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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. [ABSTRACT FROM AUTHOR]

A part from a formal university degree, there are currently no broadly accepted standards for knowledge, training and experience for an operations research practitioner. The lack of an accepted standard […]

Background & Aims: The epidemiology of hepatitis B virus (HBV) infection differs between Asians and non‐Asians, but little is known regarding the effect of ethnicity on outcomes of HBV‐related hepatocellular carcinoma (HCC). We aim to characterize the presentation and survival outcomes in Asian and non‐Asian patients with HBV‐related HCC. Methods: We analyzed the baseline characteristics and long‐term survival of 613 Asian and 410 non‐Asian patients with HBV‐related HCC from three US and one Spanish centre. Results: Overall, non‐Asian patients were more likely to have HIV or hepatitis C co‐infection, cirrhosis, decompensated liver disease and advanced BCLC stage (all P ≤.04). Compared with Asians, non‐Asians were more likely to be listed for transplantation (P <.0001) and undergo HCC treatment with curative intent (P =.003). Propensity‐score matching on HCC diagnosis year, gender and age was performed to balance the two groups for survival analysis and yielded 370 pairs of patients. There was no significant difference in survival overall (P =.43) and among patients with cirrhosis (P =.57). Among patients without cirrhosis, non‐Asians had poorer 5‐year survival compared with Asians (37.6% vs 53.7%, P =.01), and was associated with poorer survival after adjusting for age, gender, diabetes, alcohol, co‐infections, diagnosis date, antiviral therapy, BCLC stage and HCC treatment (adjusted HR 2.01 [95% CI 1.07‐3.74], P =.03). Conclusion: Among HBV‐related HCC patients, non‐Asians presented with more advanced BCLC stage compared to Asians. Non‐Asian ethnicity was independently associated with twice the risk of mortality among patients without cirrhosis, but not among those with cirrhosis. Additional studies are needed to clarify this disparity. [ABSTRACT FROM AUTHOR]

Metabolic‐associated fatty liver disease (MAFLD) is a major cause of liver‐related complications, including hepatocellular carcinoma (HCC). While MAFLD‐related HCC is known to occur in the absence of cirrhosis, our understanding of MAFLD‐related HCC in this setting is limited. Here, we characterize MAFLD‐related HCC and the impact of cirrhosis and screening on survival. This was a multicenter, retrospective, cohort study of MAFLD‐related HCC. MAFLD was defined based on the presence of race‐adjusted overweight, diabetes, or both hypertension and dyslipidemia in the absence of excess alcohol use or other underlying cause of liver disease. The primary outcome of interest was overall survival, and the primary dependent variables were cirrhosis status and prior HCC screening. We used Kaplan‐Meier methods to estimate overall survival and Cox proportional hazards models and random forest machine learning to determine factors associated with prognosis. This study included 1,382 patients from 11 centers in the United States and East/Southeast Asia. Cirrhosis was present in 62% of patients, but under half of these patients had undergone imaging within 12 months of HCC diagnosis. Patients with cirrhosis were more likely to have early stage disease but less often received curative therapy. After adjustment, cirrhosis was not associated with prognosis, but the presence of cancer‐related symptoms at diagnosis was associated with poorer prognosis. Conclusion: Cirrhosis was not associated with overall survival in this cohort of MAFLD‐related HCC, while diagnosis in the presence of symptoms was associated with poorer prognosis. The HCC surveillance rate in patients with MAFLD‐related HCC was disappointingly low in a multicenter cohort. [ABSTRACT FROM AUTHOR]

Simple Summary: It is important to understand the impact of viremia on the survival of hepatocellular carcinoma (HCC) in hepatitis C patients. This study aimed to investigate the characteristics and survival between hepatitis C patients with and without viremia at HCC diagnosis. We enrolled 1,389 HCC patients, including 301 with HCC developed after hepatitis C eradication (post-SVR HCC) and 1,088 with hepatitis C viremia (viremic HCC). Post-SVR HCC patients had better liver function, earlier tumor stages and higher median survival than viremic HCC patients. But post-SVR HCC was not independently associated with survival on further multivariate analysis. On sub-analysis, viremic HCC patients who subsequently eradicated hepatitis C had higher median survival and was also significantly associated with lower mortality as compared to post-SVR HCC. Therefore, the advantages in clinical and tumor characters determined the better overall survival of post-SVR HCC patients; however, eradication of hepatitis C after HCC also improved survival. The clinical presentation and survival of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) eradication as compared to HCC in viremic patients are not well characterized. We aimed to investigate the characteristics and survival between HCV patients with and without viremia at HCC diagnosis.: We retrospectively analyzed overall survival outcomes in 1389 HCV-related HCC patients, including 301 with HCC developed after HCV eradication (post-SVR HCC) and 1088 with HCV viremia at HCC diagnosis (viremic HCC). We also evaluated overall survival in the two groups using propensity score-matching methods.: At HCC diagnosis, post-SVR HCC patients were older, less obese, less likely cirrhotic, with better liver function, lower alfa-fetoprotein levels, earlier BCLC stages, and higher rate of treatment with surgery. Overall, post-SVR HCC patients had higher median survival than viremic patients (153.3 vs. 55.6 months, p < 0.01), but post-SVR HCC was not independently associated with survival on multivariate analysis (adjusted HR: 1.05, 95% CI: 0.76–1.47). However, on sub-analysis, viremic HCC patients who subsequently received anti-viral treatment and achieved SVR had higher median survival than post-SVR HCC patients (p < 0.01). Viremic HCC with subsequent SVR was also significantly associated with lower mortality as compared to post-SVR HCC (adjusted HR: 0.18, 95% CI: 0.11–0.29). In addition, we observed similar findings in our analysis of the propensity score-matched cohorts.: The advantages in clinical and tumor characters at HCC diagnosis determined the better overall survival of post-SVR HCC patients; however, HCV eradication after HCC development was also associated with improved survival. [ABSTRACT FROM AUTHOR]

Provides information on the dietary guidelines in Australia. Purpose of the guidelines; Components; Public acceptance of the guidelines; Approach used in setting the dietary guidelines.

The article presents a case study of a 51-year-old woman with Crohn's disease diagnosed with nephrotic syndrome after receiving certolizumab pegol treatment. She was admitted due to severe joint pains and diarrhea, and was treated with certolizumab pegol after failurtreatment with other anti-tumor necrosis factor alpha (TNFA) agents. She had complaints on her urine after six months prior to her treatment.

Public health nutrition is focused on the prevention of diet-related diseases and the attainment of good health, through policy, education and health promotion. It involves many sectors of the community, cooperating to improve the health and wellbeing of the population with emphasis on prevention, equity, wellbeing and improved quality of life. In the majority of western countries, an epidemic of coronary heart disease (CHD) began after World War One, reaching its peak in the 1970's. In Asia, the epidemic began after WW2 with the rapid economic development of the region. In western countries, of which Australia is a typical example, health promotion activities and improved hospital treatment have been effective in reducing the impact of the CHD epidemic. The life expectancy of the population has steadily grown to 75.6 years for males and 81.3 years for females. Despite major advances in the prevention and treatment of cardiovascular disease, it is still the leading cause of premature mortality and morbidity in Australia. Furthermore, cardiovascular disease shares common risk factors with other leading causes of death, including lifestyle behaviours (diet, physical inactivity, alcohol consumption, smoking), physiological states (obesity, hypertension, high blood cholesterol) and socioeconomic factors. For Asia, the challenge is to implement public health policies that will tackle the epidemic of chronic disease before it reaches its peak. Health Promotion policies will be important for all countries. The use of the disability adjusted life years (DALY) methodology to measure the association between the cause of disease and relate its occurrence to health outcomes will be an important public health planning tool. Asia Pac JPublic Health 2000;12(Supp):S18-S20 [ABSTRACT FROM PUBLISHER]