Background and Aims: Antiviral treatment can reduce mortality of viral hepatocellular carcinoma (HCC) but may be underutilized. Methods: In a multinational real-world consortium of HCC patients with hepatitis B (HBV-HCC) or C (HCV-HCC) from 16 centers (7 countries/regions), we assessed treatment rates of nucleos(t)ide analogs in HBV-HCC (2007-2023) and direct acting antivirals in HCV-HCC (2015-2023). Results: Among 3,973 HCC patients (3,186 HBV, 647 HCV, 140 HBV/HCV), 49.7% of HBV-HCC and 63.2% of HCV-HCC patients received antiviral treatment. For HBV, lower treatment rates were observed in female (41.7% vs. 51.8%), older (>60) (45.3% vs. 54.5%), noncirrhosis (41.3% vs. 56.8%), and Asia region (37.9% vs. 85.0%) patients; for HCV, lower rates in male (59.0% vs. 72.4%), cirrhosis (60.5% vs. 73.2%), and non-Asia region (58.2% vs. 69.9%) patients, all P <0.005. Child A cirrhosis and Barcelona Clinic Liver Cancer (BCLC) 0/A patients had highest treatment rates followed by Child B and C or BCLC B, C, or D for both HBV (78.6%, 48.3%, 43.8%; 59.9%, 50.9%, 36.7%, 41.0%) and HCV (68.2%, 53.3%, 38.6%; 72.5%, 53.3%, 51.9%, 30.2%), all P <0.001. Factors independently associated with lower treatment rates were: female, age>60, Asia region, noncirrhosis, and BCLC B or C (vs. 0/A) for HBV; male, age>65, Child B or C cirrhosis (vs. non-cirrhosis), and BCLC B or C for HCV. Antiviral treatment was independently associated with reduced mortality in both HBV-HCC (adjusted hazard ratio [aHR]=0.82) and HCV-HCC (aHR=0.31) patients. Conclusion: Despite survival benefits, antiviral therapies were substantially underutilized in both HBV-HCC and HCV-HCC, particularly in advanced patients.

BACKGROUND/OBJECTIVE:Limited evidence exists regarding the socioeconomic inequalities in cerebrovascular disease (CBD) mortality at different urbanization levels. Therefore, this study was conducted to assess the socioeconomic inequalities and urbanization levels in township-based CBD mortality in Taiwan.METHODS:Socioeconomic variables, including the percentages of low-income households, individuals with a university education and above, and tax payments, were measured at the township level from 2011 to 2020. Urbanization was also determined by the national survey and divided into seven levels. Age-standardized mortality rate (ASMR) of CBD was calculated using a Geographic Information System (GIS) in 358 townships. The effects of socioeconomic variables and urbanization levels on relative and absolute inequalities in township-based CBD mortality rates were examined.RESULTS:Significant differences in ASMR of CBD were observed across all socioeconomic status indicators over the years. Higher proportions of low-income households were associated with higher ASMR of CBD. Conversely, there were negative correlations between higher proportions of individuals with a university education and above and tax payments with ASMR of CBD. The regression analysis indicated significant impacts of relative and absolute socioeconomic inequalities on ASMR of CBD. Additionally, a moderation effect of socioeconomic variables and urbanization on CBD mortality rates was observed, with rural areas showing sensitivity to these factors.CONCLUSION:Although ASMR of CBD showed significant decreases over time, socioeconomic inequalities in CBD mortality rates persist. Interventions targeting socioeconomic inequalities in health outcomes, especially in rural areas, are needed to address this issue.

Police officers often face emotionally challenging interpersonal situations and numerous studies have demonstrated that policing is a stressful occupation. A study revealed a significant positive correlation between emotional demands among police officers and emotional dissonance, as well as burnout. Health-promoting behaviors can contribute to better overall health outcomes and reduce the risk of developing health problems, but there is limited research evaluating the association of job strain and health behaviors with mental health outcomes in police officers. The objective of this study was to assess the job strain associated with mental health mediated by health behaviors in Taiwanese police officers. This was a cross-sectional quantitative study conducted in Oct 2016. A total of 41,871 police officers (response rate was 79.7%) participated questionnaire that consisted of demographic information, job characteristics, health behaviors, and mental component summary (MCS) scores of the Short-Form Health Survey. Independent t-tests and one-way analysis of variance (One-way ANOVA) were conducted to assess the differences in mean MCS scores across various demographics, health behavior, and job characteristics. Multivariate regression analyses were used to assess the relationship between job strain and health behaviors with mental health outcomes. MCS scores were associated with job characteristics and health behaviors among police officers except for gender. After adjusting for covariates, multivariate analysis indicated that police officers with high job demands and high job strain index exhibited poor MCS scores. Job strain was significantly associated with MCS mediated by health behaviors (consumption of fruits and vegetables, and physical activity) in Taiwanese police officers. Since regular physical activity and increased vegetable and fruit consumption might alleviate the effects of job strain on mental health status, it is recommended that institutional policies be established to promote health-enhancing behaviors among police officers.

With rapid urbanization in Taiwan, the green space has become a key factor in modifiable cardiovascular disease (CVD) risks. We investigated the relationships between socioeconomic status (SES), green space, and cerebrovascular disease (CBD) at the township level in Taiwan, focusing on urban–rural disparities. Analyzing data from 358 townships (2011–2020), we examined SES indicators (e.g., low-income households, education levels, median tax payments), green space (Normalized Difference Vegetation Index—NDVI), and CBD mortality rates using the pooled ordinary least squares (OLS) and random-effect models (REM) in panel regression. Additionally, we explored the mediating role of the NDVI in the SES-CBD mortality association. CBD mortality decreased more in urban areas over the decade, with consistent NDVI patterns across regions. Rural areas experienced a decline in low-income households, contrasting with an increase in urban areas. SES variables, NDVI, and time significantly affected CBD mortality in rural areas but not urban ones. Notably, the NDVI had a stronger impact on CBD mortality in rural areas. Mediation analysis revealed the NDVI’s indirect effects, especially in rural areas. Despite overall declines in CBD mortality in Taiwan, urban–rural disparities in SES and green space persist. Addressing these disparities is critical for understanding and developing interventions to mitigate health inequalities.

Workplace violence (WPV) is on the rise in occupational settings across Taiwan, with civil servants being no exception to this concerning trend. This study seeks to explore gender disparities in WPV and assess its correlation with job characteristics. A total of 20,046 civil servants from 647 institutions participated in the study, revealing significant gender-based differences in the occurrence of four categories of violence. Upon adjusting for covariates, the findings indicate that female civil servants exhibit higher odds ratios (aORs) for experiencing psychological (aOR=1.62), verbal (aOR=1.43) and sexual harassment (aOR=1.40). Particularly noteworthy is the increased likelihood of WPV among female civil servants compared to their male counterparts, especially within specific demographics: those working in health services (aOR=2.24), local government (aOR=1.64), unmarried civil servants (aOR=1.88) and those in supervisory positions (aOR=1.64). These results hold significant implications for anticipating, preventing and intervening in incidents of WPV within governmental offices. There is a pressing need for enhanced training programmes addressing gender-based WPV, emphasizing the importance of preparedness and intervention strategies for civil servants, especially those identified as more vulnerable based on their demographic and occupational profiles.

Summary Background Racial and ethnic disparities exist for hepatitis C virus (HCV) treatment and hepatocellular carcinoma (HCC) survival. Aim To evaluate the impact of HCV treatment on such disparities. Methods In a retrospective cohort study, we analysed 6069 patients with HCV‐related HCC (54.2% Asian, 30.1% White, 8.5% Black, and 7.3% Hispanic) from centres in the United States and Asia. Results The mean age was 61, 60, 59 and 68, respectively, for White, Black, Hispanic and Asian patients. Black patients were most likely to have Barcelona Clinic Liver Cancer stage D, vascular invasion and distant metastasis (23% vs. 5%–15%, 20% vs. 10%–17% and 10% vs. 5%–7%, respectively; all p < 0.0001). Treatment rate with direct‐acting antiviral agents (DAA) was 35.9% for Asian, 34.9% for White, 30.3% for Hispanic (30.3%), and 18.7% for Black patients ( p < 0.0001). Among those untreated or without sustained virologic response (SVR), 10‐year survival rates were 35.4, 27.5, 19.3 and 14.0, respectively, for Asian, Hispanic, White and Black patients ( p < 0.0001). There were no statistically significant differences among those with SVR ( p = 0.44). On multivariable analysis adjusted for relevant confounders, there was no statistically significant association between survival and being Hispanic (aHR: 0.68, p = 0.26) or Black (aHR: 1.18, p = 0.60) versus White. There was a significant association between being Asian American and survival (aHR: 0.24, p = 0.001; non‐U.S. Asian: aHR: 0.66, p = 0.05), and for SVR (aHR: 0.30, p < 0.0001). Conclusion DAA treatment rates were suboptimal. Racial and ethnic disparities resolved with HCV cure. Early diagnosis and improved access to HCV treatment is needed for all patients with HCV infection.

Objective:Evidence indicated that shift work is a contributing factor to risk of obesity and leads to cardiovascular diseases (CVDs), but few researches have examined the moderating effects of job demand and contingent work schedule on overweight and obesity. Thus, we assessed the modification effect of contingent work schedules and job demand on overweight and obesity among Taiwan's civil servants.Methods:Multistage stratified random cluster sampling was used based on a proportional probabilistic sampling (PPS) in a national survey for civil servants. A total of 20,046 participants from 647 registered governmental institutions were enrolled and anonymously and voluntarily filled out web-based questionnaires.Results:Compared to fixed work schedule, odd ratios (ORs) of obesity and overweight were 1.63 and 1.78 times in contingent work schedule, respectively. In addition, the modification effects of contingent work schedule and high job demand on overweight and obesity with Rothman's synergy index were 2.43 and 2.56, respectively. Using a hierarchical regression model adjusted for covariates, both high job demand and contingent work schedule were interactively associated with overweight and obesity compared to low job demand and fixed work schedule.Conclusion:Since precarious schedules affect employee's obesity through work-related stress and unhealthy behaviors, further research is needed to determine whether interventions aimed at modification of work schedule may be useful in combating obesity.

Objectives: Work-related stress (WRS) is significantly associated with health-related quality of life (HRQoL), but the amounts of evidence on differences of effort-reward imbalance (ERI) and job strain index (JSI) remain sparse and have limited generalizability. Therefore, we aimed to assess the association between ERI and JSI with HRQoL and assess the mediation effect of social support (JS) and over-commitment (OC) on this association in Taiwan's civil servants. Material and Methods: A cross-sectional national survey was given to registered civil servants in Taiwan – 20 046 civil servants from 647 institutions were enrolled using multistage stratified random cluster sampling. A web-questionnaire collected demographic information, job characteristics, and different indexes of ERI and job-control-demand-support (JCDS) models. Structural equation model (SEM) was used to examine the association between ERI and JSI with HRQoL, and the mediation effect of JS and OC on the associations. Results: In the ERI model, ERI and OC were consistently negatively associated with the mental component score (MCS) (r = –0.46 and r = –0.37) and physical component score (PCS) (r = –0.45 and r = –0.34), which were higher than job demand (r = –0.28 and r = –0.22) and JSI (r = –0.38 and r = –0.29). Using hierarchical multiple regression analyses, ERI was significantly correlated with MCS and PCS, which was consistently higher than JSI. The ERI and JSI were significantly correlated with MCS (β = –0.170 and β = –0.140) and PCS (β = –0.150 and β = –0.082) using SEM analysis, whereas ERI was considerably higher than in JSI. In addition, OC and JS mediated the association between The ERI and JSI with HRQoL. Conclusions: We found the ERI index is significantly correlated with HRQoL superior to JSI, in particular among Taiwan civil servants. Further longitudinal studies are needed to determine the causality and spatiotemporal relation of these differences. Int J Occup Med Environ Health. 2022;35(4):425–36

Background The aims of this study were to investigate if recipient artery choice in right lobe living donor liver transplant affects postoperative complications and discuss solutions accordingly. Methods Three hundred fourteen right lobe living donor liver transplantation patients were divided into 2 groups: 163 patients using right hepatic artery as the recipient vessel and 151 patients using left hepatic artery as the recipient vessel. Cases involving 2 recipient blood vessels or the use of other blood vessels as recipient vessels were excluded. Results Overall vascular embolism rate in both groups was 1.3%, and our complication rate was lower than those in previous studies. There was no significant difference in complication rate between the groups, but a significant difference in recipient/donor artery size ratio was noted. Conclusions Although left hepatic artery's anatomical position makes it less affected by bile duct anastomosis and thus fewer postoperative complications, we believe that the ratio of the donor-recipient blood vessel size and the length of the anastomosis vessel stumps are the key factors that affect the outcome of the vascular anastomosis.

Aim Occupational strain is recognized as a risk for arthritis, yet little is known about how psychological stress affects arthritis moderated by sleep duration. The objective of this study is to assess work-related stress using the effort-reward imbalance (ERI) model and the job-demand-support (JDS) model on arthritis moderated by sleep duration. Methods A nationwide cross-sectional study randomly collected a total of 11,875 middle-aged, employed civil servants from 647 registered governmental institutions. Each participant anonymously and voluntarily filled out a web-based questionnaire and informed consent at the time of the study. Psychosocial work stress was assessed by ERI and JDS measured by a Chinese version of the job content questionnaire. Results There were significant odds ratios (ORs) of arthritis positively associated with high ERI (OR = 1.58), high overcommitment (OC) (OR = 1.57), and job demand (OR = 1.31) and negatively associated with job support (OR = 0.69) using multivariate analysis after being adjusted for covariates. For the short sleep duration group, there was an interaction effect of both high ERI and OC on arthritis, with a synergy index of 18.91 and 1.52, respectively. Similarly, there are high ORs of arthritis in both the high job demand and low job support groups. Conclusion Work-related stress related to arthritis moderated by sleep duration for civil servants. Civil servants with high job demand and low job support should use caution to reduce the risk of arthritis.

Abstract Cosmetic appearance is a major concern for living donors. However, little is known about the impact of a surgical scar on body image changes in living liver donors. The aim of this study was to identify potential factors that cause displeasing upper midline incision scar, and to evaluate the overall satisfaction regarding body image and scarring after living donor hepatectomy. Donors who underwent right lobe hepatectomy were recruited. Exclusion criteria included reoperation, refusal to participate, and lost follow-up. All donors were invited to complete the Vancouver Scar Scale (VSS) and the body image questionnaire. According to the VSS results of upper midline incision scar, donors were divided into 2 groups: good scarring group (VSS ≤4) and bad scarring group (VSS >4). we compared the clinical outcomes, including the demographics, preoperation, intraoperation, and postoperation variables. The study also analyzed the results of the body image questionnaire. The proportion of male donors was 48.9%. The bad scarring group consisted of 63% of the donors. On multivariate analysis, being a male donor was found to be an independent predictor of a cosmetically displeasing upper midline incision scar with statistical significance. The results of body image questionnaires, there were significant differences in cosmetic score and confidence score among the 2 groups. The upper midline incision and male donors have higher rates of scarring in comparison with the transverse incision and female donors. Donors who reported having a higher satisfaction with their scar appearance usually had more self-confidence. However, the body image won’t be affected. Medical staff should encourage donors to take active participation in wound care and continuously observe the impact of surgical scars on psychological changes in living liver donors.

OBJECTIVES Neurologic complications are more common in liver transplants than in other solid-organ transplants. One such neurologic complication, peripheral neuropathy, may cause functional limitations for recipients and have a negative effect on posttransplant quality of life. We aimed to examine the risk factors associated with the occurrence of clinical neuropathy after liver transplant and to investigate the frequency of sensory deficits. MATERIALS AND METHODS In this case-control study, we analyzed factors from medical records of 63 recipients who underwent living donor liver transplant during the period from January 2010 to December 2016. A neuropathy symptom score was assigned to identify the patients who had clinical neuropathy (case group) and the patients without clinical neuropathy (control group). Quantitative sensory testing was performed to measure the warm and cold detection thresholds, and the difference between the 2 groups was examined. RESULTS Compared with controls, patients with clinical neuropathy were older (61.0 vs 55.4 years; P = .028), had higher rates of diabetes (46.2% vs 16.0%; P = .03), and were taking antiviral agents against hepatitis B (100% vs 62%; P = .006). Patients with neuropathic symptoms had significantly increased frequencies of impairment of warm and cold detection thresholds. In addition, the greater severity of symptoms showed higher detection thresholds of warm (control, 40.7℃; mild-to-moderate, 43.8 ℃; severe, 46.0 ℃; P = .007) and cold (control, 28.8℃ ; mild-to-moderate, 27.0 ℃; severe, 21.8 ℃ ; P = .008). CONCLUSIONS Our findings show that older age, diabetes, and treatment with oral antiviral agents against hepatitis B virus were more likely to be associated with the occurrence of clinical neuropathy after liver transplant. Early awareness and careful monitoring are warranted.

Background: Many factors cause hospital mortality (HM) after liver transplantation (LT).Methods: We performed a retrospective research in a single center from October 2005 to June 2019. The study included 463 living donor LT patients. They were divided into a no-HM group (n=433, 93.52%) and an HM group (n=30, 6.48%). We used logistic regression analysis to determine how clinical features and surgical volume affected HM. We regrouped patients based on periods of surgical volume and analyzed the clinical features.Results: Multivariate analysis revealed that donor age (OR= 1.050, 95% CI: 1.011– 1.091, p=0.012), blood loss (OR=1.000, 95% CI: 1.000–1.000, p=0.004), and annual surgical volumes being < 30 LTs (OR=2.540, 95% CI: 1.011–6.381, p=0.047) were significant risk factors. A comparison of years based on surgical volume found that when the annual surgical volumes were at least 30 the recipient age (p=0.023), donor age (p=0.026), and ABO-incompatible operations (p<0.001) were significantly higher and blood loss (p<0.001), operative time (p<0.001), intensive care unit days (p<0.001), length of stay (p=0.011), rate of re-operation (p<0.001), and HM (p=0.030) were significantly lower compared to when the annual surgical volumes were less than 30.Conclusions: Donor age, blood loss and an annual surgical volume < 30 LTs were significant pre- and peri-operative risk factors. Hospital mortality and annual surgical volume were associated with statistically significant differences; surgical volume may impact quality of care and transplant outcomes.

The purpose of this study is to evaluate the prognostic value of preoperative Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+-M2BP) in predicting overall survival for patients with hepatitis B- and hepatitis C-related early-stage hepatocellular carcinoma (ESHCC) after liver resection. Post-operative survival rates were compared according to WFA+-M2BP level and tumor stage. Six hundred and ten patients were identified and 198 were removed after application of the exclusion criteria; the median follow-up time was 4.33 years, and cancer-related death occurred in 117 (28.4%) patients. Age (p = 0.03), fibrosis grade (p = 0.042), cancer stage (p = 0.01), and WFA+-M2BP level (p = 0.001) were identified as independent risk factors for poor overall survival. The overall survival rates at 3 and 5 years for patients with WFA+-M2BP ≤ 1.12 were 0.92 and 0.90, respectively, and 0.76 and 0.61 for patients with WFA+-M2BP > 1.12 (p < 0.001). During the analysis of survival prediction, serum WFA+-M2BP level exhibited a higher log-likelihood and a lower AIC value compared to TNM stage (log likelihood: −638; AIC: 1279). Pre-operative serum WFA+-M2BP level provided important prognostic information after curative hepatic resection in our study.

The present study aimed to compare the accuracy of Wisteria floribunda agglutinin-positive Mac-2-binding protein (WFA+-M2BP) and magnetic resonance elastography (MRE) in determining the liver fibrosis stage in patients with chronic liver disease. A retrospective review of a prospectively maintained database was performed. The eligible patients had hepatic tumors and chronic liver disease, including hepatitis B (HBV) and HCV. All patients underwent blood sampling, MRE and hepatectomy at Changhua Christian Hospital (Changhua, Taiwan). Surgical specimens were used to determine definitive histopathological diagnoses and liver fibrosis stages. Measurement of liver stiffness was performed via MRI. The value of WFA+-M2BP in each patient was also assessed. The area under the receiver operating characteristic (ROC) curve (AUC) was measured to compare the diagnostic accuracy of the two examinations. The results indicated that the serum WFA+-M2BP levels were able to detect severe liver fibrosis (≥F3) in patients with chronic liver disease and performed as well as MRE in patients with HCV. Of the 238 patients enrolled in the present study, 135 had chronic HBV 75 had chronic HCV, 92 had early liver fibrosis (F1-F2) and 139 patients had advanced liver fibrosis (F3-F4). In predicting fibrosis stages ≥F3, MRE had an AUC of 0.89 with a cutoff value of 3.76 and serum WFA+-M2BP had an AUC of 0.65 with a cutoff value of 1.32. MRE had higher AUCs than serum WFA+-M2BP for predicting the severity based on the fibrosis stage in the total cohort and the HBV subgroup. In patients with HCV, no significant differences in diagnostic performance were identified between MRE and serum WFA+-M2BP. In conclusion, determination of WFA+-M2BP as a biomarker for predicting severe liver fibrosis (≥F3) is a reliable and non-invasive method and performs as well as MRE in patients with chronic liver disease, particularly those with HCV.

BACKGROUND:Accumulating evidence has shown that exposure to environmental tobacco smoke (ETS) is associated with cardiovascular diseases (CVDs) However, few studies have assessed both exposure to ETS and high-perceived work stress on hyperlipidemia. The aim of the present study is to assess the interaction effect of ETS exposure and high-perceived work stress on the risk of hyperlipidemia.METHODS:A total of 11,875 middle-aged civil servants from 647 registered institutions employed by the Taiwan government were randomly selected using multistage stratified cluster sampling based on proportional probabilistic sampling. Each participant anonymously and independently filled out a web-based questionnaire and informed consent.RESULTS:The prevalence of hyperlipidemia in middle-aged civil servants diagnosed by physicians was 11.5% for men and 6.1% for women. Hyperlipidemia was significantly associated with smoking, alcohol consumption, betel nut chewing, weight gain and perceived work stress. In both the obesity and smoking groups, there were consistent interaction effects of ETS exposure and perceived work stress on hyperlipidemia for middle-aged civil servants. Non-obese and non-smoking groups were more at risk for hyperlipidemia from exposure to both ETS and high-perceived work stress.CONCLUSION:There is an interaction effect of ETS exposure and high-perceived work stress on hyperlipidemia, regardless of obesity and smoking. It is crucial to immediately reduce ETS exposure and stressful work by enforcing smoke-free policies and reducing pressure for civil servants.