36卷3期

• Link 綜論 Review Article
• 特定職場二甲苯暴露與成人聽覺功能之總體性評估Xylene exposure on auditory function among adults in selected occupational settings: a systematic review
• 無
  Francis T. Pleban ,  Laxmi Shrestha ,  Olutosin Oketope ,  Shih-Chen Pleban
• 二甲苯；耳毒性；聽力；人體暴露
  xylene ; ototoxicity ; hearing ; human exposure
• 本研究主要目的為評估二甲苯與二甲苯混合物對在不同作業環境工作下的勞工聽覺之潛在影響。利用網際資料庫（EBSCO以及PubMed）的英文期刊搜索發表的論文進行評估。期刊內容以研究人為主（不包括動物研究），涵蓋期限為三十年（1985-2015）。研究論文包含了同儕審查的論文，病例對照研究，案例分析，以及案例報告。初始搜尋出56件案例。依據研究設計、樣本大小、研究設置、研究日期、以及研究方法，6篇期刊論文被篩選來做更進一步的檢閱。經由詳細的評估，6項研究被取來審查。在有噪音以及無噪音的環境下，研究分為純二甲苯（n=3）與含二甲苯有機溶劑（n=3）二組。整體研究結果顯示，二甲苯與二甲苯混合物加上其他干擾因素（如老化、性別、以及噪音等）對人類聽力的影響程度可由輕微到嚴重足以喪失聽力。雖然，過度的噪音暴露可能影響勞工的聽力。但研究建議，公共衛生機構以及法令單位應多鼓勵關於二甲苯暴露與耳毒性相關的研究。除此之外，長期暴露於二甲苯的個體，應定期進行廣泛的聽力檢查，並實施工業衛生控制，以便早期偵測出聽力的損失。
  A review study was conducted to examine potential adverse effects of xylene and xylene mixtures on the auditory system in workers employed in various settings. Utilizing internet-based databases EBSCO and PubMed, we searched peer-reviewed articles focusing on human subjects, published in English language, and spanning a 30 year time period (1985-2015). Studies included peer review full papers, case control studies, and case reports. Animal studies were excluded from the final analysis. Initial search results identified 56 studies. From studies meeting the inclusion criteria, the following data were extracted: publication date, study design, sample size, exposure setting and chemical, assessment method, and outcome. Six journals were retrieved for detailed examination. After detailed examination, six studies were included in the review. Studies were further subdivided into investigations related to xylene only (n=3) and investigations related to xylene mixed with other organic solvents (n=3), with or without the association of noise. As a whole, the results range from moderate associations between xylene or xylene mixtures and hearing, to altered hearing loss due to xylene and other confounders, such as aging, gender, and noise. Exposure to excessive noise, both in and out of the worksite, may contribute to decreased hearing in workers. However, findings suggest public health and medical professionals should be made aware of the future research needs pertaining to hearing dysfunction from occupational xylene exposure. It is recommended xylene-exposed individuals be routinely monitored for signs of auditory impairment; along with the implementation of pertinent industrial hygiene controls.
• 204 - 214
• 10.6288/TJPH201736105085

• Link 綜論 Review Article
• 「男性間性行為者」捐血禁令之公共衛生倫理分析Public health ethical analysis of blood donor deferral policy on men who have sex with men
• 葉明叡、 吳建昌
  Ming-Jui Yeh, Kevin Chien-Chang Wu
• 捐血者延緩捐血政策 ； 男性間性行為者 ； 制度性歧視 ； 效益主義 ； 公共衛生倫理
  blood donor deferral policy ; men who have men with men (MSM) ; institutional discrimination ; utilitarianism ; public health ethics
• 捐血者延緩捐血政策（blood donor deferral policy）藉著設定捐血者條件，達到控制風險、確保血液品質、以及維持穩定捐血量的目的。本文簡要回顧此政策在台灣的變遷歷程，分析當前法律對於曾進行男性間性行為者（men who have sex with men, MSM）永久不得捐血的規定。結果發現，運用重疊共識之方法學，效益主義、康德主義及社群主義之公共衛生倫理檢驗皆可支持廢除此禁令。因為：第一，根據效益主義的必要性與降低傷害的原則，此禁令並非限制最小的措施，無助於擴大愛滋病感染風險的防禦範圍；第二，根據效益主義的效益最大化觀點，此禁令無法提升捐贈血液之品質，反而可能降低捐血量，無法達到最大化良好品質捐贈血液數量的效果；第三、根據康德主義及平等權觀點，此禁令是國家對特定群體之制度性歧視，既不尊重自主，又不公平，甚至可能產生傷害的效果；第四、根據自由社群主義觀點，人們應能共同為了良好品質捐血的社會共同良善而努力，如此可超越威權社群主義維持禁令的主張。本文建議若政府無法提出合理的公共證成，應廢止此規定。
  Blood donor deferral policy aims at maintaining blood quality and a stable blood supply. In this ethical analysis, we review the transitions of the policy in Taiwan and focus on the lifetime ban on men who have sex with men (MSM). We subject the ban to a public health ethical examination based on three ethical theories. Using overlapping consensus as the methodology of justification, we have found that utilitarianism, Kantianism and communitarianism all support the repeal of the ban. First, we apply the doctrine of necessity and minimal harm and note that the ban cannot widen risk protection from HIV/AIDS. Second, we turn to the principle of maximizing utility and contend that the ban does not improve the quality of the blood, nor does it maximize the quantity of donated blood. Third, we apply Kantian and egalitarian perspectives to contend that the ban is actually a state-sanctioned act of institutional discrimination against MSM. Lastly, we apply liberal communitarianism and point out that virtuous society members would have the capacity to pursue the common good, which is maintaining the quality blood for the needy, if there were no such regulation unjustly targeting MSM. We suggest that if governmental authorities for the blood donor deferral policy cannot provide public justification for this regulation, it should be abolished.
• 215 - 228
• 10.6288/TJPH201736105126

• Link 綜論 Review Article
• 手機測皮膚癌、血壓？－談美國行動健康應用程式（mHealth app）發展與法制趨勢Using your smart phones to detect melanoma or measure blood pressure? - the latest developments and regulatory schemes regarding mobile health in the United States
• 孫文玲、 林于凱
  Wen-Ling Sun, Yu-Kai Lin
• 電子健康 ； 行動健康 ； 行動健康應用程式 ； 醫療器材
  electronic health (eHealth) ; mobile health (mHealth) ; mobile health applications ; medical devices
• 運用資通訊技術於健康的電子健康（eHealth），已被世界健康組織（WHO）列作定期檢視項目；83%會員國更已致力推動行動健康（mHealth）。依最新調查顯示，於主要行動平台上架的行動健康應用程式（mobile health applications, mHealth app）已近26萬個，至2020年市場規模可達310億美元。然而，mHealth app是否屬於醫療器材？應適用哪些法令規範？對於多數為科技創新而非傳統健康照護產業背景的mHealth app業者來說，確屬攸關後續發展的議題。本文以美國立法例切入，首先檢視近兩年聯邦貿易委員會（FTC）就偵測黑色素瘤、量測心跳血壓兩款mHealth app的案例，繼而分析食品藥物管理局（FDA）指引與FTC mHealth app線上版指引工具的規範架構；最後，本文檢視我國在醫用軟體管理與個人資料保護相關法令最新發展，進而建議為建構可預見性高、遵法成本低的mHealth app法制架構，宜納入以下考量：以終端使用者區分設計規範架構，並考慮跨國規範議題；使業者簡單判分「是否屬於醫療器材」與「是否與如何適用其他法令」；兼顧「科技創新」與「健康」需求。
  As electronic health (eHealth) has played a key role on the WHO agenda, 83% of WHO member states have implemented mobile health (mHealth) policies. The latest survey shows that the total number of mobile health applications (mHealth apps) on main mobile platforms has reached 260,000 and its market value is estimated to reach 31 billion USD by 2020. Since the majority of mHealth app publishers are technology companies or app developers rather than traditional healthcare industries, however, uncertainty about whether mHealth apps should be regulated as medical devices and governed by other laws and regulations might hinder their growth and development. The aim of this paper was to investigate the latest Federal Trade Commission (FTC) cases regarding the use of mHealth apps to detect melanoma and measure blood pressure. It also examined the Federal Drug Administration's (FDA) guidance and the FTC's interactive web tool to determine the regulatory approaches taken in the United States. In Taiwan, the TFDA issued medical software guidelines in 2015 and the highly controversial Article 6 of the Personal Information Protection Act regarding health information came into effect in March, 2016. To encourage the development of mHealth apps in Taiwan, we suggest the following: set up rules for end-users with different backgrounds and solve cross-border problems; help developers decide easily if regulations for medical devices apply, as well as how they comply with other laws and regulations; strike the perfect balance between innovation and health.
• 229 - 238
• 10.6288/TJPH201736106015

• Link 原著 Original Article
• 台灣版WHOQOL-OLD問卷之發展與驗證Development and validation of the WHOQOL-OLD in Taiwan
• 姚開屏、錢承君、張育誠、 林韋伶、王榮德、謝清麟、林茂榮
  Grace Yao, Cheng-Chun Chien, Yu-Chen Chang, Wei- Ling Lin, Jung-Der Wang, Ching-Lin Hsieh, Mau-Roung Lin
• 生活品質；老人；WHOQOL-100；WHOQOL-BREF；WHOQOL-OLD
  quality of life ; senior ; WHOQOL-100 ; WHOQOL-BREF ; WHOQOL-OLD
• 目標：發展及驗證台灣版世界衛生組織老人生活品質問卷（WHOQOL-OLD）。方法：研究之初先以標準化程序進行問卷的翻譯，然後於2012年六至八月，以橫斷面研究設計在大台北地區與嘉義地區收集438名60歲以上社區老人的資料，包括WHOQOL-OLD、WHOQOLBREF、短式台灣老年憂鬱量表（Geriatric Depression Scale-15, GDS-15）、巴氏量表（Barthel Index, BI）、簡短式智能評估（Mini-Mental State Examination, MMSE）。心理計量分析包括內部一致性信度、內容效度、建構效度、同時效標關聯效度、預測效度與區辨效度，採用的統計方法有相關、迴歸、兩獨立樣本t檢定、驗證性因素分析等。結果：WHOQOL-OLD問卷之內部一致性係數介於0.71~0.86。問卷題目與自己所屬的向度之相關（r= 0.62~0.88）都高於跟其他向度之相關。驗證性因素分析（confirmatory factor analysis）大略支持WHOQOL-OLD為兩階層因素之理論模型。WHOQOL-OLD六個層面跟多個同時效標之相關雖然幾乎都達到0.01的顯著水準，但部分相關仍不如預期假設的強。在預測數個整體生活品質指標方面（除WHOQOLBREF的整體自評題G1、G2外），WHOWQOL-OLD六個層面的解釋力約達到四成，而且是一個可接受的外加模組。最後，WHOQOL-OLD可區別健康與較不健康的老人。結論：研究結果支持WHOQOL-OLD台灣版問卷有良好的信、效度，可以使用在如同本研究樣本較為健康的台灣六十歲以上的社區老人。
  Objectives: To develop and validate the WHOQOL-OLD-Taiwan version. Methods: This was a cross-sectional study. First, we translated this questionnaire by following standard procedure. After a pilot study, we collected data from 438 seniors over 60 years of age from communities in greater Taipei and Chiayi from June to October, 2012. In addition to filling out the WHOQOL-OLD, the participants also completed the WHOQOL-BREF, Geriatric Depression Scale-15, Barthel Index, and Mini-Mental State Examination as the criterion variables. We examined the following psychometric properties: internal consistency reliability, content validity, construct validity, concurrent validity, predictive validity, and discriminant validity by using correlation analysis, regression analysis, two independent group t-tests, and confirmatory factor analysis. Results: The internal consistency coefficients were between 0.71~0.86. The correlation coefficients between each item (r=0.62~0.88) and the facet of belonging were higher than those with other facets. Confirmatory factor analysis generally supported the idea that the WHOQOLOLD was a second-order factor model, which indicated that six factors were subsumed under an overall ”quality of life” factor. Most of the correlation coefficients between the facets of WHOQOL-OLD and several concurrent criteria were statistically significant (p < 0.01), but some correlations were not as high as expected. Except for predicting G1 and G2, the WHOQOL-OLD explained about 40% of the variation in the overall quality of life indices. This study also showed that the WHOQOL-OLD was a good add-on module. Elderly people with better and worse health conditions could be discriminated by the WHOQOL-OLD through independent group t-tests (p < 0.01). Conclusions: The WHOQOL-OLD-Taiwan version has good psychometric properties. The WHOQOL-OLD module appears to be a useful instrument for use with community-dwelling Taiwanese seniors.
• 239 - 258
• 10.6288/TJPH201736106018

• Link 原著 Original Article
• 個人化之營養支持對於接受手術治療之大腸直腸癌病患其營養狀態、生活品質之影響The impact of individualized nutritional support for patients with colorectal cancer who had undergone surgery
• 郭雅琦、劉仁沛、季瑋珠
  Ya-Chi Guo, Jen-Pei Liu, Wei-Chu Chie
• 營養 ； 生活品質 ； 大腸直腸癌 ； 手術 ； PG - SGA
  ?Nutrition?;?quality of life?;?colorectal cancer?;?surgery?;?PG - SGA
• 目標：藉由早期個人化之營養支持與長期追蹤、比較病患其生理指標、生活品質與營養狀態之差異，以評估營養介入之成效。方法：本研究為前瞻性、隨機分派之對照臨床試驗研究，於2014年9月至2015年5月期間共收取84名罹患大腸直腸癌之受試者，分為營養介入組（實驗組）與常規照護組（控制組），各有42名受試者。受試者於手術治療並開始腸道進食後，經隨機分派分組行初次營養教育介入訪視並評估其營養狀態與收集生活品質相關問卷（EORTCQLQ - C30、EORTC QLQ - CR29）等，於初訪後第三個月進行後續資料收集，以評估個人化的營養支持對於大腸直腸癌病患後續之營養與生活品質相關成效。結果：於營養狀態方面，營養介入組（實驗組）於第三個月的營養狀態皆顯著優於常規照護組（控制組）；生活品質方面，在EORTC QLQ - C30問卷部份，受試者於第三個月追蹤發現其整體健康狀況與生活品質、身體功能、角色功能、情緒功能、認知功能、疲勞感、噁心與嘔吐、疼痛、呼吸困難與食慾不振等項目，營養介入組（實驗組）皆顯著優於常規照護組（控制組）；在EORTC QLQ - CR29問卷部份，受試者於第三個月追蹤發現其焦慮、體重、解尿頻率、血便與黏液便、尿失禁、腹痛、腹脹、口乾、味覺、大便失禁與肛門皮膚痠痛等項目，營養介入組（實驗組）皆顯著優於常規照護組（控制組）。結論：適時、適切與持續的個人化營養支持對於大腸直腸癌經手術切除病灶之受試者而言，能顯著提升攝食量而達到其自身營養需求，並能改善營養狀態與生活品質。
  Objectives: To investigate the impact of early individualized nutritional support on long-term physiology, quality of life (QoL), and nutritional outcome in patients with colorectal cancer after surgery. Methods: This prospective randomized clinical trial was carried out between September 2014 and May 2015; patients who were diagnosed with colorectal cancer and underwent surgery (n = 84), were randomly assigned in a 1:1 ratio to receive either individualized nutritional counseling (intervention group, n=42), or the usual care (control group, n = 42). Nutritional intake (dietary history), status (Patient-Generated Subjective Global Assessment), and QoL (EORTC QLQ - C30, QLQ - CR29) were evaluated at baseline and three months after surgery. Results: At the three month follow up, the groups were compared and nutritional status was significantly improved in the intervention group (p < .0001). There were significant differences in EORTC QLQ - C30 scores and QLQ - CR29 scores between two groups in terms of global health status/ QoL (p = 0.0017), physical function (p = 0.0005), role function (p = 0.0001), emotional function (p = 0.0228), cognitive function (p = 0.001), fatigue (p = 0.0002), nausea and vomiting (p = 0.0011), pain (p = 0.0431), dyspnea (p = 0.0006), appetite loss (p = 0.001), anxiety (p < .0001), weight (p < .0001), urinary frequency (p = 0.0185), blood and mucus in stool (p = 0.0061), urinary incontinence (p = 0.0042), abdominal pain (p < .0001), bloating (p < .0001), dry mouth (p < .0001), taste (p = 0.0115), faecal incontinence (p = 0.0042) and sore skin (p = 0.0223). Conclusions: Early, timely and continuous individualized nutritional intervention was key to improvement in nutritional outcome and quality of life for patients with colorectal cancer after surgery.
• 259 - 272
• 10.6288/TJPH201736106016

• Link 原著 Original Article
• 醫院退出市場因素之分析An empirical analysis of exits from the hospital market
• 劉亞明、羅德芬、粘毓庭
  Ya-Ming Liu, Te-Fen Lo, Yu-Ting Nien
• 醫院退出 ； 全民健康保險 ； 總額預算
  exit of hospital ; National Health Insurance ; global budget scheme
• 目標：本文主要在探討台灣實施全民健康保險後，影響醫院退出市場之因素，並瞭解醫院總額預算支付制度實施前後，影響醫院退出市場的因素是否有所不同。方法：利用全民健康保險研究資料庫，以1998年至2012年與健保署簽有特約之區域醫院及地區醫院為觀察對象，結束健保特約作為退出市場之代理變數，分為實施醫院總額預算制度前（1998-2002）及實施後（2003-2012）兩組樣本，利用Cox比例危險模型進行分析。結果：醫院的特性，如院齡、門診診次、住院診次，以及地區特性，如上年度進入率、最小有效規模、老年人口比例、家戶可支配所得、人口數等，為實施醫院總額預算制度之前影響醫院存活之重要因素。而在實施醫院總額預算制度後，地區醫院之權屬別、門診規模賀芬達指數、平均每公頃土地現值、門診與住院診次成長率，則成為影響醫院是否退出市場的主要因素。結論：台灣醫院市場在實施總額預算後，市場競爭與醫院權屬別成為影響醫院退出的重要因素，而醫療院所產業似乎也更朝向兩極化的不平衡發展。
  Objectives: Using the termination of the NHI contracts as a proxy for exit from the hospital market, this study investigated the factors that affect exits from the hospital industry, and compared these factors before and after implementation of the Global Budget Scheme (GBS) in July 2002. Methods: The data, including metropolitan and local community hospitals, were extracted from the NHI Research Database from 1998-2012. We divided samples into two parts (before the GBS [1998-2002] and after the GBS [2003-2012]), and used a Cox proportional hazards regression model to conduct our analysis. Results: The factors that affect exits from the hospital industry include the following: (1) characteristics of hospitals, such as the duration of hospitals, outpatient visit volume, and admission volume; and (2) characteristics of areas, such as the rate of entry last year, minimum efficient scale, proportion of aged population, disposable income per household, and population. After implementation of the GBS, ownership of the local community hospital, the Herfindahl-Hirschman index, the average current land value per hectare, the number of outpatient visits, and the admission growth rate became significant factors of exit from the hospital industry. Conclusions: After the implementation of the GBS, market competition and ownership of hospitals affect the exiting of hospitals. There is a more unbalanced development among large- and small-scale hospitals.
• 273 - 286
• 10.6288/TJPH201736106005

• Link 評論 Commentary
• 評論：造成200家地區醫院歇業之真因為市場競爭或健保制度？Commentary: is it really the market competition or health insurance system cause the 200 district hospitals shut down?
• 郝宏恕
  Horng-Shuh Hao
• 無
  none
• 無
  none
• 287 - 287
• 10.6288/TJPH20173610600501

• Link 原著 Original Article
• 醫師面對老年病人時之電子病歷交換資訊需求與意願的初探研究A preliminary study of the information needed in Electronic Medical Records exchange and physicians' usage intention when treating elderly patients
• 佘明玲、翁儷禎
  Ming-Ling Sher, Li-Jen Weng
• 電子病歷 ； 電子病歷資訊 ； 電子化醫療資訊 ； 電子病歷交換 ； 健康資訊交換
  electronic medical records (EMR) ; information of EMR ; electronic medical information ; EMR exchange ; health information exchange
• 目標：從需求面探討面對老年病人時醫師需要其他機構電子病歷的項目，及其對醫師使用電子病歷交換之意願與可能性的影響。方法：由文獻歸納電子病歷交換需求項目，以德菲法修改問卷，再對某醫療體系之醫師進行調查。復以因素分析探討電子病歷需求之因素，並以之對醫師使用電子病歷交換之意願與在不同診療途徑之使用可能性進行複迴歸分析。結果：電子病歷交換資訊需求之因素分析呈現四因素，醫師需求依次為：個人特殊病史，檢驗檢查報告，療程變化記錄，家系資料與照護記錄。個人特殊病史有助於增進醫師取用意願與在住院和急診時取用電子病歷交換之可能性，家系資料與照護記錄則可增進醫師於預防保健時取用電子病歷之可能性。結論：醫師面對老年病人最需要的病歷內容非現行電子病歷交換平台之主要項目。建議電子病歷交換宜以使用者需求為出發點，將來可考慮自健保資訊系統自動擷取醫師所需之重要項目，或由醫師協助彙整提報，以增進電子病歷交換之臨床應用價值。
  Objectives: This study explored the information in Electronic Medical Records (EMR) exchange that physicians need when dealing with elderly patients, and the relationship between information needed and physicians' intention to use EMR exchange in clinical settings. Methods: A questionnaire containing items of EMR exchanges crucial in the treatment of elderly patients was constructed based on a literature review, revised by the Delphi method, and distributed to physicians in a medical care system. Factors underlying the items were revealed by factor analysis and subject to multiple regression analysis to determine their relationships with physicians' intention to use EMR exchange. Results: Four factors listed in a descending order of necessity for treating elderly patients were identified: Patient's Special History, Laboratory and Radiology Reports, Progress Notes, and Family Data and Healthcare Records. Patient's Special History could facilitate physicians' intention to use EMR exchange and the likelihood of adopting EMR exchange for in-patient and emergency care, while Family Data and Healthcare Records may enhance the possibility of using EMR exchange for preventive care. Conclusions: The information most needed in EMR exchange when treating elderly patients is not among the main retrieval items provided by the current EMR exchange platform. It is recommended that the information physicians need should be the major concern when designing an EMR exchange system. The items that physicians need the most can be retrieved automatically from National Health Insurance information systems or provided by physicians in order to enhance the clinical value of EMR exchange in the future.
• 288 - 300
• 10.6288/TJPH201736106023

• Link 政策論壇 Policy Forum
• 十字路口的長照：制度設計與社會價值Long term care at the crossroads: institutional designs and social values
• 葉明叡
  Ming-Jui Yeh
• 無
  none
• 無
  none
• 297 - 203
• 10.6288/TJPH201736106011

• Link 原著 Original Article
• 糖尿病患同時罹患B型或C型肝炎患者服用Statin藥物是否可以降低肝癌罹患風險？Is it possible for diabetics infected with HBV or HCV to reduce the risk of hepatocellular carcinoma by taking a Statin?
• 邱桂芬、張郁函、林昆德
  Guei-Fen Chiu, Yu-Han Chang, Kun-Der Lin
• 肝癌 ； 糖尿病 ； Statin
  hepatocellular carcinoma ; diabetes mellitus ; Statin
• 目標：探討Statin劑量效應與罹患肝癌之相關性。方法：本篇研究為病例對照研究，利用國衛院2010年承保抽樣檔納入50歲以上2005-2010年糖尿病之群體（ICD-9 code: 250.x）至少使用OAD或insulin三個月以上之個案往前回溯Statin暴露量。病例組為糖尿病且被確診肝癌個案（ICD-9: 155），對照組為糖尿病並未診斷肝癌之個案。結果：HBV（累積劑量＞298 DDDs:OR=0.41; 95% CI: 0.24-0.72）或HCV（累積劑量＞205 DDDs: OR=0.25; 95% CI: 0.13-0.48）糖尿病患者若服用Statin累積劑量越高與降低肝癌之風險呈現劑量效應關係（p＜0.001）。結論：HBV、HBC之糖尿病個案先前合併使用糖尿病藥物與Statin與降低肝癌之風險呈現劑量效應相關。
  Objectives: To determine the relationship between the dose effect of Statin and the risk of HCC. Methods: This study was a case-control study. All participants were > 50 years of age and were diagnosed with diabetes (ICD-9: 250.x0, 205.x2) and were treated with an anti-diabetic agent for at least for 3 months according to the NHID, LHID 2010 (Longitudinal Health Insurance database 2010). We captured the use of a Statin before the index date in patients with type II diabetes. Patients diagnosed with a hepatoma (ICD-9:155) were defined as the case group. Results: The risk of hepatoma was reduced in patients with higher cumulative DDDs Statin use compared to Statin non-users (HBV population: cumulative dose> 298 DDDs [OR=0.41, 95% CI: 0.24-0.72]; HCV population: cumulative dose > 205 DDDs [OR= 0.25; 95% CI: 0.13-0.48]). Conclusions: A dose-response relationship exists between lower risk for hepatoma and higher cumulative DDDs of Statin use.
• 301 - 313
• 10.6288/TJPH201736105113