases for computing the risk level of the villages. The performance of the models is evaluated using ROC curves and logistic regression under different thresholds for the confirmed cases. Results: The mobility derived from the telecommunication data provided better prediction performance than that from the census data; they have an average AUC of 0.75 and 0.69, respectively. Besides, the telecommunication data had a tendency to identify a further village as high-risk zone compared to the gravity model. According to the results of logistic regression, the odds ratio (OR) of exceeding the cases’ threshold estimated from the telecommunication data is 1.45 on average, while the one estimated from the census data is 1.10. Conclusions: Telecommunication data can be beneficial in identifying the potential high-risk areas and enhancing situational awareness in advance.
• 611-626
• 10.6288/TJPH.202212_41(6).111074

• Link 原著 Original Article
• 新型冠狀病毒(COVID-19)流行初期每日確診人數趨勢型態及相關因子分析-世界各國開放資料研究Trends and factors associated with daily number of new cases of COVID-19 in the early stage of the pandemic: a worldwide open-data study
• 高慈敏、李子奇
  Tzu-Min Kao, Charles Tzu-Chi Lee
• 新型冠狀病毒、每日新增確診人數、趨勢型態、時間序列階層群集分析、多項邏輯斯迴歸
  COVID-19, daily new cases, trend type, time-series hierarchical clustering, multinomial logistic regression
• 目標：本研究探討世界各國COVID-19流行初期第一波疫情之每日新增確診人數趨勢型態及其相關背景因素。方法：本研究納入151個國家為研究對象，研究基準日為首次每日新增確診人數7天移動平均值≥100人，並自研究基準日起，對每一個國家觀察了60及90天。以時間序列階層群集分析（Time-series hierarchical clustering）將研究的國家進行趨勢型態分類，再以多項邏輯斯迴歸（Multinomial logistic regression）探討與此趨勢型態相關的背景因素。結果： COVID-19流行初期每日新增確診人數趨勢型態可歸類為「成長型」、「消退型」及「平緩消退型」三種。肥胖人口比例≥25.60%（勝算比=6.69，p值=0.004）相較於9.60-20.79%的國家更傾向「成長型」疫情趨勢型態。國內生產總值≥34,341美元（勝算比=0.10，p值=0.001）相較於5,277-14,932美元的國家更傾向於「消退型」疫情趨勢型態。結論：COVID-19防疫政策應參考如國家的肥胖人口比例與國內生產總值等特性差異來擬定。
  Objectives: We analyzed global trends in the daily number of new cases during the first wave of COVID-19 and factors associated with these trends. Methods: Data from 151 countries were analyzed. The index date for each country was set with consideration for a 7-day moving average (MA7) of ≥100 people. Data were collected for 60 and 90 days from the index date. Time-series hierarchical clustering was used to analyze the trends in the number of new cases in each country on the basis of their MA7 values. Multinomial logistic regression was performed to identify factors associated with these trends. Results: The trends in the daily number of new cases in the early stage of COVID-19 were classified into growth, declines, and smooth declines. The number of cases in countries with ≥25.60% residents with obesity (odds ratio = 6.69; p = 0.004) was more likely to exhibit growth than were those with obesity of 9.60-20.79%. The number in countries with a GDP of ≥US$34,341 (odds ratio = 0.10; p = 0.001) was more likely to exhibit a decline than were those with a GDP of US$5,277–14,932. Conclusions: COVID-19 epidemic prevention policies should account for country-specific characteristics such as the proportion of residents with obesity and GDP.
• 627-638
• 10.6288/TJPH.202212_41(6).111062

• Link 原著 Original Article
• 台灣成年民眾室內空氣污染健康識能不足者之特性研究Characteristics of Taiwanese adults with inadequate indoor air pollution health literacy
• 黃渝涵、吳嘉玲、黃乙芹、侯文萱、榮建誠、李佩珍、林明彥、李中一
  Yu-Han Huang, Jia-Ling Wu, Yi-Chin Huang, Wen-Hsuan Hou, Chien-Cheng Jung, Pei-Chen Lee, Ming-Yeng Lin, Chung-Yi Li
• 室內空氣污染、健康識能、環境健康識能、決策樹、網路面訪
  indoor air pollution, health literacy, environmental health literacy, decision tree, internet face-to-face interview
• 目標：本研究旨在利用經信效度確認之「室內空氣污染健康識能量表」來界定出我國成年民眾中室內空氣污染健康識能不足者族群之特性。方法：本研究屬於橫斷性研究，利用網路面訪方式，針對我國20歲以上之民眾進行訪談。樣本按台灣2020年4月成年人口地區、性別、與年齡分佈進行加權計算後，以決策樹模型歸類出屬於室內空氣污染健康識能不足（分數低於中位數者）的族群特性。結果：共蒐集647份問卷，加權樣本數為616人。決策樹模型分析結果指出，我國民眾室內空氣污染健康識能不足比例較高（158/234=67.5%）且人數占比較高的族群（36%）之族群特性為：自己或同住者的工作不會接觸室內空污資訊，且從事特定工作者。結論：本研究發現從事工作別以及民眾與其同住者的工作是否會接觸室內空污資訊為影響民眾室內空氣污染健康識能程度的重要因子，針對特定行業的工作族群開發適性衛教教材，並進行介入是台灣未來提升成年族群室內空氣污染健康識能可以考慮採行的作法。
  Objectives: We used the Indoor Air Pollution Health Literacy (IAPHL) model to determine the characteristics of Taiwanese adults with inadequate health literacy regarding indoor pollution. Methods: This cross-sectional study collected data on the characteristics of Taiwanese participants aged ≥20 years through online questionnaires based on the IAPHL model. The responses were analyzed and categorized by region, gender, and age group of the interviewees as of April 2020. The characteristics of the participants with inadequate IAPHL (i.e., less than the median score) were described by using decision tree. Results: In total, 616 out of 647 questionnaires were included in the analysis after weighting. The decision tree model revealed that 67.5% (158/234) of Taiwanese citizens had inadequate IAPHL. Furthermore, 36% of the participants lacked information on indoor air pollution at their workplace or home. Conclusions: This study found occupation type and a lack of knowledge regarding indoor air pollution at the workplace are key predictors of inadequate IAPHL. These findings suggest that IAPHL can be better improved through the use of occupation specific educational materials for adults in Taiwan.
• 639-650
• 10.6288/TJPH.202212_41(6).111096

• Link 原著 Original Article
• 縣市層級含糖飲料社會規範與青少年含糖飲料攝取習慣關係之多階層研究Association between the social norm toward sugar sweetened beverages at the county level and the consumption of sugar sweetened beverages among adolescents: a multilevel analysis
• 林峻吉、邱弘毅、張齡尹
  Chun-Ji Lin, Hung-Yi Chiou, Ling-Yin Chang
• 青少年、含糖飲料、多層次分析、社會規範
  adolescent, sugar-sweetened beverages, multilevel, social norms
• 目標：利用多層次模式探討縣市層級含糖飲料攝取之社會規範與青少年含糖飲料攝取習慣的關係，並進一步分析不同年齡層社會規範之交互作用的影響。方法：資料來源為「2013– 2016年國民營養健康狀況變遷調查」，研究對象為15歲以上未滿18歲之青少年，共計879位（每縣市大約有40位青少年）。統計分析採用多層次邏輯斯迴歸模型，以估計縣市層級不同年齡世代社會規範與青少年含糖飲料攝取習慣之關係。結果：青少年族群對於含糖飲料的社會規範越正向，該縣市之青少年有攝取含糖飲料習慣的風險越高（aOR=1.75；95%CI: 1.17– 2.61），且該相關性進一步受到同縣市年輕成年族群含糖飲料社會規範的調節（aOR=1.49； 95%CI: 1.17–1.90）。結論：青少年含糖飲料攝取習慣與其居住縣市同年齡層對含糖飲料社會規範有顯著關係，並且該效應會受到該縣市內年輕成年族群社會規範所調節。建議未來針對青少年含糖飲料相關政策推行時，除了考慮青少年族群的整體社會規範外，可同時改變年輕成年族群對含糖飲料的社會規範，以強化其推廣效益。
  Objectives: Multilevel analysis was used to explore the association between county-level social norm toward sugar-sweetened beverages (SSBs) and the consumption of SSBs among adolescents. Methods: This study used data from the Nutrition and Health Survey in Taiwan between 2013 and 2016. Data on 879 adolescents were included in the analysis. Personal attitudes toward SSBs for different age groups were aggregated at the county level as the social norm, respectively. Results: A multilevel logistic regression analysis revealed that the likelihood of SSBs consumption among adolescents increased as the social norm toward SSBs in the county improved (adjusted odds ratio [aOR] = 1.58, 95% confidence interval [CI] = 1.11-2.26). In addition, the social norm of young adults (18-24 years) toward SSB living in the same residential areas significantly moderated the association between the county-level social norm of adolescents toward SSBs and the consumption of SSBs among adolescents (aOR = 1.41, 95% CI = 1.10- 1.80). Conclusions: The prevention of overconsumption of SSBs among adolescents may be more effective when the social norm toward SSBs at the county level are considered.
• 651-665
• 10.6288/TJPH.202212_41(6).111056

• Link 實務 Public Health Practice
• 新型冠狀肺炎疫情下健保重大政策及滿意度之探討Major National Health Insurance policies in Taiwan and residents’ satisfaction with them during the COVID-19 pandemic
• 謝京辰、莊欣怡、吳宜蓁、王宗曦、李伯璋
  Ching-Chen hsieh, hsin-i Chuang, Yi-Chen Wu, Joyce Tsung-hsi Wang, Po-Chang Lee
• 全民健康保險、滿意度調查、新型冠狀肺炎疫情
  National Health Insurance, satisfaction survey, Coronavirus disease 2019
• 目標：探討疫情下民眾對健保重大政策之認知度、支持度、使用率和滿意度，以供衛生單位相關政策決策之參考。方法：以中央健康保險署「110年運用資料治理建置健保政策應用及監測模式」之問卷調查所收集之資訊，調查對象為台閩地區年滿18歲民眾。內容涵蓋健保滿意度、健保雲端查詢系統、健康存摺、分級醫療、保費緩繳、視訊診療、虛擬健保卡等議題。結果：年度民調有效樣本3,266份，主題式民調有效樣本2,226份，對健保及院所的滿意度達九成以上。86.3%民眾滿意旅遊史、職業別、接觸史及群聚史(TOCC)查詢提示機制，38.4%受訪者知道健康存摺可查詢就醫資料、86.4%使用者滿意使用經驗，88.8%民眾有參與分級醫療意願、33.5%民眾受疫情影響就醫意願，86.2%民眾贊成保費緩繳政策，七成民眾支持推動視訊診療服務及虛擬健保卡政策。結論：民眾對健保重大政策之態度似乎無受疫情影響，且有正向上升的趨勢，亦對健保推出之各項因應疫情的政策表示肯定態度。未來若能持續以科技協助防疫，將使全民面對嚴峻疫情挑戰時，能有最即時的支援工具。
  Objectives: In this study, we explored major National Health Insurance (NHI) policies in Taiwan and residents’ awareness about, support for, utilization rate of, and satisfaction with them during the COVID-19 pandemic to create a reference for health-care policymakers. Methods: We analyzed data collected through a survey conducted among the residents (age ≥18 years) of Taiwan using the 2021 NHI satisfaction questionnaire. The questionnaire comprised questions on NHI satisfaction, NHI MediCloud system, My Health Bank, referral system, premium payment deferral or installment, telemedicine, virtual NHI cards, and other topics. Results: A total of 3,266 and 2,226 valid samples were obtained through annual and thematic polls, respectively. The rate of satisfaction with NHI and medical institutions was >90%. Of the respondents, 86.3% were satisfied with the travel history, occupation, contact history, and cluster query reminder system; 38.4% were aware that My Health Bank can be used to seek medical information; >86.4% were satisfied with their experience; 88.8% were willing to participate in the referral system; 33.5% did not seek medical care due to the pandemic; 86.2% supported the policy related to deferred payment of premiums; and 70% supported telemedicine promotion and virtual NHI card policies. Conclusions: The COVID-19 pandemic appears to have had no negative effects on the general public’s attitude toward major NHI policies, which showed an upward trend. In the future, technology may be used to facilitate epidemic prevention and provide immediate support to individuals during severe epidemics.
• 666-677
• 10.6288/TJPH.202212_41(6).111069