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Data on direct-acting antiviral agent (DAA) treatment for mixed genotype hepatitis C virus (HCV) infection are scant. This study examined the effectiveness of glecaprevir/pibrentasvir (GLE/PIB) and ledipasvir/sofosbuvir (LDV/SOF) for mixed HCV genotype infection in a real-world setting in Taiwan. We analysed the data from all patients with mixed HCV genotype infections treated with GLE/PIB or LDV/SOF from 2017 to 2019 in three Chang Gung Memorial Hospitals in Taiwan. The primary treatment outcome was sustained virologic response 12 weeks after treatment cessation (SVR12). Adverse events (AEs) were also evaluated. A total of 5190 HCV patients received DAA treatment during this time period. Among them, 116 patients (2.2%) had mixed infections of any 2 or 3 genotypes of 1a, 1b, 2, 3 and 6. Fifty-four patients received GLE/PIB and 62 received LDV/SOF. SVR12 rates for LDV/SOF vs GLE/PIB therapy were 96.6% (56/58) vs 100% (51/51) by the per-protocol analysis and 90.3% (56/62) vs 94.4% (51/54) by the evaluable population analysis. Two patients with 1b + 6 and 1b + 2 genotype infections in the LDV/SOF group had relapse. Evaluating the GLE/PIB vs LDV/SOF groups for the most common AEs revealed pruritus (16.7% vs 4.8%), abdominal discomfort (5.6% vs 8%) and fatigue (5.6% vs 4.8%). One patient with AE-related treatment discontinuation presented with liver decompensation after 4-week GLE/PIB therapy. DAA-related significant laboratory abnormalities occurred in two patients with >3× elevated bilirubin level in the GLE/PIB group. GLE/PIB and LDV/SOF are well tolerated and achieve high SVR12 rates for patients with mixed HCV genotype infection.

PURPOSE To explore the prevalence of hepatitis C virus (HCV) infection as well as the levels of liver health literacy and association with the health status of people with HCV through the nurse-led community health development goal of global elimination. METHODS A community-based, cross-sectional study was conducted between July 2018 and June 2019 in coastal Western Yunlin County, Taiwan. This study was conducted at five townships, and serum HCV antibody (anti-HCV) screening was used for the identification of potentially infected people by a collaborating local hospital. RESULTS Of the 1,963 adults from rural areas enrolled in this study, 321 (16.4%) were anti-HCV positive, 237 (73.8%) reported that they were unaware of their HCV positivity, and none of them were provided information on direct-acting antiviral agent therapy. The levels of anti-HCV positivity were higher among female patients (p < .05), elderly people (p < .001), those with a low education level (p < .001), and those from the Sihu Township within Yunlin County (p < .001). Participants with anti-HCV positivity tended to have lower intakes of vegetables (p < .01) and fruit (p < .05), a greater number of comorbidities (p < .05), as well as a greater incidence of abnormal liver (p < .001) and renal function (p < .001) compared to those with anti-HCV negativity. Multivariable linear regression analysis showed that the presence of HCV infection and a greater number of metabolic syndrome components were associated with poor liver and renal function. CONCLUSIONS These findings showed a high prevalence of HCV infection among adults living in rural areas, who had low literacy levels on hepatitis, unhealthy lifestyles, and abnormal liver and renal function. CLINICAL RELEVANCE Clinicians and primary healthcare providers should initiate efforts to increase the levels of liver health literacy by increasing the accessibility to infection confirmation tests and reducing the number of barriers to the reception of antiviral treatment.

Aims To study the future outcomes and health needs of chronic hepatitis C (CHC) patients after receiving direct-acting antiviral (DAA) therapy based on the health promotion perspectives and cardiometabolic risks in a rural setting. Design This cross-sectional study was conducted from May to December 2019 in coastal western and southern Taiwan. Methods We included CHC patients who were diagnosed and transferred by the gastroenterologist and hepatologist in outpatient clinics and completed DAA treatments. Data on demographic characteristics, health-related behaviours and physiological biomarkers were collected through one-on-one interview using a questionnaire and from medical records obtained from a teaching hospital. Results In total, 124 participants were enrolled. Most participants (87.1%) had no side effects and 79.8% felt satisfied after treatment. However, 62.1% had metabolic syndrome, 48.4% had hypertension and 37.9% had diabetes. Furthermore, 71.8% patients were considered to have medium-to-high risk based on Framingham risk scores. In the multiple regression model, after adjusting for education level, other chronic diseases were negatively associated with health-promoting behaviours in participants. Conclusions Although there were few side effects and most patients were satisfied after treatment, there was a high prevalence of cardiometabolic risk factors and cardiometabolic diseases and less adoption of healthy behaviours in CHC patients. Despite the small sample size, the study suggests that clinicians can reduce the burden of the aforementioned comorbidities by providing adequate treatment and individualized lifestyle modification. Impact This study highlights that primary healthcare providers should consider the health needs of CHC patients after DAA treatment since many patients have high cardiometabolic risks, but only a few adopt a healthy lifestyle. Further studies are needed to initiate health-promoting programs for these patients to reduce further injury to vital organs.

To explore the effectiveness of an oral hygiene programme combined with home phone counselling on hepatitis C patients during antiviral treatment.Hepatitis C virus infection is the leading cause of liver diseases. Evidence indicates that the antiviral treatment for hepatitis C virus infection has been successful, albeit its many side effects, such as discomfort symptoms of oral ulcers, which, in turn, leads to discontinued treatment. Inappropriate oral hygiene may worsen the side effects and increase the risk of dropping out of the treatment.A quasi-experimental pre-post-test design was used.The oral hygiene programme was based on a standardized protocol of oral health care combined with home phone counselling. The participants were recruited from an outpatient clinic between August 2016 and July 2017. The generalized estimating equation was used for repeated measures of oral health behaviour, oral health status and discomfort symptoms.Thirty-four participants completed this study. The findings indicated that the oral hygiene programme significantly improved tooth brushing, use of dental floss and oral comfort. The result showed that the participants' oral health status significantly improved in 3 months.This pilot study supports the finding that an oral hygiene programme can reduce oral discomfort, improve oral hygiene behaviour, and enhance the oral health status of hepatitis C patients receiving treatment. This is a simple and low-cost programme, which can be performed at home easily and boosts the completion of antiviral treatment.目的: 探讨口服卫生计划结合家庭电话咨询对丙型肝炎患者抗病毒治疗期间的效果。 背景: 丙型肝炎病毒感染是引起肝病的主要原因。有证据表明,丙型肝炎病毒感染的抗病毒治疗已取得成功,尽管它有许多副作用,如口腔溃疡的不适症状,这进而导致停止治疗。不适当的口腔卫生可能会加重副作用,增加退出治疗的风险。 设计: 采用准实验前后试验设计。 方法: 口腔卫生方案是根据一项标准化的口腔保健方案,并结合家庭电话咨询。参与者于2016年8月至2017年7月期间从门诊招募。采用广义估计方程对口腔健康行为、口腔健康状况和不适症状进行重复测量。 研究结果: 34名参与者完成了这项研究。研究结果显示,口腔卫生计划显著改善刷牙、使用牙线和口腔舒适度。结果表明,3个月后患者口腔健康状况明显改善。 结论: 这项初步研究证实,口腔卫生计划可减少口腔不适,改善口腔卫生行为,并改善接受治疗的丙型肝炎患者的口腔健康状况。这是一个简单和低成本的项目,可以在家里轻松执行,并促进抗病毒治疗的完成。.

Background and Objectives The majority of patients with diabetes foot ulcer have peripheral arterial disease. The technique of near infrared spectroscopy (NIRS) used to monitor the dorsal foot blood circulation condition is by measuring the absorption differences between oxy-hemoglobin and deoxy-hemoglobin. Study Designs/Materials and Methods Patients with diabetic foot ulcer (DFU) treated in our wound care center were divided into two sub-groups based on the Duplex ultrasound or angiography. Patients with peripheral arterial disease (PAD) and non-peripheral arterial disease were divided into group A1 and A2, respectively. We applied wireless NIRS on patients’ dorsal foot to assess the peripheral circulation by continuously detect the signal penetrating the tissue while patients were asked to do Buerger's exercise. The same procedure was also repeated on 15 healthy participants as control group B. Results From January to August 2015, 30 patients with DFU (Group A) were enrolled in the study, 9 patients in Group A1 and 21 patients in Group A2. Tissue concentration of oxygenated hemoglobin (HbO2) in each group varied in a similar trend among five stages of Buerger's exercise. HbO2 concentration increases at post-exercise stages in all groups (P = 0.006 in Group A1, P = 0.223 in Group A2, P = 0.03 in Group B), however, there were significant difference in both pre- and post-exercise stages (P = 0.001 and P = 0.01, respectively) between Group A and B. Moreover, significant differences (P = 0.0009) of HbO2 were also found between Group A1 and A2 in pre-exercise status, but no significant difference (P = 0.294) was found in post-exercise status. Similar results were also found in total hemoglobin (Hb) concentration analyses. Conclusions Buerger's exercise could increase peripheral HbO2 and total Hb circulation in patients with diabetes foot ulcer. The NIRS could continuously and quantitatively monitor real-time peripheral circulation in postural changes and is novel to rehabilitation program. A larger scale study to prove the accuracy of NIRS system in detecting peripheral circulation could be worthwhile. Lasers Surg. Med. © 2017 Wiley Periodicals, Inc.

Background Peripheral neuropathy and vasculopathy are important risk factors for diabetic foot ulceration (DFU). Buerger exercises for patients with arterial occlusive disease have previously been noted; however, current evidence to support this intervention is limited. Aim We established a standardized procedure for Buerger exercises combined with a health-promoting program and investigated its effectiveness in reducing peripheral neurovasculopathy among rural Taiwanese residents with type 2 diabetes who were at high risk of developing DFU. Methods A one group quasi-experimental pretest–posttest design was used. The Buerger exercise protocol composed of a three-step posture change with 9 minutes for each cycle. The health-promoting program composed of six dimensions of healthy habits. Outcome measurements 1 year after the beginning of the intervention included the ankle brachial pressure index (ABI), the Michigan neuropathy screening instrument (MNSI), blood pressure, frequency of self-reported leg discomfort, and a type 2 Diabetes Health Promoting Score. Findings Thirty-one of 66 (47%) subjects completed this study. Buerger exercises combined with the health-promoting program significantly improved (a) the ABI in the legs, (b) health-promoting behaviors, (c) MNSI values, and (d) leg discomfort symptoms. Linking Evidence to Action This study supports the use of Buerger exercises combined with the health-promoting program to improve symptoms of peripheral neuropathy and peripheral circulation in patients with type 2 diabetes.

Challenging stressors have been positively linked to various work outcomes. However, the role of individual differences in stress appraisal in shaping the function of challenging stressors and work outcomes has been rarely discussed. Drawing on the individual differences perspective, the authors propose that employees higher in challenge appraisal are more likely to have challenging stressors and are more responsive to such stressors to have a higher positive affect at work. Results obtained from 117 employees supported the hypotheses. The results indicated that challenge appraisal is positively related to challenging stressors. In addition, challenging stressors has a positive association with positive affect at work when challenge appraisal is high but has a null association when challenge appraisal is low. The findings suggest that challenging stressors does not necessarily bring positive work outcomes as suggested in past studies and highlight the importance of considering dispositional tendency in stress appraisal when looking into the function of challenging stressors and work outcomes.

Aims To evaluate the self-perception of diabetes control associated with physical indicators and with practicing exercise and a healthy diet, among rural residents. Background It remains unclear whether a subject's self-perception of diabetes control increases its deleterious effects. Design Cross-sectional, correlational. Methods We recruited 715 participants from 18 primary healthcare centres in the rural regions of Chiayi County, Taiwan. Data were collected between 1 January 2009–30 June 2010. Logistic regression was conducted to identify the determinant factors associated with perceptions of diabetes control. Results A high percentage of participants overestimated their fasting blood glucose and HbA1C status. Total cholesterol, triglyceride, low density lipoprotein cholesterol, blood pressure, and waist circumference exceeded the medical standard in the ‘feel good’ group, and many did not adopt a healthy diet and undertake physical activity. The final logistic regression model demonstrated that residents with diabetes who exercised frequently had normal fasting glucose, and normal HbA1C tended to perceive ‘feel good’ control. Conclusion Misperception and unawareness of diabetes control were prevalent among rural residents. Addressing misperceptions among rural residents with diabetes and increasing their knowledge of professional advice could be important steps in improving diabetes control in an elder population.

chen m.-y., huang w.-c., peng y.-s., guo j.-s., chen c.-p., jong m.-c. & lin h.-c. (2011) Effectiveness of a health promotion programme for farmers and fishermen with type-2 diabetes in Taiwan. Journal of Advanced Nursing 67(9), 2060–2067. Abstract Aims. This paper is a report of a study examining the diabetes control and foot self-care capability in farmers and fishermen following introduction of a multi-stage, multi-disciplinary team and community-based small group health promotion programme. Background. Improving the control of diabetes is a critical issue in Taiwan because mortality rates are increasing dramatically, particularly in rural populations. Methods. A quasi-experimental research design was deployed from January to December 2009. A total of 387 participants living in nine rural districts with previous diagnoses of type-2 diabetes were randomly selected. Three hundred and twenty-three completed the 3-stage programme, including health assessment, health promotion education and individually tailored telephone counselling and evaluation over a 1-year period. Results. Most of the participants were fishermen or farmers who had

The objective was to explore health-related behaviors among adolescent mothers living in the rural area of Taoyuan Taiwan. Design: A cross-sectional descriptive design and nonrandom survey method were used. Sample: The sample consisted of 37 adolescent mothers identified by public health nurses. Measurements: Standardized interview and Adolescent Health Promotion (AHP) questionnaire. Findings revealed a pattern of economic disadvantage. Nearly half of the participants still lived with their biological parents. Two-thirds needed economic support from their parents (generally coming from their biological mother). Thirty-five percent of participants reported never using contraceptives two-thirds had never had a Pap smear and 44% did not breast-feed their infants. Nearly 60% of the children were cared for by the biological mothers of the participants. Adolescent mothers with high school education and who were employed married and received parental economic support had better health-related behaviors than adolescent mothers without these characteristics. Although the study sample has geographic limitations future international studies with similar populations of adolescent mothers in rural settings will help public health nurses understand adolescent mothers_ stressors and needs which in turn affect their health-related behaviors. Intervention strategies are needed to encourage behaviors to keep this population healthy. (authors)

Background. The mortality rate and prevalence for some chronic diseases are higher for aborigines compared with the rest of the Taiwanese population. Health professionals in many countries have been concerned with the health of aborigines, but specific health policies for native adolescents have been neglected. Aims. This paper reports a study comparing the general health status of aborigines and non-aborigine female adolescents, based on school enrolment health examinations. Methods. A cross-sectional prevalence study with between group comparison was conducted. School enrolment health files were accessed between September 2000 and June 2001. A total of 320 selected female aboriginal students were compared with 237 non-aborigines. Results. With the exception of eye problems, general health status was inferior for the aboriginal female adolescent students. They had lower mean red blood cell volumes, lower haemoglobin concentrations, more oral decay, a greater prevalence of hepatitis B virus carriers and were more likely to be overweight. Conclusions. It seems reasonable to suggest that health intervention strategies specific for indigenous adolescents should be provided. The design of these strategies should target lifestyle modification and provision of more accessible health information. Health professionals, and particularly nurses, are in a prime position to offer advice and support to this group.