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Exploring the Care Experiences Among Clinical Staffing During Emerging Infectious Disease: From the COVID-19 Pandemic Approach
No full text[[abstract]]Purpose: The coronavirus disease 2019 (COVID-19), one of the most significant recent emerging infectious diseases, has evolved into a global pandemic, resulting in an unprecedented public health crisis with substantial morbidity. The aim of this study was to investigate the care experiences of nursing staff during the COVID-19 pandemic.
Methods: A qualitative, exploratory interview study. This study was conducted from August 2022 to January 2023. Participants were recruited from a medical center in northern Taiwan. A purposive sampling approach was employed to select the participants, and in-depth interviews were conducted with a total of 30 individuals. The collected data were analyzed using content analysis.
Results: The findings of this study revealed five themes that summarized the care experiences of participants during the COVID-19 pandemic, enhanced nursing competence in pandemic mitigation, adherence to clear safety measures, effective adaptation to the stress of the "unknown," and recognition of the meaning of the pandemic mitigation experience.
Conclusion: This study informs pandemic readiness for nurses and policy enhancement. Medical institutions and governments must prioritize policies ensuring staffing, PPE access, and mental health support. Educators and administrators should elevate on-the-job crisis management training. Future planning should cater to Taiwanese nurses' needs during unforeseen crises such as COVID-19
Mediation and Dose-Response Relationship Among Physical Activity, Daylight Exposure, and Rest-Activity Circadian Rhythm in Patients With Esophageal and Gastric Cancer
No full text[[abstract]]Background: Physical activity and daylight exposure predict rest-activity circadian rhythm (RACR) in patients with cancer. However, whether daylight exposure mediates the relationship between physical activity and RACR and the optimal amounts of physical activity and daylight that benefit RACR remain unclear.
Objectives: This study investigated the mediating role of daylight exposure and determined the dose-response relationship among daylight exposure, physical activity, and RACR in patients with cancer.
Methods: This cross-sectional exploratory study recruited 319 patients with esophageal and gastric cancer from 2 surgery outpatient departments in Taiwan. Daylight exposure (>500 lux), physical activity (up activity mean), and RACR (midline estimating statistic of rhythm) were measured through actigraphy. Regression was performed, and the receiver operating characteristic curve was plotted.
Results: Daylight exposure (>500 lux) partially mediated the relationship between physical activity (up activity mean) and RACR (midline estimating statistic of rhythm). The optimal cutoffs for discriminating between satisfactory and poor RACR were 187.43 counts/min for physical activity (sensitivity, 90.3%; specificity, 84.4%) and 35.71 min/d for daylight exposure (sensitivity, 55.9%; specificity, 78.2%).
Conclusions: Participants who engaged in physical activity were more likely to receive daylight exposure and experience improved RACR. The optimal level of daylight exposure and frequency of physical activity that can improve RACR in patients with esophageal and gastric cancer are 36 min/d and 187 counts/min, respectively.
Implications for practice: Healthcare professionals should encourage patients to engage in exercise or physical activity during the daytime to improve their circadian rhythm
[[alternative]]Exploring Novice Counselors’ Professional Growth in Graduate Counselor Education
No full text[[abstract]]本研究目的乃探詢新手心理師於專業養成教育中，專業成長經驗本質結構。因此採用現象學分析方法，以立意取樣對六位執業未滿三年，且具一年以上實務工作經驗的心理師進行分析。研究結果發現研究參與者在專業養成教育中的專業成長歷程，主要有三個經驗結構，即「模糊」、「凝聚」與「顯化」。經驗者在這三個結構中，最終顯化的不僅有專業，還有學習者自身。專業成長的歷程於「模糊」的結構中，由學習的動機拉開序幕，在專業養成教育的制度中反覆「外探與內尋」對自己、對專業的期待，以及學習的動力；在「被動承受」學習的焦慮和挫折中，逐漸學習「主動迎向」制度與挑戰的方式，並讓自己得以持續學習與成長。於「凝聚」的結構中，「實務現場」中的案主現身，使「學習現場」所指出的理想化概念得以被學習者實踐；由各方詮釋的「專業期許」，也於「案主需求」被學習者感知並嘗試回應後，逐漸變得更具體且有彈性。最終於「顯化」的結構中，發現專業能力不是「說」出來，而是得投身去「做」。不僅學習者得做，教師與督導若能示範、引導，並協助學習者體會何為「專業」，能催化專業成長歷程；學習「專業」的歷程，從與「生活」分隔，轉至跨場景的實踐，在實踐中使專業與個人交織成形。以上發現顯示專業成長，是一專業能力學習與個人成長交織的經驗歷程，不僅發生於專業學習的場景，也發生於生活的場景中。專業養成教育提供了學習者過渡至實務現場的學習空間，其中督導與教師帶給學習者的體驗性學習具有深遠的影響。最後依據研究結果，分別對未來研究、專業養成教育與學習者提出建議。[[abstract]]This study is aimed to explore the general structure of novice counselors’ professional growth experiences in graduate counselor education. The phenomenological analysis is applied to analyze six participants for purposive sampling in the semi-structured interviews. They are all novice counselors with 1-3 years of work experience. The study shows that the participants' professional growth process in graduate counselor education is characterized by three structures of experience: "blur," "coalesce," and "manifest." Through these three structures, participants eventually manifest not only professionalism but also their personal growth. The process of professional growth begins in the "blur" structure, where learning motivations are initiated. Participants repeatedly explore external and internal expectations of themselves and of their profession in the institutional framework of graduate counselor education as well as the motivation for learning. In the "passive endurance" of learning anxiety and setbacks, participants gradually learn to "actively approach" challenges in the system, which enables them to continuously learn and grow. In the "coalesce" structure, the emergence of clients in the "practice field" allows participants to put the idealized concepts in the "learning field" into practice. The "professional expectations" interpreted from various sources become more concrete and flexible over time as the participants perceive and respond to their "clients’ needs." Ultimately in the "manifest" structure, professional competence cannot be merely "spoken," but must be actively "done." Not only must participants engage in action, but if teachers and supervisors can demonstrate, guide, and assist learners in understanding what "professionalism" entails, which can catalyze the process of professional growth. The process of learning "professionalism" transitions from being separated from "life" to cross-scenario practice, which intertwines professionalism and personal growth. Conclusion: These findings demonstrate that professional growth is an experiential process that intertwines professional learning and personal growth, occurring not only in professional learning environments but also in life situations. Graduate counselor education provides learners with a learning space to transition to real-world practice, and the experiential learning provided by supervisors and teachers has a profound impact on learners. Recommendations, based on the research findings, are presented for future research, graduate counselor education, and learners
[[alternative]]The Research on Resilience and Quality of Holistic Care for Patients with Mental Illness
No full text[[abstract]]近年來，全球精神疾病患者人數逐漸上升，突顯心理健康及個體復原力的重要性。醫療端也發展更全面的全人醫療服務，旨在提供患者身、心、社、靈四層面更完善的綜合性照護，以提高患者面對疾病之復原力。因此本研究探討精神疾病患者在背景變項、復原力及全人醫療照護品質之現況及差異性，以及復原力與全人醫療照護品質兩變項間的相關性。本研究針對馬偕醫院之精神科門診患者進行問卷調查，有效問卷共計153份，使用工具包含「Connor-Davidson復原力量表」及「全人醫療照護品質評估量表-病人版」，將所得資料以描述性統計、t檢定、單因子變異數分析及Pearson積差相關進行統計分析。本結果研究分述如下：一、精神疾病患者之復原力屬低復原力，以「個人的勝任能力、高標準和韌性」分數最高。二、精神疾病患者之全人醫療照護品質平均分數及題平均分數略高於中間的程度，以「我能感受到醫療人員對我的態度是友善的」題分數最高。三、復原力及全人醫療照護品質兩者呈現正相關。四、40-60歲患者的復原力顯著大於18-39歲患者。五、男性的整體全人醫療照護品質的感受高於女性。六、患者的婚姻狀態及教育程度在復原力上有部份顯著差異。七、有接受個管關懷、志工服務及社區醫療服務的患者在全人醫療照護品質的感受上皆大於沒有者。八、情緒障礙及焦慮相關障礙在復原力和全人醫療照護品質的高低分組中均存在顯著差異，復原力較高的患者對全人醫療照護品質的感受度也較佳，反之對全人醫療照護服務感受越好的患者，其復原力也越高。九、患者接受醫療服務種類數越多，在全人醫療照護品質的感受上越高，其中患者對於全人醫療照護品質感受度以社區醫療服務最高，志工服務次之，個管追蹤關懷第三。本研究依據上述研究結果，提供復原力及全人醫療照護服務相關建議，供醫療相關人員及後續研究者參考。[[abstract]]In recent years, the global increase in the number of individuals with mental illnesses has underscored the importance of mental health and individual resilience. Consequently, there has been a development towards more comprehensive holistic care services aimed at providing patients with integrated care addressing physical, mental, social, and spiritual aspects to enhance their resilience in facing illnesses. Therefore, this study explores the current status, differences, and correlation between resilience and the quality of holistic care.The study employed a questionnaire survey method. It was conducted among psychiatric outpatients at Mackay Memorial Hospital as the research populations. convenience sampling was used to obtain a sample of 153 patients with mental illness for the study. The research tool used included the Connor-Davidson Resilience Scale and the Holistic Care Quality Assessment Scale-Patient for Patients. The summarized research findings of this study are as follows:1.The resilience of patients with mental illnesses exhibited low levels of resilience, with the highest scores observed in "personal competence, high standards, and tenacity."2.The average scores for the quality of holistic care among mental illness patients were slightly above the median, with the highest score recorded for the item " I can feel that the medical staff have a friendly attitude towards me."3.There was a positive correlation between resilience and the quality of holistic care.4.Patients aged 40-60 had significantly higher resilience than those aged 18-39.5.Male patients perceived a higher overall quality of holistic care compared to female patients.6.There were partial significant differences in resilience based on patients' marital status and educational level.7.Mental illness patients who received case management, volunteered services, and community healthcare services perceived a higher quality of holistic care.8.Significant differences were found in the resilience and quality of holistic care among patients with affective disorders and anxiety-related disorders, with those having higher resilience perceiving better quality of holistic care, and vice versa.9.The more types of medical services patients received, the higher their perception of the quality of holistic care, with community medical services being rated the highest, followed by volunteer services and case management care.Based on the above results, this study offers valuable suggestions related to resilience and holistic care for the medical personnel and future researchers
[[alternative]]Establishment and Strategy Application for Early Detection of Fires in Special Recreational Areas— Application of a Visual Artificial Intelligence Detection System
No full text[[abstract]]特殊休閒場所涵蓋舞廳業、舞場業、酒家業、酒吧業、特種咖啡茶室業、視聽歌唱業、夜店業與三溫暖業，亦為公安事件頻傳之場所。本研究旨在探討臺灣特殊休閒場所，如視聽歌唱業的KTV，因火災導致的人員傷亡與財產損失問題。為此，本研究開發了一套結合視覺型人工智慧與現有建築內部監控技術的火災偵測與人員監控系統。此系統核心功能為在火災發生初期，自動識別火焰、煙霧和場內人員，進行實時追蹤與記錄，其目的是為了快速提供有用的火災資訊及受困人員位置給消防人員，以利消防人員能夠訂定滅火與救援策略進行更有效率的救援行動，確保人員安全並減少財產損失。本研究開發之系統的創新性在於它將火焰和煙霧識別功能與人員追蹤功能融為一體，有效提升了整體救援操作的速度和準確性。通過對特定場景進行模擬測試，本系統證明能夠根據煙霧的濃度精確評估火場的危險等級，並持續監測人員動向，為救援的消防人員提供了迅速且清晰的重要資訊。儘管系統在高煙霧環境中的人員辨識效率尚存在挑戰，未來的研究將專注於這些技術的改進，特別是提升系統在各種視覺條件下對人員動態的識別與追蹤能力。總結來說，本研究所開發的火場監控與人員追蹤系統對於提升火災救援效率和安全性具有顯著貢獻，對於增進公共安全領域有著深遠的影響。[[abstract]]Special leisure venues include dance halls, dance clubs, restaurants, bars, specialty coffee and tea houses, audio-visual singing establishments, nightclubs, and sauna businesses. These venues are also frequently associated with public safety incidents.This study aims to explore the issues of personnel casualties and property losses due to fires in special leisure venues in Taiwan, such as KTVs within the audio-visual singing industry. To address this, the thesis developed a fire detection and personnel monitoring system that integrates visual artificial intelligence with existing internal building surveillance technologies. The core functionality of this system lies in its ability to automatically identify flames, smoke, and individuals present at the onset of a fire, enabling real-time tracking and recording. The purpose is to quickly provide useful fire information and the locations of trapped individuals to firefighters, facilitating the formulation of efficient firefighting and rescue strategies, thereby ensuring personnel safety and minimizing property loss.The innovation of the system developed in this thesis lies in its integration of flame and smoke detection capabilities with personnel tracking functionalities, significantly enhancing the speed and accuracy of overall rescue operations. Through simulated testing in specific scenarios, the system has proven capable of accurately assessing the level of fire hazard based on the density of smoke and continuously monitoring the movements of individuals. This provides rapid and clear crucial information to the rescue firefighters.Despite the challenges in personnel identification efficiency in high-smoke environments, future research will focus on improving these technologies, particularly enhancing the system's capability to recognize and track human movements under various visual conditions. In summary, the fire monitoring and personnel tracking system developed in this research significantly contributes to improving the efficiency and safety of fire rescue operations, having a profound impact on advancing the field of public safet
[[alternative]]Establishing a Healthcare Data Transformation Platform in Compliance with the International FHIR Standard–Using Personal Health Records as an Example
No full text[[abstract]]個人健康紀錄(Personal Health Records)的出現不僅改善了過去患者難以取得自己就醫資料的狀況，還能隨時掌控自身的健康數據，增強了個人對自己健康狀況的了解和管理能力。健康存摺(My Health Bank, MHB)的資料來源為台灣健康保險之醫療資料，為台灣國家級的個人健康紀錄系統，然而MHB目前還無法與國際間資料交換，嚴重降低了患者出國的就醫品質。FHIR(Fast Healthcare Interoperability Resources)為最新的健康照護數據標準，提供了可以使醫療數據之間交換的標準化方法，雖然先前有他人開始將MHB資料轉換為FHIR標準，但是MHB與FHIR標準之間的映射過程並未完整的公布，加上FHIR的映射過程大多都是由手動的方式居多，時常容易出錯，以及MHB時常會因為滿足不同的醫療領域需求而不斷地更新，因此容易影響到格式的呈現。本研究主要希望達成兩個目標：1. 開發符合FHIR標準的數據映射轉換平台，不僅能解決過去使用手動方式造成的錯誤，還能夠有效的管理並應對時常須要更新的資料集。2. 透過MHB資料設計FHIR實作指引(Implementation Guide, IG)，此IG將會採用FHIR IPS(International Patient Summary)之規範，不僅可以提供規範給其他相關開發者參考與驗證來達到資料的一致性，還可以透過IPS的基礎，未來能將MHB與國際達到數據間的資料交換。[[abstract]]The emergence of Personal Health Records (PHRs) has not only improved patient access to medical records but also allows them to monitor their health data, enhancing their understanding and management of their health conditions. My Health Bank (MHB), sourced from Taiwan's health insurance, operates at a national level. However, MHB currently lacks support for international data exchange, significantly impacting care quality for patients seeking medical treatment abroad.FHIR (Fast Healthcare Interoperability Resources) is the latest healthcare data standard that provides a standardized method for exchanging medical data and is becoming increasingly popular in the healthcare field. Although there have been previous efforts to convert MHB data to the FHIR standard, the mapping process between MHB and FHIR has not been fully disclosed. In addition, most FHIR mapping processes are manual, which is often error-prone, and MHB is constantly updated to meet the needs of different medical fields, which can easily affect the presentation of the format.This study aims to achieve two main objectives: 1. Develop a data mapping and conversion platform compliant with the FHIR standard. This platform will not only solve the errors caused by manual methods in the past but also effectively manage and respond to the frequently updated datasets. 2. Through the MHB Data Design FHIR Implementation Guide (IG), the IG will adopt the specifications of FHIR IPS (International Patient Summary). This IG not only provide specifications for other developers to reference and validate to achieve data consistency but also facilitates future data exchange between MHB and international platforms based on IPS
[[alternative]]Tactile Medium and Infant Gaze Behavior
No full text[[abstract]]嬰兒期是人類生命中最重要的時期，感知與凝視行為在嬰兒期扮演重要的角色。嬰兒透過感知與凝視行為發展並習得技能，學會解決許多問題。本研究透過手動操作二種不同觸覺介質刺激:粗介質玩具組 (gross tools, GT) 和細介質玩具組 (fine tools, FT)，檢驗嬰兒凝視次數與凝視時間。以實驗方式募集30名6-12個大的嬰兒，隨機分配為GT組 (N=15) 和FT組 (N=15)，分別給予不同觸覺介質，同時以嬰兒前方之單一紅色燈光閃燈，頻率為4分鐘內每24秒出現一次，每次持續2秒鐘，觀察嬰兒抬頭凝視紅色燈光的次數和時間。研究結果為粗、細觸覺介質組，在凝視次數與凝視時間皆無統計上之顯著差異，故推論6-12個月大嬰兒的凝視行為，尚不致於受到粗介質玩具或細介質玩具之影響。另在嬰兒凝視行為相關動作行為觀察方面，發現嬰兒觸覺介質的操作和凝視行為與其是否可獨立坐姿有關，意即無法獨立坐姿的嬰兒，較無法表現出流暢的手部操作及凝視行為。[[abstract]]The infancy is the most significant period in life span. Perception and gaze behavior play a vital role in infancy, in which the infants acquire skills and learn to solve problems through these processes. Two different tactile medium stimuli were manipulated as the gross tools (GT) and fine tools (FT) groups for triggering the visual attention and gaze behavior. Thirty infants from 6 to 12 months old were recruited and randomly assigned to the GT group (N=15) and FT group (N=15) for exploring different tactile mediums. A single red light was set in front of the infants with the lighting frequency every 24 seconds and each time lasting 2 seconds. The researchers observed their frequency and time of looking at the red light in 4 minutes. It was found that both the infant’s gaze time and the number of gazes were not significantly different, meaning that the infants’ gaze behavior in this age duration is not influenced yet by the gross or fine tools. From the qualitative observation, it was found that the tactile materials and gaze behavior were related to sitting posture. The infants with the independent sitting ability would show better hand control and gaze behavior
[[alternative]]The effect of high-intensity interval exercise on physiological and hormonal modulation of primary dysmenorrhea
No full text[[abstract]]目的：經痛是所有女性不分年齡、種族的常見婦科問題之一，整體上，經痛降低了許多女性的生活品質，且隨著社會進步，女性在經濟產值的貢獻扮演重要的角色，經痛程度造成日常活動受到限制、心理壓力增加及影響工作效率等等；經痛可分為原發性經痛與續發性經痛，實行健康的生活方式有助於緩解經痛的症狀，包括適當的營養、運動、戒菸和少量飲酒，特別是在運動方面，有許多研究顯示運動可緩解經痛。方法：本研究旨在探討高強度間歇訓練 (high intensity interval training, HIIT) 是否亦可緩解女性經痛不適症狀，並將受試者分為無經痛不適組、經痛不適組、經痛不適合併飛輪HIIT組，實驗為期10週，在訓練前與後進行血液採樣，觀察10週飛輪高強度間歇訓練對於女性原發性經痛的改善效益，並從內分泌、荷爾蒙與生理生化等多個角度探討運動介入下其可能的作用機轉與效益。結果：持續10週高強度間歇訓練 (一) 可顯著改善雌二醇、血清泌乳激素、黃體素、皮質酮以及前列腺素 (PEG2) 和前列腺素 (PGF2α) 等指標之濃度。(二) 可顯著降低運動代謝損傷指標的乳酸脫氫酶以及發炎指標的的高敏感度C反應蛋白之數值，改善體內發炎指標。(三) 可以緩解女性經期之不適。結論：持續10週飛輪高強度間歇訓練，可以有效改善經痛生理與荷爾蒙調控，本研究之運動處方可進一步作為女性健康促進教育計劃之一部分，以促進女性生活品質與婦科疾病之預防。[[abstract]]Purpose: Dysmenorrhea is one of the common gynecological issues affecting females regardless of age or race, significantly diminishing the quality of life during menstruation. With the advancement of society, females play crucial roles in economic productivity. Dysmenorrhea results in the restriction of daily activities, increment of psychological stress, and work efficiency decrement. Dysmenorrhea could be categorized into primary and secondary types, and a healthy lifestyle could alleviate its symptoms, including proper nutrition, exercise, smoking cessation, and moderate alcohol consumption. Several studies have also indicated that exercise could be an alternative modality to relieve dysmenorrhea but the mechanism and exercise prescription still need to be further investigated. Method: This study aims to investigate whether high-intensity interval training (HIIT) could also alleviate discomforts associated with dysmenorrhea. Participants were divided into three groups: control (Control), dysmenorrhea (Dysmen), and dysmenorrhea with HIIT (DysmenHIIT) group. The intervention was implemented for 10 weeks, with blood sampling conducted before and after training, to observe the benefits of 10-week stationary bike HIIT on improving primary dysmenorrhea. Additionally, the potential effects of exercise intervention were evaluated from various perspectives such as endocrines, hormones, and physiological biochemistry. Results: 10-week of HIIT significantly improved the hormones concentrations of estradiol, serum prolactin, progesterone, and cortisol among other indicators. Accordingly, HIIT training program significantly reduced the levels of lactate dehydrogenase, an indicator of exercise metabolism damage, and high-sensitivity C-reactive protein, an indicator of inflammation, and improving internal inflammatory prostaglandins (prostaglandin E2 and prostaglandin F2α). In addition, the 10-week HIIT could alleviate distress during the menstrual period in females with dysmenorrhea. Conclusion: Continuous 10-week stationary bike HIIT exercise prescription could effectively improve menstrual physiological adaptation and hormone modulation. The exercise prescription from this study could further serve as a part of women's health promotion education programs and further enhance the quality of life and gynecological diseases prevention among females
[[alternative]]Development of Measurement Scale for Mandarin Chinese Articulation/ Phonological Clinical Assessment Tool
No full text[[abstract]]有鑑於台灣量化且經過信效度檢定程序的構音音韻評估工具缺乏，故本研究愈建立《華語構音/音韻臨床測驗工具》之量尺並探討其信度與效度水準。研究由台北、南投及澎湖地區公私立幼兒園及醫療院所中徵得語音正常及異常共224名學齡前兒童。參考Bankson-Bernthal Test of Phonology建立《華語構音/音韻臨床測驗工具》構音及音韻分測驗之五點量尺後，分別探討其內容與評分者信度以及內容描述、建構識別與校標預測校度。研究結果顯示《華語構音/音韻臨床測驗工具》三個分測驗皆具有良好評分者信度，同意百分率0.88-0.99，一致性係數0.86-0.92；內部一致性係數為0.95、0.88、0.72。效度檢定結果顯示，測驗的內容涵蓋度良好，項目之間的相關係數為0.16，表明測驗項目涵蓋了多樣的語音能力範疇。平均項目困難度為0.85，且有足夠項目鑑別度，項目與總分相關係數範圍在0.37至0.54之間。測驗具有良好的地板足夠度以及梯度足夠度，平均標準分數變動在2.80至4.62分之間。差別試題功能析顯示，118個計分項目中僅有4個項目存在均一差異。子群體比較顯示，性別與地區間的標準分數無顯著差異（t檢定和ANOVA分析）。假設檢定結果表明，原始分數與年齡顯著中度相關，分測驗之間顯著高度相關，驗證自然音韻以及言語鏈理論。效標相關分析顯示，測驗原始分數與輔音正確率顯著高度相關。進一步的子群體比較顯示，語音正常與語音異常兒童的標準分數存在統計上顯著差異（t檢定）。最後，語音障礙診斷的精準度評估顯示，ROC曲線下面積在0.87至0.94之間，表明該測驗具有高度的篩檢準確性。本研究結果支持《華語構音/音韻臨床測驗工具》及量尺可應用至未來兒童語音能力相關研究以及目前臨床上構音音韻評估、介入的參考。[[abstract]]Due to the lack of quantitative and psychometrically validated single word speech sound test in Taiwan, this study aimed to establish the scale for Mandarin Articulation and Phonological Test and evaluate its reliability and validity. The study recruited 224 preschool children with typical and atypical speech from public and private kindergartens and medical institutions in Taipei, Nantou, and Penghu. The scale of Mandarin Articulation and Phonological Test was developed based on the Bankson-Bernthal Test of Phonology, establishing a five-point scale for articulation and phonological subtests. The study examined content and rater reliability, as well as content-description, construct-identification and criterion-prediction validity.Results indicated that the Mandarin Articulation and Phonological Test demonstrated good rater reliability across three subtests, with agreement percentages ranging from 0.88 to 0.99 and consistency coefficients from 0.86 to 0.92. The internal consistency coefficients were 0.95, 0.88, and 0.72. Validity tests showed that the test had good content coverage, with item inter-correlation coefficients of 0.16, indicating a diverse facets of speech abilities. The average item difficulty was 0.85, with adequate item discrimination, as item-total correlations ranged from 0.37 to 0.54. The test also exhibited good floor and gradient adequacy, with average standard score variations between 2.80 and 4.62 points. Differential item functioning analysis revealed that only 4 out of 118 items showed uniform differences. Subgroup comparisons indicated no significant differences in standard scores across gender and regional groups (t-tests and ANOVA).Hypothesis testing showed that raw scores were moderately correlated with age, and subtests were highly correlated, validating natural phonology and speech chain theories. Criterion-related validity analysis revealed a significant high correlation between raw test scores and consonant accuracy rates. Further subgroup comparisons indicated statistically significant differences in standard scores between children with typical and atypical speech (t-tests). Finally, the precision of speech disorder diagnosis showed ROC curve areas ranging from 0.87 to 0.94, indicating high screening accuracy. These findings support the potential application of the Mandarin Articulation and Phonological Test in future research on children's speech abilities and provide a valuable reference for current clinical assessment and intervention in articulation and phonological disorder
[[alternative]]Speech Fluency Performance in Patients with Cognitive Decline
No full text[[abstract]]在認知衰退初期，臨床神經心理測驗較難檢測出輕微衰退表現，而語言能力為高敏感度且早期顯現之指標，可協助鑑別早期認知衰退族群。相較於保存較多的語言理解能力，語言產出衰退更為明顯，隨著認知能力下降，詞彙量、語意豐富度及流暢度也隨之下降。流暢度包含詞語流暢度（verbal fluency）及言語流暢度（speech fluency）。前者為在一定時間內提取特定詞彙的能力，可反應說話者的語意知識及執行功能，後者則指說話的流暢度、速度及節奏，反應運動言語規劃、工作記憶、執行功能等，兩者皆與潛在認知過程及處理速度相關。相比於由施測者主觀判斷之詞彙、語意層面指標，言語流暢度量測說話速度、停頓次數、平均音節長度等客觀量化之參數，便於自動化分析，能有效減少耗時及人力。因此，本研究旨在探討認知衰退族群於流暢度之表現及鑑別度最高之流暢度指標，期能提供臨床快速、準確且高效之工具，以檢測認知衰退族群。本研究與台北榮民總醫院合作，招募健康長者16名，主觀認知衰退（Subjective Cognitive Decline, SCD）34名，及兩組認知受損族群：輕度認知障礙（Mild Cognitive Impairment, MCI）39名及阿茲海默症患者（Alzheimer’s Disease, AD）16名。平均年齡 71.6.8 ± 5.4歲，簡易心智量表（MMSE）平均分數26.7 ± 2.4分。四組皆完成聽覺數字記憶廣度、蒙特利爾認知測驗（MoCA）、波士頓命名測驗（BNT）等認知功能及語言測驗，並以語意流暢度測驗、圖片描述測驗、短文念讀任務誘發語言樣本。以MANCOVA分析四組間在言語流暢度指標上的差異，並使用多元線性回歸分析探討言語流暢度對認知能力的解釋力。研究結果顯示，語意流暢度測驗中，總詞彙數（WC）、節點數（N）、邊線數（E）、密度（Density）及平均出入度（ATD）等指標上出現組間差異。圖片描述任務中，停頓次數在組間接近顯著。短文念讀中，停頓次數在組間亦接近顯著。而以三項語言任務的流暢度面向解釋認知能力，發現語意流暢度測驗對認知測驗的解釋力最高，其次為短文念讀，圖片描述任務最低。綜上所述，流暢度可作為量測認知能力的客觀指標，且此三項語言任務皆有助於臨床診斷，而流暢度指標能有效區分不同認知衰退階段的族群，例如語意流暢度的總詞彙數、節點數，及圖片描述任務及短文念讀的說話速度、停頓次數等。[[abstract]]During the early stages of cognitive decline, detecting subtle symptoms using clinical neuropsychological assessments may be challenging. Language performance, on the contrary, may provide a highly sensitive and early indication. In particular, compared to the relatively intact comprehension abilities, language production exhibits a more notable deterioration, evidenced by decreases in lexical diversity, semantic richness and speech fluency. Fluency includes verbal fluency and speech fluency. Verbal fluency refers to the capability to retrieve specific words within a set time frame, reflecting the speaker's semantic knowledge and executive functions. While speech fluency pertains to the smoothness, speed, and rhythm of speech, indicating motor speech planning, working memory, and executive functions. Both are associated with underlying cognitive processes and processing speed. Fluency provides objective and quantifiable parameters such as speech rate and pause frequency, facilitating automated analysis and reducing examination time. This study aims to investigate the speech fluency profiles of patients with cognitive decline and identify fluency indicators with the highest discriminatory ability, offering rapid, accurate and efficient clinical method for detecting cognitive decline. All participants were recruited from Taipei Veterans General Hospital, including 16 healthy controls (HC), 34 with subjective cognitive decline (SCD), 39 with Mild Cognitive Impairment (MCI), and 16 with Alzheimer's Disease (AD). The mean age was 71.6.8 ± 5.4 years, with an average Mini-Mental State Examination (MMSE) score of 26.7 ± 2.4. All completed a battery of neuropsychological assessments: digit span, the Montreal Cognitive Assessment (MoCA), and the Boston Naming Test (BNT). A semantic fluency test, a picture description task, and a passage reading task were administered to elicit language samples. One-way ANOVA was used to analyze differences in speech fluency indicators among the four groups of participants. The research findings indicate significant intergroup differences in semantic fluency test indicators such as Word Counts (WC), Nodes (N), Edges (E), Density, and Average Total Degree (ATD). In picture description tasks, the number of pauses nearly approached significance between groups. In passage reading tasks, the number of pauses nearly differentiated between groups. When examining cognitive abilities through fluency measures across these three language tasks, semantic fluency tests showed the highest explanatory power for cognitive test performance, followed by passage reading, with picture description tasks having the least explanatory power.In conclusion, speech fluency serves as an objective measure of cognitive abilities, and the three language tasks discussed are beneficial for clinical diagnostics. Certain fluency indices effectively differentiate stages of cognitive decline, such as total word count and node count in semantic fluency tasks, as well as speech rate and number of pauses in picture description and passage reading tasks