42卷3期

• Link 其他 Others
• 紀念陳拱北博士：串起過去與未來的母校慶應義塾大學醫學部（第五屆陳拱北教授公共衛生紀念講座）In memory of Dr. Kung-Pei Chen: linking the past to the future of his alma mater, Keio University School of Medicine
• 天谷雅行
  Masayuki Amagai
• 陳拱北、慶應義塾大學、公共衛生、陳拱北教授公共衛生紀念講座
  Kung-Pei Chen, Keio University, public health, KP Chen Memorial Lecture in Public Health
• 陳拱北教授（1917-1978）被譽為偉大的公共衛生導師和台灣公共衛生之父。由於陳拱北教授對台灣公共衛生的貢獻，他的熱情和奉獻精神得到了廣泛的迴響，為年輕一代提供了精神上和財務上的充分支持，對台灣公共衛生事業日漸開展,有重大的影響。自他去世至今的40多年中，陳教授的許多優秀學生都跟隨他的步伐,以同樣的熱情，努力推進台灣的公共衛生發展。由於陳教授的貢獻，台灣已展現出全球最好的公共衛生政策實踐經驗，這些努力為人民帶來了富庶和幸福，該國成功地管理COVID-19疫情全球爆發就是一個很好的近例。 我們可以回顧陳教授的青年時代來了解這位偉人的成長。他在日本待了很長時間，並於1942 年畢業於慶應義塾大學醫學部。慶應義塾大學由福澤諭吉先生於1858年創建，是日本第一所現代高等教育機構。 在經歷了江戶時代200多年的鎖國政策之後，慶應義塾大學的歷史與日本近代相互映照。慶應義塾大學醫學院成立於1917年，首任院長是北里柴三郎。其創立理念是「防止醫學中的部門主義,加強基礎醫學和臨床醫學之間的連結」。該校的另一個重要精神是強調文武雙全。 在本次講座中，我將概述陳教授在慶應義塾大學度過的時光，以及慶應義塾大學如何憑藉著陳教授也十分推崇的哲學教育理念發展至今，期盼這次演講能夠展示台灣和日本之間的牢固聯繫。
  Prof. Kung-Pei Chen (1917–1978) has been praised as a great public health mentor and the father of public health in Taiwan. His enthusiasm and dedication to the progress of public health in Taiwan are extensively recognized and provide an important spiritual and physical foundation that influences younger generations. Countless outstanding students of Prof. Chen have followed his footsteps with the same degree of enthusiasm and passion, striving to advance public health in Taiwan over the 40 years since his death. Thanks to the contribution of Prof. Chen, Taiwan has some of the best public health policies in the world, which bring prosperity and happiness to its people. The country’s successful management of COVID-19 is one example. To understand how such a great person was brought up, it is essential to look at his youth. He spent much time in Japan and graduated from Keio University School of Medicine in 1942. Yukichi Fukuzawa founded Keio University in 1858 as Japan’s first modern institute of higher education. After more than 200 years of national isolation in the Edo Period, the history of Keio University parallels Japan’s modern era. Keio University School of Medicine was founded in 1917 with Shibasaburo Kitasato as the first Dean. Its founding philosophy was to “prevent sectionalism in medicine and strengthen the connection between basic science and clinical medicine as one family.” Another essential characteristic of the school is its focus on both the literary and martial arts. In this lecture, I outline how Prof. Chen spent his time at Keio University and how Keio University has evolved to its present status with the philosophy Prof. Chen admired. I hope this lecture will demonstrate the strong bond between Taiwan and Japan.
• 251-260
• 10.6288/TJPH.202306_42(3).AL202301

• Link 政策論壇 Policy Forum
• 台灣失智症的醫療照護The health care for dementia in Taiwan
• 黃立楷、胡朝榮
  Li-Kai Huang, Chaur-Jong Hu
• 無none
  無none
• 無none
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• 261-263
• 10.6288/TJPH.202306_42(3).PF03

• Link 公衛今與昔 Public Health Now and Then
• 台灣應用流行病學訓練班的成立與貢獻The establishment and contribution of Field Epidemiology Training Program in Taiwan
• 葉宏明、陳國東
  Horng-Ming Yeh, Kow-Tong Chen
• 無none
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• 無none
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• 264-270
• 10.6288/TJPH.202306_42(3).112035

• Link 公衛論壇 Public Health Forum
• 第二次《兒童權利公約》國際審查對台灣兒少公共衛生政策之啟示The implications of the second review on the implementation of children’s rights to national policies on child public health in Taiwan
• 張弘潔
  Hung-Chieh Chang
• 無none
  無none
• 無none
  無none
• 271-274
• 10.6288/TJPH.202306_42(3).111112

• Link 公衛論壇 Public Health Forum
• 衛生所在新冠疫情期間偵測兒虐高風險的經驗分享Experiences in detecting maltreatment high risk children in public health center during the COVID-19 pandemic
• 黃姿飴、呂建德
  Tzu-Yi Huang, Jen-Der Lue
• 無none
  無none
• 無none
  無none
• 275-280
• 10.6288/TJPH.202306_42(3).112012

• Link 原著 Original Article
• 台灣兒少空氣污染治理之系統性政策回顧：兒童權利公約之觀點Systematic policy review of air pollution governance for children in Taiwan: perspective from the United Nations Convention on the Rights of the Child
• 張弘潔
  Hung-Chieh Chang
• 兒童權利公約、空氣污染、系統性政策回顧、兒童健康、脆弱性
  UNCRC, air pollution, systematic policy review, child health, vulnerability
• 目標：過去研究顯示，相較於成人，兒童對空氣污染之脆弱性較高。《兒童權利公約施行法》規範國家應於該法實施五年內完成兒少相關法規之修法改善，因此，本文分析我國兒少空氣污染治理法規與修法內容，與其考量兒少脆弱性之程度。方法：本文採用系統性政策回顧，納入兒少空污和環境健康相關之12項法規，分析2014年11月至2021年11月間之最新法規與修法內容。結果：本研究發現主管之法規，分屬於不同部會，顯示此議題需要跨部會合作，但法規未將重要相關部會納入事務機關。目前政策具校園空品惡化之因應措施，但缺乏校園之室內空品監測、軟硬體等制度性改善和相關預算之條文。過去幾年相關之主要修法，為空品不佳時，停止學生戶外體育課程。結論：我國兒少空污治理法規，目前著重個人層次之因應行為，為維護兒少之健康權、生存和發展權，本文建議政府強化跨部會法規合作，考量兒童之脆弱性，提供系統性支持和預算的法源。
  Objectives: Children are vulnerable to air pollution. The Implementation Act of the Convention on the Rights of the Child stipulates that revisions of child-related policies should be completed within 5 years after this Implementation Act comes into effect. This study analyzed the latest policies relating to air pollution governance for children, the revisions, and the extent to which these policies are designed with the vulnerability of children in mind. Methods: This systematic policy review analyzed 12 policies relating to air pollution and environmental governance for children. Policies and revision documents published between November 2014 and November 2021 were analyzed. Results: The policies included in this study were managed by different ministries, suggesting that air pollution governance for children requires cross-ministerial collaboration. However, the policies did not involve key ministries to collaborate in managing this issue. In response to the deterioration of air quality on campuses, current policies have focused mainly on coping behaviors with poor air quality rather than the budgets and support for improving air quality. The policy revision involved banning students from outdoor sports during periods of poor air quality. Conclusions: Current air pollution governance policies for children mainly involve individual-level changes in behavior. To protect the health and development of children, the government should strengthen cross-ministerial collaboration, account for the needs of children, and provide systematic and financial support.
• 283-293
• 10.6288/TJPH.202306_42(3).111072

• Link 原著 Original Article
• 探討台灣民間救護車公司緊急救護技術員工作環境與工作家庭衝突之相關性Correlation between working conditions and work-family conflict in emergency medical technicians working for private ambulance companies in Taiwan
• 魏 搴、江宛霖
  Qian Wei, Wan-Lin Chiang
• 緊急救護技術員、民間救護車公司、工作環境、工作家庭衝突
  emergency medical technicians (EMTs), private ambulance company, working conditions, work-family conflict
• 目標：本研究旨在探討民間救護車救護技術員（救護員）的工作環境與工作家庭衝突之關係。方法：採橫斷式線上問卷調查，依方便取樣法選取滿20歲民間救護車公司救護員為研究對象。主要依變項為工作家庭衝突，由工作家庭衝突量表測量。首先，以描述統計進行單變項分析，呈現樣本社會人口學變項、工作環境與家庭關係衝突的狀況。接著，以線性迴歸分析檢視工作環境與工作家庭衝突之關係。結果：收案人數計113人，平均33.46歲，男性佔84.07%。結果顯示，近三成樣本的工作時段為24小時制，且值班（75.22%）、加班（76.11%）情形普遍，平均每月薪資30,001-50,000元的佔64.6%。迴歸分析發現，工作時段為24小時制者，工作家庭衝突分數顯著較8小時制者高（β = 2.93, p = 0.01），有加班者相較未加班者，亦有較高的工作家庭衝突。結論：民間救護車公司救護員的工作環境與工作家庭衝突息息相關。建議政府與民間救護車公司落實執行勞基法政策以改善救護員的工作環境，使其能兼顧工作與家庭，進而提升健康照護品質。
  Objectives: We investigated the correlation between working conditions and work–family conflict in emergency medical technicians (EMTs) working for private ambulance companies in Taiwan. Methods: A cross-sectional online questionnaire survey was conducted. EMTs (age, ≥20 years) of private ambulance companies were recruited through convenience sampling. The primary dependent variable was work–family conflict, which was measured using the Chinese version of the Work–Family Conflict Scale. Descriptive data were collected to identify trends in sociodemographic variables, working conditions, and work–family conflict in EMTs. Linear regression was performed to identify the likely correlation between working conditions and work–family conflict. Results: We analyzed the data of 113 EMTs (mean age: 33.46 years; men, 84.07%). Approximately 30% of the EMTs worked on a 24-hr system, with most respondents working regular shifts (75.22%) and overtime (76.11%). Of the EMTs, 64.6% received an average monthly salary of NT$30,001–NT$50,000. Linear regression analysis revealed that the EMTs working under a 24-hr system had a significantly higher average score for work–family conflict than did those working under an 8-hr system (β = 2.93; p = .01). In addition, the EMTs who worked overtime generally had higher work–family conflict scores than did those who did not work overtime. Conclusions: A correlation was found between working conditions and work–family conflict in EMTs working for private ambulance companies. Therefore, governmental and private ambulance companies are recommended to implement the Labor Standards Law policy to improve the working conditions of EMTs and thus their work–family balance, subsequently enhancing the quality of health care provided by EMTs.
• 294-307
• 10.6288/TJPH.202306_42(3).112014

• Link 原著 Original Article
• 失智症病患家庭照顧者的健康識能之質性探討Health literacy of family caregivers of patients with dementia: a qualitative study
• 謝寧惠、鍾國彪、陳雅美、曹汶龍、張弘潔
  Ning-Huei Sie, Kuo-Piao Chung, Ya-Mei Chen, Wen- Long Tsao, Hung-Chieh Chang
• 失智症、家庭照顧者、健康識能
  dementia, family caregiver, health literacy
• 目標：健康識能可改善獲得健康管理的能力，對家庭照顧者在失智症照護過程中扮演重要的角色，本研究之目的在探討失智症病患家庭照顧者的健康識能，亦即其獲得、理解、評估及運用失智症照顧資訊的能力。方法：本研究訪談11位雲林、嘉義地區失智症病患家庭照顧者，並以主題分析法，進行分析、歸納和討論。結果：整體而言，教育程度較低、高齡配偶的家庭照顧者是健康識能有限的族群；健康識能在個人層級的四面向中，以評估資訊的能力較有限。失智症相關資訊來源主要以醫療專業人員為主、自行搜尋網路資訊為輔，失智症病程漫長又複雜，家庭照護者需求各有不同，因此需要醫療團隊與照顧者共同協作，持續調整和提供不同資訊和支持，有助於家庭照顧者對失智症患者和自我之照顧。結論：了解失智症病患家庭照顧者的健康識能現況，有助於了解家庭照顧者面對失智病患各階段的疾病特性，與其衍伸的健康識能需求，作為國家提供失智症家庭照護之健康識能政策之參考，並規劃適切資源。
  Objectives: Health literacy is a crucial aspect of health management and plays an essential role in the care provided by family caregivers to patients with dementia. In this study, we investigated the role of health literacy in the ability of the family caregivers of patients with dementia to access, understand, appraise, and apply dementia care information. Methods: We interviewed 11 family caregivers of patients with dementia in Taiwan’s Yunlin and Chiayi counties and used thematic analysis to analyze and categorize the data. Results: Compared with their counterparts, less educated and older spousal caregivers had lower health literacy. The dimension of health literacy that was weakest among the interviewees was their ability to appraise information. The caregivers reported their main source of health information on dementia to be health professionals, followed by the Internet. The findings of this study reveal that the process for caring for patients with dementia is long and complex and that family caregivers have different needs. Therefore, health-care teams must cooperate with caregivers to make consistent adjustments and provide information and support, which can help family caregivers provide care for patients and for themselves. Conclusions: Understanding the health literacy of family caregivers for patients with dementia can assist clinicians in determining the caregivers’ health literacy needs as the patients they care for reach different stages of dementia. Our findings can serve as a reference for the government to guide the development of health literacy policies related to family care and the allocation of resources.
• 308-320
• 10.6288/TJPH.202306_42(3).112026

• Link 原著 Original Article
• 長照A單位個案管理人員工作滿意度、角色衝突與留任意願之探討Relationships among job satisfaction, role conflicts, and intention to stay for case managers of Tier A centers
• 蔡育真、許芝穎、吳宗晉、蔡蕙鞠、張李淑女、黃靖媛、翁瑞宏
  Yu-Chen Tsai, Chih-Ying Hsu, Tsung-Chin Wu, Hui-Chu Tasi, Shu-Nu Chang-Lee, Ching-Yuan Huang, Rhay-Hung Weng
• 個案管理人員、長照A單位、工作滿意度、角色衝突、留任意願
  case manager, community-based integrated service centers (Tier A), job satisfaction, role conflict, intention to stay
• 目標：在長照2.0計畫的推動下，由A單位個案管人員（簡稱A個管）與照顧管理專員共同執行照顧管理機制，卻也產生分工與責任模糊與工作滿意度的問題，如此一來恐將影響A個管之留任意願，為此本研究欲探討A個管的工作滿意度、角色衝突與留任意願之相關性。方法：本研究採橫斷面研究設計，以全台A單位個管人員為對象，利用自填問卷的方式進行資料收集，共計回收236份之A個管的有效自填問卷。經信度與效度分析後，後續以複迴歸分析進行。結果：A個管整體平均工作滿意度為3.48分，整體角色衝突得分為2.88分，留任意願為3.02分。複迴歸分析結果顯示，在工作滿意度中，工作成就構面對留任意願呈顯著負向影響（β = -0.183，p < 0.05），薪資福利構面對其有顯著正向影響（β = 0.345，p < 0.01）；在角色衝突中，僅角色過度負荷構面對留任意願呈顯著負向影響（β = -0.205，p < 0.01）。結論：本研究證實A個管的工作成就滿意度、薪資福利滿意度與角色過度負荷皆對其留任意願產生顯著影響，可做為未來強化A個管留任意願之重點改善方向。
  Objectives: The Taiwanese government launched the National 10-Year Long-Term Care Plan 2.0, which requires the participation of case managers in long-term community-based integrated care centers (Tier A centers). However, because of the ambiguity in the allocation of responsibilities in long-term care management, it may affect the intention to stay for case managers. This study explored the relationships among job satisfaction, role conflict, and intention to stay for case managers in Tier A centers. Methods: This cross-sectional study collected information from case managers of Tier A centers in Taiwan. A total of 236 valid questionnaires were obtained. After reliability and validity analysis, multiple regression analysis was performed to explore the relationships among job satisfaction, role conflict, and intention to stay. Results: The average scores for job satisfaction, role conflict, and intention to stay were 3.48, 2.88, and 3.02, respectively. Multiple regression analysis revealed that the work accomplishment dimension of job satisfaction had a significant, negative effect on intention to stay (β = -.183, p < .05), but that the pay and benefits dimension had a significant, positive effect on intention to stay (β = .345, p < .01). The role overload dimension of role conflict had a significant, negative effect on intention to stay (β = -.205, p < .01). Conclusions: The work accomplishments, pay and benefits, and role overload dimensions significantly affected intention to stay among case managers of Tier A centers. These findings can be used to increase intention to stay among case managers.
• 321-335
• 10.6288/TJPH.202306_42(3).111107

• Link 原著 Original Article
• 以「兒童蓬勃指數」評估台灣兒童健康福祉之現況Evaluation of children’s well-being in Taiwan by using the Child Flourishing Index
• 羅方妤、張弘潔
  Fang-Yu Lo, Hung-Chieh Chang
• 兒童蓬勃指數、兒童、健康福祉、永續發展、兒童權利公約
  Child Flouring Index, child, health and well-being, sustainable development, UNCRC
• 目標：WHO-UNICEF-Lancet委員會於2020年提出「兒童蓬勃指數」（Child Flourishing Index, CFI），作為評估各國兒童健康福祉之新國際指標，該指標之各國評比未納入我國，因此本研究旨在計算台灣之分數，了解我國兒童健康福祉現況。方法：本研究依照「兒童蓬勃指數」之方法學，採用聯合國SDGs資料庫、「健康指標與評估研究所」（IHME）資料及我國政府統計資料，計算出我國「兒童蓬勃指數」。結果：「兒童蓬勃指數」分數介於0-1間，台灣2017年總分為0.9分，全球排第24名。生存維度應改善的指標有2項，包括「孕產婦死亡率」、「0-19歲道路傷害死亡率」。 茁壯維度中3項指標可加強，即「低出生體重率」、「5歲以下兒童發展遲緩盛行率」、「18-29歲民眾在18歲以前受過性別暴力的比例」。我國的環境永續指標，碳排嚴重超量344%，公平性指標吉尼指數為31.5。結論：「兒童蓬勃指數」是結合永續發展、兒童權利、性別平等、世代正義之新指標，可檢視我國政策友善兒童健康福祉的程度，作為政策改善的實證基礎。本研究建議強化我國兒少統計專區中，補充兒童指標數據之完整性，並藉由跨部會合作，將兒童納入所有政策，改善兒童健康福祉。
  Objectives: In 2020, the WHO–UNICEF–Lancet Commission developed the Child Flourishing Index (CFI) to evaluate the health and well-being of children in different countries. In the current study, we used this index to evaluate the health and well-being of children in Taiwan, who are not currently considered in the CFI. Methods: In accordance with the original CFI methodology, we calculated the CFI in Taiwan by using data obtained from the Sustainable Development Goals, Institute for Health Metrics and Evaluation, and official statistics of Taiwan. Results: CFI scores range from 0 to 1, Taiwan’s CFI score in 2017 was 0.9, indicating Taiwan had the 24th highest score in the world. The results in the survival domain of the CFI indicated that Taiwan should focus on improving the rate of maternal mortality and the rate of road injury mortality among individuals aged 0–19 years. The results for the thriving domain indicated that Taiwan should also focus on improving the rate of low-weight births, the prevalence of stunting among children younger than 5 years, and the proportion of young men and women aged 19–29 years who experience sexual violence before the age of 18 years. The results for sustainability indicated that Taiwan should reduce its carbon emissions, which reached 344%, and that the Gini index value for income inequity in Taiwan was 31.5. Conclusions: The CFI can be used as an index of sustainable development, child rights, gender equality, and generational justice to evaluate the child-friendliness of Taiwanese policies. We suggest that child-related indicators be improved and that cross-departmental collaborators be encouraged to include children in policies to improve child health and well-being in Taiwan.
• 336-347
• 10.6288/TJPH.202306_42(3).112018

• Link 評論 Commentary
• 評論：衛生所在新冠疫情期間偵測兒虐高風險的經驗分享Commentary: experiences in detecting maltreatment high risk children in public health center during the COVID-19 pandemic
• 呂宗學
  Tsung-Hsueh Lu
• 無none
  無none
• 無none
  無none
• 281
• 10.6288/TJPH.202306_42(3).11201201

• Link 作者回覆 Authors' response to commentary
• 作者回覆：衛生所在新冠疫情期間偵測兒虐高風險的的經驗分享Authors' response to commentary: experiences in detecting maltreatment high risk children in public health center during the COVID-19 pandemic
• 黃姿飴、呂建德
  Tzu-Yi Huang, Jen-Der Lue
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• 282
• 10.6288/TJPH.202306_42(3).11201202