台灣公共衛生雜誌/Taiwan Journal of Public Health
臺灣公共衛生學會,正常發行
選擇卷期
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日前衛生福利部表示「三代健保」將回歸家戶總所得為費基的改革方案，本文從公平性、中立性、行政執行性等三個角度分析現制保費收費方式（含補充保險費）與「以家戶總所得為費基」方案之優缺點；再就2010年推動以家戶總所得為費基改革方案時所衍生的相關爭議進行討論，並提出相關建議，作為政府未來三代健保政策制定時之參考。
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目標：探討加入糖尿病共照網之病患與未加入者之糖化血色素控制與健康行為改變是否有異，並檢視兩組病患之糖尿病相關健康行為改變，分別與何種健康信念之改變有關及其影響之程度。方法：採類實驗研究法，收案對象為第二型糖尿病病患，分成「共照組」與「非共照組」，依性別、年齡配對，以1：2比例分別收案208與421人，並於首次收案時及6個月後，進行糖化血色素與問卷資料收集。結果：自迴歸多變項分析顯示，共照組之後測糖化血色素較低（β=-0.18），後測健康行為得分亦較高（β=0.13）。共照組後測健康行為與自覺利益（β=0.29）、行動線索（β=0.15）之提升具顯著關聯，非共照組後測健康行為則與自覺罹患性（β=0.13）、自覺利益（β=0.19）之提升，以及自覺障礙（β=-0.16）、行動線索（β=-0.12）之下降具顯著關聯。結論：共照組病患之糖化血色素控制與健康行為改變均較非共照組佳，但兩組之健康行為改變係由不同健康信念所驅動，故未來糖尿病健康照護介入，可參考本研究之發現，於兩組分別針對不同之健康信念設計合適之介入策略。
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Objectives: Many factors impact the onset of diabetes. Higher levels of physical activity and fruit-vegetable (FV) consumption are considered to be effective in reducing the risk; however, the combined effect is largely unknown. This study attempted to determine the combined effect of a higher level of physical activity and higher FV consumption on the subsequent risk of new diabetes. Methods: Data for this analysis were taken from the 1999 and 2003 datasets of the ”Taiwan Longitudinal Survey on Aging”. A total of 4,400 participants (≥ 53 years old) completed the survey in 1999. After excluding those who had diabetes, heart disease, cancer, BMI＜18.5, or incomplete data at baseline, those who died during 1999-2003, and those who failed to complete the 2003 survey, the net N was 2,243. Multivariate binary logistic regression analysis was performed to determine the independent or combined effect of physical activity and FV consumption on the risk of new diabetes four years later. Results: When the combination of high physical activity and high FV consumption was compared to no physical activity and low FV consumption, the risk of having new diabetes four years later was reduced to 39% (OR=0.39, 95% CI=0.20-0.76, p=0.006). All other combinations were not significant. When analyzed independently, only high physical activity was significant, high FV consumption was not. Conclusions: The combination of high physical activity and high FV consumption was highly effective in reducing the risk of new-onset diabetes in older Taiwanese. High physical activity alone was significant but high FV consumption alone was not. These results highlight the importance of having both daily physical activity and FV intake. Our results could provide the basis for a national policy on diabetes prevention.
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目標：基於生命質的改善和量的增加同等重要，對老人健康之關注，不應侷限於以往罹病或功能障礙老人之照顧，而是積極提升其整體生活品質及安適狀態為目標，即「成功老化」與「活躍老化」的概念。不論成功老化或活躍老化，均同時涵蓋老年人身體、心理、社會三個面向。本研究旨在探討台灣老年人口在成功老化及活躍老化之變遷及可能影響因素。方法：利用國民健康署所建立之「台灣地區中老年人身心社會狀況長期追蹤研究調查」資料，依成功老化與活躍老化定義，就老人成功、活躍老化變動趨勢，以馬可夫鏈模式軟體IMaCh（interpolatedMarkov chain，IMaCh）推算60歲以上老人世代平均餘命，成功、活躍老化健康餘命及各年齡盛行率；另亦就高血壓、心臟病及糖尿病等重要慢性疾病探討其對成功、活躍老化健康餘命影響差異。結果：影響成功老化、活躍老化之各組成項目（ADL、IADL、無憂鬱症狀、認知功能正常、良好社會支持、具生產力）正常百分比大致隨著年齡增長而逐年下降，成功老化及活躍老化盛行率亦呈現相同趨勢；平均餘命方面，成功老化健康餘命佔平均餘命約四至五成間，其中活躍老化在15%～25%間。三種慢性疾病中，糖尿病成功、活躍老化健康餘命百分比在各年齡組均較高血壓及心臟病為低。結論：提升活躍老化應是有關單位努力的理想目標；在慢性疾病上，以糖尿病的負面影響最為明顯，相對於其他慢性疾病，糖尿病的防治有極大的改善空間。
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目標：每年約有五萬名勞工發生職業災害，研究發現職傷後有一定比例的勞工會發生精神疾病，進而影響其復工。目前台灣鮮少研究探討職業傷害勞工之復工需求。期望了解勞工發生職災到順利復工的協助需求，以提供相關單位作為擬訂職災勞工照護之參考。方法：本研究以2009年02月01日至08月31日因職業傷害住院超過3天以上的職業傷害勞工（N=4,403）為研究對象，於其職業傷害發生後12個月寄發問卷。本問卷是採自填式問卷，問卷內容包括基本資料、職業傷害處理狀況、身體受傷狀況、與復工情形。結果：共有1,233人回覆，回覆率為28.0%。受傷後一年已復工者969位（78.6%），未復工者264位（21.4%）。相較於已復工者，未復工者的平均年齡較高、教育程度較低、離開原公司的比例較高、對於公司提供職災協助的滿意程度較低、覺得職災補助取得不容易、自覺受傷程度較嚴重，且身體外觀有明顯缺陷。已復工者，僅18.1%（n=175）有接受復工評估，有接受復工評估者的休養週數比未進行復工評估者長（14.3±13.1 vs. 10.7±12.0），復工主要決定者多為雇主決定（n=109，62.3%），而接受復工評估者比沒有接受復工評估的人有較高的比例發生受傷部位復發的狀況為（39.4% vs. 31.2%，p=0.03）。結論：建議政府結合社區資源，建立常設之職災服務單一窗口，普及職災個案照護，並建議職業傷病勞工的復工評估與醫療應經由各地區之職業傷病防治中心或職業病專科醫師執行，以強化職業傷病防治中心與職業病專科醫師的角色並落實復工的功能。
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目標：參考Andersen第一與第二階段醫療服務利用行為模式，擬欲探討2000至2009年精神疾病社區復健使用者之個人特質，並且分析使用精神疾病社區復健病患歷經指標出院一年期間，其往後一年內再入院風險及相關危險因子。方法：採回溯性世代設計，資料出處為國衛院所發行之全民健康保險資料庫1999至2009年「居家照護特殊需求檔」，研究對象為2000至2007年精神疾病社區復健使用者為新收個案，共25,218人。以Cox比例風險迴歸模式預測精神疾病社區復健使用者在指標出院後經歷一年期間，其往後一年內再入院之風險。結果：研究發現以Cox迴歸模式在出院後一年內精神疾病社區復健使用次數為8－14次與≥15次的再入院風險較使用1－7次者低，女性、中區分局病患、精神分裂症患者與住院小於55天等變項，再入院之風險較低。結論：精神疾病社區復健使用次數越少之個案，其爾後再入院之風險比使用次數多者還高，值得健康照護相關人員進一步思考影響其使用的因素，另外，其使用的模式及其與再入院之關係為何？亦值得未來進一步探究。
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Objectives: In the context of Confucian culture, the main unit of support for older parents in Taiwan is the family system. This points out the important connection between intergenerational relations and subjective economic strain. We utilized the intergenerational solidarity theory to explore whether ”intergenerational emotional bond” (affection solidarity) predicted a lower level of subjective economic strain than did ”received money from children” (functional solidarity). Methods: This study used data from the Taiwan Longitudinal Study on Aging, a nationally representative sample of older adults aged 60 and above, collected between 1989 and 2003. Generalized linear modeling with GEE estimates was employed because of the repeated measures. Results: After SES and other covariates were controlled, females who felt that their children were reliable when they were sick were 0.36 points lower on the four point scale of economic strain (β=-0.36, p＜0.001) while those who received monetary support from sons were 0.09 points lower (β=-0.09, p＜0.001). Males who felt that their children were reliable when they were sick were also less likely to experience economic strain (β=-0.22, p＜0.001); however, the effect of monetary support from sons was insignificant. Conclusions: These findings suggest that ”children's care” produced a stronger and more positive effect on alleviating parents' subjective economic strain than did monetary support. Health and Welfare policy makers promoting economic well-being among older adults should take mutual emotional respect and an understanding of intergenerational relations into consideration.