42卷2期

• Link 政策論壇 Policy Forum
• 台灣青少年自殺率上升的相關因素：對預防策略的啟發Factors associated with the rise in adolescent suicide rates in Taiwan: implications for prevention strategies
• 張奕涵、張書森
  Yi-Han Chang, Shu-Sen Chang
• 無none
  無none
• 無none
  無none
• 131-136
• 10.6288/TJPH.202304_42(2).PF02

• Link 公衛今與昔 Public Health Now and Then
• 鐵肺與鐵鞋：從國際扶輪社的參與談全球根除小兒麻痺運動Iron lung and iron leg: the global polio eradication initiative and the role of Rotary International
• 曾稔育、曾育慧
  Ren-Yu Zeng, Yu-Hwei Tseng
• 無none
  無none
• 無none
  無none
• 137-143
• 10.6288/TJPH.202304_42(2).111119

• Link 公衛論壇 Public Health Forum
• 《優生保健法》修法之迫切性：從身心障礙者權利觀點論之The urgent of amending the Genetic Health Law in Taiwan: from the perspective of rights of persons with disabilities
• 蘇崇閔
  Chong-Min Su
• 優生保健法、身心障礙、生育權、《身心障礙者權利公約》
  Genetic Health Law, disability, reproductive rights, Convention on the Rights of Persons with Disabilities
• 19世紀生物醫學的蓬勃發展與社會達爾文主義的風行，衍生發展出優生學領域，障礙者被認為對人類發展存在威脅性並應予以淘汰。台灣於20世紀中後葉出現優生主義政策化的討論，並在1984年通過《優生保健法》。2003年首次有立法委員在質詢時提出「優生」一詞蘊含歧視的質疑，開啟該法對障礙者汙名、歧視與權利侵害的檢討，然而直至今日仍未順利完成修法。生育權作為基本人權，且我國也已將《身心障礙者權利公約》與多項國際公約國內法化，更應當積極消除現行制度對障礙者權利之歧視與排除。現行《優保法》修法勢在必行，以落實社會正義及人權立國之精神與願景。
  In the 19th century, the vigorous development of biomedicine and the popularity of social Darwinism led to the development of the field of eugenics, and people with disabilities were considered to be a threat to human development and should be eliminated. In Taiwan, discussions on the policy legitimation of eugenics emerged in the middle and late 20th century, and the Genetic Health Law was enacted in 1984. In 2003, for the first time, a legislator questioned that the term "eugenics" contained discrimination, which has invited a reflection of the law on the stigma, discrimination, and rights invasions of people with disabilities. However, the revision of the law has not been completed until today. Reproductive right is a basic human right, and Taiwan has legalized the Convention on the Rights of Persons with Disabilities and several international conventions. We should actively eliminate the discrimination and exclusion of the rights of people with disabilities in society. It is imperative to amend the Genetic Health Law to implement the spirit and vision of social justice and human rights to build a country.
• 144-147
• 10.6288/TJPH.202304_42(2).111110

• Link 公衛論壇 Public Health Forum
• 人潮流動資料於傳染病防治決策之應用：以新冠肺炎為例The use of human mobility data on infectious disease control: COVID-19 as an example
• 傅 涵、詹大千、伍倢瑩、溫在弘、藍之辰、周玫芳、林征發、李維森、陳為堅、劉宇倫、鄭皓元、林柏丞、郭飛鷹、林雨宣、蔡懿晨、張 寧、林先和、張筱涵
  Han Fu, Ta-Chien Chan, Chieh-Yin Wu, Tzai-Hung Wen, Chih-Chan Lan, Mei-Fang Chou, Chen-Fatt Lim, Wei-Sen Lee, Wei-Jen Chen, Yu-Lun Liu, Hao-Yuan Cheng, Bo-Cheng Lin, Fei-Ying Kuo, Yu-Xuan Lin, Yi-Chen Tsai, Ning Chang, Hsien-Ho Lin, Hsiao-Han Chang
• 人潮流動資料、傳染病防治、新冠肺炎、大數據
  human mobility data, infectious disease control, COVID-19, big data
• 人潮流動資料被應用於評估人流管制措施的有效性與建立防疫分區等新冠肺炎疫情的防疫決策。本次應用經驗也暴露出人流資料應用於傳染病研究與實務所面臨的共同挑戰，如：缺少公開資料與使用規範、尚無實證資料佐證人流與疫情研究結果、以及缺少資料提供及開發端、研究端與應用端之三方交流連結。建議未來可發展國內主要電信公司提供、國家災防中心處理維護、政府與研究單位向災防中心申請使用的三方合作模式；建立完整資料平台與強化即時溝通與合作管道。
  Human mobility data are used to evaluate the effectiveness of crowd control measures and delineate geographical zones and other epidemic prevention decisions for the COVID-19 epidemic. This application experience also revealed the challenges faced by the application of human mobility data in infectious disease research and practice. For example, there is no available public data and its usage regulations and empirical data to support the research results of the relationship between human movement and epidemic. Moreover, the three parties - data provider, researcher, and practical worker - have no approach to communicating with each other. It is suggested that in the future, a tripartite collaboration mode can be developed in which major domestic telecommunications companies provide, the National Disaster Prevention Center handles and maintains, and the government and research institutions apply to the National Disaster Prevention Center for use; establish a complete data platform and strengthen instant communication and cooperation channels.
• 148-152
• 10.6288/TJPH.202304_42(2).112010

• Link 綜論 Review Article
• 新冠肺炎疫苗險保單承保範圍與可能糾紛The scope of COVID-19 vaccine insurance coverage and possible disputes
• 何建志、廖昱翔
  Jen-Ji Ho, Yu-Xiang Liao
• 新冠肺炎、疫苗險、不良事件、不良反應、因果關係
  COVID-19, vaccine insurance, adverse events following immunization, adverse reaction, causality
• 為控制新冠肺炎（COVID-19）疫情，2021年起世界各國與台灣大規模接種新冠肺炎疫苗。在台灣，新冠肺炎疫苗接種者如發生副作用傷害，可向政府申請預防接種受害救濟。因申請政府救濟金必須適用嚴格法定條件，加上程序複雜漫長且補償金額有限，接種者可另外藉由購買商業保險分攤、轉嫁接種疫苗風險。由於新冠肺炎疫苗是全新疫苗，各國醫師對疫苗副作用臨床經驗不多，而實證醫學證據也仍在發展當中，目前政府與保險公司所認定的新冠肺炎疫苗嚴重副作用相當有限。因此某些被保險人或受益人可能不易證明傷害與疫苗因果關係。本文分析台灣各家保險公司疫苗險保單承保範圍及除外不保項目，討論新冠肺炎疫苗受害人、保險受益人行使保險請求權之條件、實際困難與可能法律糾紛。最後，本文提出預防、處理疫苗險理賠法律糾紛建議方案：一、保險公司應詳細說明承保範圍，保單內容應解釋預防接種「不良事件」與「不良反應」差異。；二、政府宜積極主動更新補充新冠肺炎疫苗副作用資訊；三、法院可根據公平原則解釋疫苗險保單條款及調整舉證責任。
  In response to the COVID-19 pandemic, many countries have implemented large-scale vaccination programs. In Taiwan, COVID-19 vaccine insurance is available. However, as the COVID-19 vaccine is a new vaccine, there is limited research assessing its safety, and many physicians are not fully informed about its potential risks. Additionally, there is limited recognition of the risks associated with the COVID-19 vaccine by the government and insurance companies, making it difficult for individuals to prove that an injury is a result of the vaccine. This study examined legal elements, insurance coverage, and potential disputes related to COVID-19 vaccine insurance in Taiwan. This study proposed three ways to resolve vaccine insurance disputes: 1. Insurance companies should clarify the scope of insurance policies and the difference between adverse events following vaccination and adverse reactions. 2. The government should proactively update and supplement the information available on the adverse effects of COVID-19 vaccines. 3. The courts should reduce the burden of proof for individuals with vaccine injuries by interpreting insurance contracts and evidence law.
• 153-164
• 10.6288/TJPH.202304_42(2).111070

• Link 綜論 Review Article
• 推動消除C肝政策之回顧Implementation of hepatitis C policies in Taiwan
• 楊雯雯、劉嘉玲、吳慧敏、鄭國本、盧勝男、簡榮南、蒲若芳
  Wen-Wen Yang, Chia-Ling Liu, Grace Hui-Min Wu, Kuo-Pen Cheng, Sheng-Nan Lu, Rong-Nan Chien, Raoh-Fang Pwu
• 慢性C型肝炎、國家消除C肝政策綱領、國家消除C肝辦公室、消除C肝、篩檢
  chronic hepatitis C (HCV), Taiwan Hepatitis C Policy Guideline, Taiwan National Hepatitis C Program Office (TWNHCP), elimination of hepatitis C, screening
• 為滿足我國C肝防治需求及呼應世界衛生組織消除C肝的目標，衛生福利部於2016年12月成立「國家C型肝炎旗艦計畫辦公室」，並於2019年12月更名為「國家消除C肝辦公室」，以展現政府決心及消除C肝之承諾。為能更有效地溝通及協調相關政策，辦公室蒐集全國的C肝流行病學概況及臨床特徵等實證資料，並在肝病、流病、經濟專家、公衛官員及署司首長的指導下，在2019年5月公布「國家消除C肝政策綱領2018-2025」。綱領設立2025年消除C肝之願景，錨定三大核心策略、三大政策方向及八大行動方針，讓各界理解政府的施政目標及方向，以利各界辦理消除C肝活動時能有依循。本文旨在彙整這幾年來中央與地方政府結合民間資源，在公私協力下的作為與進展，包括確保充足的預算；降低C肝防治障礙，提高服務可近性，落實防治一條龍；落實精準篩檢及診治策略；推動高風險族群C肝防治；加強C肝識能； 政策成效評估；鼓勵研究發展與引進有效之篩檢診斷工具等面向。
  The Taiwan National Hepatitis C Program Office has been established since December 2016 by the Ministry of Health and Welfare of Taiwan, to respond to the society’s calling for a national policy on hepatitis C control, as well as being the first step toward the WHO’s goal set on 2015. Aimed to more effective on communicating and coordinating related policies, the Office gathered information about epidemiological profile and clinical characteristics of hepatitis C nationwide and, with the advice and guidance provided by experts from hepatologists, epidemiologists, economists, public health officers, and government leaders, the “Taiwan Hepatitis C Policy Guideline 2018-2025” was formulated and announced in May 2019. The Guideline set up a goal of hepatitis C elimination by 2025 and highlighted three policy directions, three core strategies, eight action plans that could be implemented by relevant stakeholders at all levels of governments and across public and private sectors. This article aims to summarize the activities which have been implemented as of to date - from the central and local governments, or public and private sectors. These activities include securing adequate budget; lowering barriers of access to care; maintaining continuum of care to leave no one behind; implementing precision screening and diagnosis and treatment strategies; promoting the interventions and strategies among high-risk groups; raising the public awareness on HCV screening and treatment; evaluating outcomes of policy and interventions; encouraging R&D and the introduction of HCV screening and in vitro diagnostic kits products as well.
• 165-179
• 10.6288/TJPH.202304_42(2).112006

• Link 綜論 Review Article
• 我國緊急醫療救護資訊智能平臺的回顧與前瞻Review and outlook of an intelligent information platform for emergency medical services in Taiwan
• 莊秀文、劉越萍、林珮芸
  Sheuwen Chuang, Yueh-Ping Liu, Pei-Yun Lin
• 緊急醫療救護、智能平臺、韌性災防、韌性醫療
  emergency medical services, intelligent platform, resilient disaster management, resilient health care
• 天災人禍事件頻傳以及巨災常態化，再加上隨社會人口老化所帶來的平時急重症病人增加，造成平時與災時持續且大量隨機的傷病患需求增加，已是當前國際社會緊急醫療救護服務（EMS）面對的重要挑戰。緊急醫療服務體系發展受到國際上兩大趨勢的影響，一是韌性災防與韌性醫療的倡議，另一是EMS資訊整合的推動。衛生福利部於2021年正式推動優化與整合緊急醫療資訊智能平臺計畫，然而國內缺少相關EMS資訊系統發展的文獻，本文的目的是依據國際上緊急醫療救護體系與EMS資訊系統的發展趨勢，綜合概述我國緊急醫療救護資訊智能平臺之發展現況與前瞻，做為公共衛生維護與緊急醫療救護資訊系統發展之參考。
  Taiwan’s health-care resources are strained by the prevalence of natural and man-made disasters and an aging population in the country. This is a key challenge that emergency medical services (EMSs) facilities in Taiwan are facing. Thus, Taiwan’s Ministry of Health and Welfare officially released a refinement plan in 2021 to improve the existing platform for sharing emergency medical information. EMS information systems have been developed as part of two trends globally. The first is a focus on resilience in disaster prevention and health-care provision, and the second is a focus on EMS information integration. However, literature on the development of EMS information systems in Taiwan is lacking. Therefore, this paper introduces the development status and functions of EMS intelligent information platform in use in Taiwan.
• 180-188
• 10.6288/TJPH.202304_42(2).112009

• Link 原著 Original Article
• 失智症態度量表中文版之發展與信效度驗證Development and psychometric validation of the Dementia Attitude Scale - Chinese Version
• 吳奕廷、劉懿萱、洪素蘋、王靜枝、古鯉榕
  Yi-Ting Wu, Yi-Hsuan Liu, Su-Pin Hung, Jing-Jy Wang, Li-Jung Elizabeth Ku
• 失智症、態度、量表發展
  dementia, attitude, scale development
• 目標：本研究旨在發展失智症態度的中文版量表（Dementia Attitude Scale -Chinese Version, DAS-C），以測量一般大眾對失智症的態度並驗證其心理測量特性。方法：參考Beaton等人的跨文化翻譯指引，翻譯成中文版量表，原始量表有20題，採用7分李克特計分，得分越高表示態度越正向。量表收案對象包括參與失智友善課程的大學生和兩家金融機構的臨櫃人員，並於課前進行問卷調查。內容效度由相關領域專家進行評估，並採取項目分析評估量表題目，使用主軸因素法進行探索性因素分析，建立量表整體的效度，信度測試使用Cronbach’s alpha值。結果：5位專家對翻譯後的DAS-C量表內容進行評估，S-CVI值為0.94-1.00達到標準。共236人納入樣本，經項目分析刪減合計3項或以上指標未達標準的題目後共17題；透過主軸因素法萃取三個因素，分別為認知、情感和行為。DAS-C整體信度為0.83。結論：DAS-C具有良好的信效度，可以有效測量一般大眾對失智症的態度，未來研究建議擴大收案對象，以進一步驗證此量表在台的適用性。
  Objectives: This study developed the Chinese version of the Dementia Attitude Scale (DAS), which measures attitudes about dementia, and its psychometric properties were tested on individuals from the general population. Methods: This study developed the DAS-Chinese version (DAS-C) following Beaton’s cross-cultural translation guidelines. The original DAS has 20 items rated on a 7-point Likert scale, with higher scores indicating more positive attitudes. We recruited college students and frontline staff from two banks in Taiwan, who completed the questionnaire before attending dementia-friendly lectures. The content validity of DAS-C was established by an expert panel by using the scale-level content validity index (S-CVI), and item analysis was performed for each item. Exploratory factor analysis was performed through principal axis analysis (PAF) to establish the construct validity of the scale, and reliability was measured using Cronbach’s α. Results: The content of the DAS-C was verified by five experts, and the S-CVI value of 0.94-1.00 was satisfactory. A total of 236 completed questionnaires were included in the analysis. After removal of the items that failed to meet three or more criteria based on item analysis results, the DAS-C contained 17 items. PAF revealed a three-factor structure: cognitive, affective, and behavioral factors. The revised DAS showed acceptable internal consistency overall (Cronbach’s α = 0.83). Conclusions: The 17-item DAS-C has good validity and reliability and can effectively measure the general public’s attitudes toward individuals with dementia. Future studies with larger sample sizes and individuals with different characteristics are warranted to further validate the use of the DAS-C in Taiwan.
• 189-201
• 10.6288/TJPH.202304_42(2).111106

• Link 原著 Original Article
• 精神護理之家住民生活品質與幸福感Quality of life and well-being among residents of psychiatric nursing homes
• 洪宜惠、王美嬅
  I-Hui Hung, Mei-Hua Wang
• 精神護理之家、住民、生活品質、幸福感
  psychiatric nursing home, residents, quality of life, well-being
• 目標：慢性精神病患常因功能缺失及生活適應問題而影響其生活品質與幸福感，他們需要親人、機構或社區資源來幫忙照顧，本研究旨在探討精神護理之家住民生活品質與幸福感的關係。方法：採橫斷式問卷調查法。以高屏地區五所精神護理之家住民為研究對象，研究工具包括：個人基本資料、生活品質量表及幸福感量表三部分，完成訪談之有效問卷共150份。結果：精神護理之家住民生活品質的整體總分介於53至122分（M ± SD = 89.41 ± 15.87）。幸福感的整體總分介於0至46分（M ± SD = 23.66 ± 10.16）。幸福感的重要影響因素為整體生活品質與宗教信仰。結論：本研究結果可提供國內精神病患長照機構之工作人員做為未來提升住民生活品質與幸福感介入之參考。
  Objectives: Quality of life and well-being among patients with chronic mental illness are affected by deficits in functional abilities and difficulties with adjusting to everyday life. Patients benefit from support provided by relatives, institutions, and communal resources. This study explored quality of life and well-being among residents of psychiatric nursing homes. Methods: This cross-sectional study administered a questionnaire to residents of five psychiatric nursing homes in Kaohsiung city and the Pingtung area. Results from 150 valid questionnaires with three parts (personal information, quality of life scale, and well-being scale) were analyzed. Results: Mean overall quality of life scores were 89.41 ± 15.87 (range 53-122). Mean overall scores were 23.66 ± 10.16 (range 0-46). Well-being was influenced by overall quality of life and religious beliefs. Conclusions: The findings of this study can be used by the staff of long-term care institutions for patients with mental illness to help guide interventions and improve quality of life and well-being among residents.
• 202-213
• 10.6288/TJPH.202304_42(2).111066

• Link 原著 Original Article
• 復能服務規範調整對接受長期照顧十年計畫2.0對象使用服務的影響因素分析-基於安德森健康服務利用行為模式的實證研究Factors influencing service utilization of reablement services after specification adjustments of the 10-Year Long-Term Care Plan 2.0 in Taiwan: Andersen’s Behavioral Model of Health Services Use
• 吳銘堂、廖宏恩
  Ming-Tang Wu, Hung-En Liao
• 長期照顧2.0、居家復能、專業服務
  long-term care 2.0, home reablement, professional services
• 目標：本研究旨在探討衛福部於2020年前、後居家復能服務作業規範改變，服務使用者對服務與政策滿意度的影響。方法：本研究採橫斷面調查研究設計，援引Andersen健康服務利用行為模式為架構，設計具信效度結構式問卷，資料來源為現居台中市並於2018年1月起曾使用過居家復能者。結果：受訪者對服務滿意度為94.1%；另外相對於低度需求者，對照顧問題清單具中度需求者服務滿意度較低（OR = 0.317）。2020年前、後均接受過服務者（n = 177）， 對2020年前與後的政策滿意度分別為96.0%及50.3%。雖然以目標導向的補助次數是影響政策滿意度的共通決定因子，但服務手冊指引內容改變與部分服務組合評量適用性，可能是導致服務使用者滿意度差異的根本原因。復能服務規範調整對復能計畫執行的影響因素，並沒有明顯差異。結論：2020年根據長照復能服務操作指引相關規定執行後，政策滿意度明顯下滑。宜建立多面向照顧思維，不應以單一標準衡量所有專業服務組合，並藉由評值使服務期程與次數動態性合理化，讓不同失能程度者均能獲得符合所需的專業服務。
  Objectives: This study explored changes in the operating norms of home reablement services implemented by the Ministry of Health and Welfare before and after 2020 and their effects on service users’ satisfaction levels. Methods: This study adopted a cross-sectional survey design with Andersen’s Behavioral Model of Health Services Use as the framework. A structured questionnaire was designed and distributed to individuals in Taichung who had used home reablement services since January 2018. Results: The respondents’ level of satisfaction with the services was 94.1%, and those with moderate needs on the list of care problems were less satisfied than those with low needs (OR = 0.317). Those who had received services before and after 2020 (n = 177) had satisfaction levels of 96.0% and 50.3% with the policy before and after 2020, respectively. Although goal-oriented satisfaction with a subsidy program is often employed as a determinant of policy satisfaction, changes in service manual guidelines and the applicability of some service package measures may be the underlying causes of differences in service user satisfaction. The reablement service specification adjustments did not significantly affect the implementation of the reablement plan. Conclusions: After implementing changes in the operational guidelines for long-term care reablement services in 2020, users’ satisfaction level with services declined significantly. Policymakers are advised to adopt a multidimensional approach to patient care and to not measure all professional service combinations by a single standard. Furthermore, policymakers should implement evaluations to assess the effectiveness of various combinations of service duration and frequency to ensure that service users with varying degrees of disability receive professional services that meet their needs.
• 214-232
• 10.6288/TJPH.202304_42(2).111124

• Link 原著 Original Article
• 北台灣某大學學生接受心理健康促進與自殺防治守門人課程之效益研究Effectiveness of mental health and suicide prevention course in northern Taiwan
• 吳欣庭、吳佳儀、李明濱、路馥銘、侯庭凱、汪聖偉
  Hsin-Ting Wu, Chia-Yi Wu, Ming-Been Lee, Fu-Ming Lu, Ting-Kai Ho, Sheng-Wei Wang
• 大學生、心理健康、自殺防治、守門人訓練、縱貫性研究
  college students, mental health, suicide prevention, gatekeeper training, longitudinal study
• 目標：本研究欲調查北部某校大學生參與16週自殺防治守門人課程後之(1)學期中心理困擾及自殺風險程度變化；以及(2)自殺防治守門人知能改變及其他成效。方法：受試者為通識課程修課學生，該課程主要教授心理健康促進與自殺防治守門人知能，學期中以線上問卷進行資料收集，包括人口學資料與心理社會評估、自殺認知量表、復原力及興盛感評估、學習與生活自評量表等，以成對樣本T檢定進行分析。結果：於159位受試者中，近三成個案整體自殺風險偏高，學生於自殺認知、復原力因應、興盛感及生活自評量表皆有顯著成效；而在近一週自殺意念變項顯著下降，其餘如心理困擾程度、學習困擾自評兩者未有顯著影響。結論：本研究發現16週的自殺防治守門人教育課程可顯著改善受試者的自殺認知、復原力、興盛感、生活自評與近一週自殺意念的表現，且對於心理困擾評估之五個面向無影響，研究結果可提供國內大學設計心理健康促進與自殺防治守門人訓練時之參考。
  Objectives: This study investigated 1) changes in mental distress and suicide risk levels among participants of a 16-week suicide prevention course and 2) the effectiveness of the suicide prevention course. Methods: A total of 159 undergraduate students enrolled in a mental health promotion and suicide prevention course in northern Taiwan were enrolled. Online questionnaires were used to collect data on participant demographics and psychosocial status. The questionnaire was based on a suicide perception scale, a sense of resilience scale, a sense of thriving scale, and self-rated academic and life situation scales. A paired sample t-test was conducted. Results: Among the 159 participants, 30.2% were at high risk of suicide. The course had significant effects on suicide perception, resilience and coping, sense of thriving, and self-rated life situation. Additionally, suicidal ideation distress significantly decreased after the program. However, no significant changes in mental distress levels or self-rated academic scores were observed. Conclusions: The 16-week suicide prevention course led to improvements in knowledge, sense of resilience, sense of thriving, lifestyle adjustments, and suicidal ideation. No effects on the five variables of the mental distress assessment were observed. These findings aid universities in Taiwan in designing mental health and suicide prevention courses.
• 233-250
• 10.6288/TJPH.202304_42(2).111116