Publications by authors named "Chien-Yeh Hsu"

102 Publications

Association between Dietary Pattern, Lifestyle, Anthropometric Status, and Anemia-Related Biomarkers among Adults: A Population-Based Study from 2001 to 2015.

Int J Environ Res Public Health 2021 Mar 26;18(7). Epub 2021 Mar 26.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.

Inadequate dietary intake, poor nutritional status, heavy smoking, and alcohol consumption are associated with the risk of anemia. The objective of this study was to investigate the associations between dietary patterns, lifestyle, nutritional status, and anemia-related biomarkers among adults using a multivariable regression model. Taiwanese adults aged 20-45 years ( = 118,924, 43,055 men and 75,869 women) were obtained from the Mei Jau Health Management Institution database, between 2001 and 2015, for data analysis. The anemia-inflammation-related dietary pattern was derived by reduced rank regression analysis. Dietary patterns with high intakes of eggs, meat, organ meats, rice or flour products, fried foods, sugary beverages, and processed foods significantly increased the risk of anemia, and was associated with decreased hemoglobin, hematocrit, and red blood cells, but increased white blood cells and C-reactive protein levels. Moreover, current alcohol drinkers, as well as people who were underweight, overweight, obese, and central obese, were more likely to increase their risk of anemia by 46%, 20%, 23%, 34%, and 28%, respectively. Interestingly, participants who are current or past smokers were inversely associated with risk of anemia. In conclusion, adherence to the anemia-inflammation dietary pattern was associated with an increased risk of anemia in Taiwanese adults. Furthermore, abnormal weight status and alcohol drinking were correlated with an increased risk of anemia.
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http://dx.doi.org/10.3390/ijerph18073438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037593PMC
March 2021

Association between Dietary Patterns and Serum Hepatic Enzyme Levels in Adults with Dyslipidemia and Impaired Fasting Plasma Glucose.

Nutrients 2021 Mar 18;13(3). Epub 2021 Mar 18.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.

We investigated the association between dietary patterns and serum hepatic enzyme levels in adults with dyslipidemia and impaired fasting glucose in Taiwan. A total of 15,005 subjects (5452 men and 9553 women) aged 35-69 years were selected. Two major dietary patterns were identified by principal component analysis: Western dietary pattern and Mediterranean dietary pattern. Subjects in the highest quartile (Q4) of the Western dietary pattern showed an increased risk of elevated serum alanine aminotransferase (ALT) levels (OR: 1.24, 95% CI: 1.06-1.45, -trend = 0.01). Fur-thermore, in the highest quartile of the Western dietary pattern, subjects with high waist circum-ference were observed to have a greater risk for developing abnormal serum ALT levels compared to those in the lowest quartile (Q1) (OR: 1.43, 95% CI: 1.04-1.97, -trend = 0.01). In the highest quartile of the Western dietary pattern, only women were at an increased risk for having abnormal serum ALT levels (OR: 1.28, 95% CI: 1.04-1.59, -trend = 0.03). By contrast, in the highest quartile of the Mediterranean dietary pattern, only men were at a reduced risk for having abnormal serum gamma-glutamyl transferase (GGT) levels (OR: 0.72, 95% CI: 0.53-0.97, -trend = 0.048). We report a positive association between the Western dietary pattern and abnormal serum ALT levels.
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http://dx.doi.org/10.3390/nu13030987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003213PMC
March 2021

Calcium Channel blockers are associated with reduced risk of Parkinson's disease in patients with hypertension: A population-based retrospective cohort study.

J Neurol Sci 2021 Mar 24;424:117412. Epub 2021 Mar 24.

Department of Neurology, Sijhih Cathay General Hospital, New Taipei City, Taiwan. Electronic address:

Background: The use of dihydropyridine calcium channel blockers (DCCBs) was proposed to reduce the risk of Parkinson's disease (PD). This study aimed to evaluate the association between DCCB and its dose effect and the risk of PD in patients with newly diagnosed hypertension.

Methods: This population-based retrospective cohort study enrolled 107,207 patients with newly diagnosed hypertension, between 2001 and 2013, from Taiwan's National Health Insurance Research Database. Patients who had PD before hypertension or were taking antipsychotics for more than 30 days in the 6 months prior to the end of the observation period were excluded. A Cox proportional hazard model was used to estimate the risk of PD in different groups. The dose-related effects of DCCB on the risk of PD were evaluated according to the cumulative defined daily dose (DDD).

Results: We observed 832 (1.2%) PD cases in patients treated with DCCB as compared to 950 (2.4%) PD cases in those not treated with DCCB, during a median follow-up duration of 8.3 years and 6.2 years, respectively. The risk of PD in the DCCB-treated group (hazard ratio [HR] = 0.50) was significantly lower than that in the group without DCCB treatment. DCCB reduced the risk of PD in a dose-dependent manner, with HRs ranging from 0.61 to 0.37 for DDDs of 90-180 to >720.

Conclusions: DCCB treatment was associated with a significantly reduced risk of PD in patients with newly diagnosed hypertension. Further clinical trials are needed to confirm the proposed neuroprotective effects of DCCB in PD.
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http://dx.doi.org/10.1016/j.jns.2021.117412DOI Listing
March 2021

A 10-Year Probability Deep Neural Network Prediction Model for Lung Cancer.

Cancers (Basel) 2021 Feb 23;13(4). Epub 2021 Feb 23.

Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan.

Cancer is the leading cause of death in Taiwan. According to the Cancer Registration Report of Taiwan's Ministry of Health and Welfare, a total of 13,488 people suffered from lung cancer in 2016, making it the second-most common cancer and the leading cancer in men. Compared with other types of cancer, the incidence of lung cancer is high. In this study, the National Health Insurance Research Database (NHIRDB) was used to determine the diseases and symptoms associated with lung cancer, and a 10-year probability deep neural network prediction model for lung cancer was developed. The proposed model could allow patients with a high risk of lung cancer to receive an earlier diagnosis and support the physicians' clinical decision-making. The study was designed as a cohort study. The subjects were patients who were diagnosed with lung cancer between 2000 and 2009, and the patients' disease histories were back-tracked for a period, extending to ten years before the diagnosis of lung cancer. As a result, a total of 13 diseases were selected as the predicting factors. A nine layers deep neural network model was created to predict the probability of lung cancer, depending on the different pre-diagnosed diseases, and to benefit the earlier detection of lung cancer in potential patients. The model is trained 1000 times, the batch size is set to 100, the SGD (Stochastic gradient descent) optimizer is used, the learning rate is set to 0.1, and the momentum is set to 0.1. The proposed model showed an accuracy of 85.4%, a sensitivity of 72.4% and a specificity of 85%, as well as an 87.4% area under ROC (AUROC) (95%, 0.8604-0.8885) model precision. Based on data analysis and deep learning, our prediction model discovered some features that had not been previously identified by clinical knowledge. This study tracks a decade of clinical diagnostic records to identify possible symptoms and comorbidities of lung cancer, allows early prediction of the disease, and assists more patients with early diagnosis.
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http://dx.doi.org/10.3390/cancers13040928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926302PMC
February 2021

Association of Nutrition Education and Its Interaction with Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors among Chronic Kidney Disease Patients in Taiwan.

Nutrients 2021 Jan 21;13(2). Epub 2021 Jan 21.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Xinyi District, Taipei 110, Taiwan.

We evaluated the interactive effects of nutrition education (NE) and lifestyle factors on kidney function parameters and cardiovascular risk factors among chronic kidney disease (CKD) patients. This cross-sectional cohort study recruited 2176 CKD stages 3-5 patients aged > 20 years from Integrated Chronic Kidney Disease Care Network, Shuang Ho Hospital, Taiwan between December 2008 and April 2019. The multivariable regression analysis was performed to investigate the interactive effects of NE with lifestyle factors on kidney function parameters and cardiovascular risk factors. Relative excess risk due to interaction (RERI) and attributable proportion (AP) were applied to assess additive interaction. Patients who were smoking or physically inactive but received NE had better estimated glomerular filtration rate (eGFR) (β: 3.83, 95% CI: 1.17-6.49 or β: 3.67, 95% CI: 2.04-5.29) compared to those without NE. Patients with smoking and NE significantly reduced risks for having high glycated hemoglobin A (HbA) by 47%, high low-density lipoprotein cholesterol (LDL-C) by 38%, and high corrected calcium (C-Ca) by 50% compared to those without NE. Moreover, NE and smoking or inactive physical activity exhibited an excess risk of high C-Ca (RERI: 0.47, 95% CI: 0.09-0.85 for smoking or RERI: 0.46, 95% CI: 0.01-0.90 and AP: 0.51, 95% CI: 0.03-0.99 for physical activity). Our study suggests that CKD patients who were enrolled in the NE program had better kidney function. Thus, NE could be associated with slowing kidney function decline and improving cardiovascular risk factors.
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http://dx.doi.org/10.3390/nu13020298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909784PMC
January 2021

Association of Testosterone-Related Dietary Pattern with Testicular Function among Adult Men: A Cross-Sectional Health Screening Study in Taiwan.

Nutrients 2021 Jan 18;13(1). Epub 2021 Jan 18.

Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, 365 Ming-Te Road, Beitou District, Taipei 112, Taiwan.

Diets could play an important role in testicular function, but studies on how adherence to the dietary patterns influences human testicular function in Asian countries are scarce. Herein, we examined the association between testosterone-related dietary patterns and testicular function among adult men in Taiwan. This cross-sectional study recruited 3283 men who attended a private medical screening program from 2009 to 2015. Testosterone-related dietary pattern was generated by the reduced rank regression (RRR) method. The association between adherence to quartile of dietary pattern scores with sex hormones (testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2)) and sperm quality (sperm concentration (SC), total sperm motility (TSM), progressive motility (PRM), and normal sperm morphology (NSM)) were examined by multivariable linear regression. Hemoglobin (β = 0.57, < 0.001), hematocrit (β = 0.17, = 0.002), triglyceride (β = -0.84, < 0.001), HDL-cholesterol (β = 3.58, < 0.001), total cholesterol to HDL-cholesterol ratio (β = -0.78, < 0.001), and uric acid (β = -10.77, < 0.001) were highly correlated with testosterone levels. Therefore, these biomarkers were used to construct a testosterone-related dietary pattern. Highest adherence (Q4) to dietary pattern scores were negatively associated with lower testosterone in the pooled analysis (β = -0.89, = 0.037) and normal-weight men (β = -1.48, = 0.019). Likewise, men in the Q4 of the dietary pattern had lower SC (β = -5.55, = 0.001) and NSM (β = -2.22, = 0.007) regardless of their nutritional status. Our study suggesting that testosterone-related dietary pattern (rich in preserved vegetables or processed meat or fish, deep-fried foods, innards organs, rice or flour products cooked in oil, and dipping sauce, but low in milk, dairy products, legumes, or beans, and dark or leafy vegetables) was associated with a poor testicular function.
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http://dx.doi.org/10.3390/nu13010259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830687PMC
January 2021

Integration of an Image-Based Dietary Assessment Paradigm into Dietetic Training Improves Food Portion Estimates by Future Dietitians.

Nutrients 2021 Jan 8;13(1). Epub 2021 Jan 8.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan.

The use of image-based dietary assessments (IBDAs) has rapidly increased; however, there is no formalized training program to enhance the digital viewing skills of dieticians. An IBDA was integrated into a nutritional practicum course in the School of Nutrition and Health Sciences, Taipei Medical University Taiwan. An online IBDA platform was created as an off-campus remedial teaching tool to reinforce the conceptualization of food portion sizes. Dietetic students' receptiveness and response to the IBDA, and their performance in food identification and quantification, were compared between the IBDA and real food visual estimations (RFVEs). No differences were found between the IBDA and RFVE in terms of food identification (67% vs. 71%) or quantification (±10% of estimated calories: 23% vs. 24%). A Spearman correlation analysis showed a moderate to high correlation for calorie estimates between the IBDA and RFVE ( ≥ 0.33~0.75, all < 0.0001). Repeated IBDA training significantly improved students' image-viewing skills [food identification: first semester: 67%; pretest: 77%; second semester: 84%) and quantification [±10%: first semester: 23%; pretest: 28%; second semester: 32%; and ±20%: first semester: 38%; pretest: 48%; second semester: 59%] and reduced absolute estimated errors from 27% (first semester) to 16% (second semester). Training also greatly improved the identification of omitted foods (e.g., condiments, sugar, cooking oil, and batter coatings) and the accuracy of food portion size estimates. The integration of an IBDA into dietetic courses has the potential to help students develop knowledge and skills related to "e-dietetics".
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http://dx.doi.org/10.3390/nu13010175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827495PMC
January 2021

Association between Dietary Patterns and Kidney Function Parameters in Adults with Metabolic Syndrome: A Cross-Sectional Study.

Nutrients 2020 Dec 24;13(1). Epub 2020 Dec 24.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.

This study explored the association between dietary patterns and kidney function parameters in adults with metabolic syndrome in Taiwan. This cross-sectional study was undertaken in 56,476 adults from the health screening centers in Taiwan from 2001 to 2010. Dietary intake and dietary patterns were assessed using a food frequency questionnaire and principal component analysis, respectively. Blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR), and uric acid were measured as clinical parameters of kidney function. Multivariate linear regression was conducted to explore the relationship between dietary patterns and kidney function parameters. After adjusting for confounders, the highest tertiles of the processed food-sweets dietary pattern and the meat-seafood-eggs dietary pattern were associated with increased BUN, creatinine, and uric acid but decreased eGFR (all adjusted < 0.05). Meanwhile, the highest tertiles of the veggie-fruit-grains dietary pattern and the milk-dairy dietary pattern were associated with decreased BUN, creatinine, and uric acid but increased eGFR (all adjusted < 0.05). A processed food-sweets dietary pattern or a meat-seafood-eggs dietary pattern is associated with worse kidney function parameters in adults with metabolic syndrome. In contrast, a veggie-fruit-grains dietary pattern or a milk-dairy dietary pattern is associated with better kidney function parameters.
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http://dx.doi.org/10.3390/nu13010040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823384PMC
December 2020

Global Infectious Disease Surveillance and Case Tracking System for COVID-19: Development Study.

JMIR Med Inform 2020 Dec 22;8(12):e20567. Epub 2020 Dec 22.

Taiwan e-Health Association, Taipei, Taiwan.

Background: COVID-19 has affected more than 180 countries and is the first known pandemic to be caused by a new virus. COVID-19's emergence and rapid spread is a global public health and economic crisis. However, investigations into the disease, patient-tracking mechanisms, and case report transmissions are both labor-intensive and slow.

Objective: The pandemic has overwhelmed health care systems, forcing hospitals and medical facilities to find effective ways to share data. This study aims to design a global infectious disease surveillance and case tracking system that can facilitate the detection and control of COVID-19.

Methods: The International Patient Summary (IPS; an electronic health record that contains essential health care information about a patient) was used. The IPS was designed to support the used case scenario for unplanned cross-border care. The design, scope, utility, and potential for reuse of the IPS for unplanned cross-border care make it suitable for situations like COVID-19. The Fast Healthcare Interoperability Resources confirmed that IPS data, which includes symptoms, therapies, medications, and laboratory data, can be efficiently transferred and exchanged on the system for easy access by physicians. To protect privacy, patient data are deidentified. All systems are protected by blockchain architecture, including data encryption, validation, and exchange of records.

Results: To achieve worldwide COVID-19 surveillance, a global infectious disease information exchange must be enacted. The COVID-19 surveillance system was designed based on blockchain architecture. The IPS was used to exchange case study information among physicians. After being verified, physicians can upload IPS files and receive IPS data from other global cases. The system includes a daily IPS uploading and enhancement plan, which covers real-time uploading through the interoperation of the clinic system, with the module based on the Open Application Programming Interface architecture. Through the treatment of different cases, drug treatments, and the exchange of treatment results, the disease spread can be controlled, and treatment methods can be funded. In the Infectious Disease Case Tracking module, we can track the moving paths of infectious disease cases. The location information recorded in the blockchain is used to check the locations of different cases. The Case Tracking module was established for the Centers for Disease Control and Prevention to track cases and prevent disease spread.

Conclusions: We created the IPS of infectious diseases for physicians treating patients with COVID-19. Our system can help health authorities respond quickly to the transmission and spread of unknown diseases, and provides a system for information retrieval on disease transmission. In addition, this system can help researchers form trials and analyze data from different countries. A common forum to facilitate the mutual sharing of experiences, best practices, therapies, useful medications, and clinical intervention outcomes from research in various countries could help control an unknown virus. This system could be an effective tool for global collaboration in evidence-based efforts to fight COVID-19.
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http://dx.doi.org/10.2196/20567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758088PMC
December 2020

Comparing two methods for deriving dietary patterns associated with risk of metabolic syndrome among middle-aged and elderly Taiwanese adults with impaired kidney function.

BMC Med Res Methodol 2020 10 14;20(1):255. Epub 2020 Oct 14.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan.

Background: Dietary patterns were associated with the risk of chronic disease development and outcome-related diseases. In this study, we aimed to compare the correlation between dietary patterns and metabolic syndrome (MetS) using two methods for identifying dietary patterns.

Methods: The participants (n = 25,569) aged ≥40 years with impaired kidney function were retrieved from Mei Jau (MJ) Health Screening database from 2008 to 2010. Dietary patterns were identified by principal component analysis (PCA) and reduced rank regression (RRR) from twenty-two food groups using PROC FACTOR and PROC PLS functions.

Results: We identified two similar dietary pattern characteristics (high intakes of deep fried foods, preserved or processed foods, dipping sauce, meat, sugary drinks, organ meats, jam/honey, fried rice/flour products, instant noodles and eggs) derived by PCA and RRR. Logistic regression analysis revealed that RRR-derived dietary pattern scores were positively associated with an odds ratio (OR = 1.70, 95% CI: 1.56, 1.86) of having MetS than PCA-derived dietary pattern scores (OR = 1.38, 95% CI: 1.27, 1.51). The correlations between RRR-derived dietary pattern scores and elevated systolic and diastolic blood pressure (OR = 1.30 for both) or low high density lipoprotein cholesterol in women (OR = 1.32) were statistically significant but not significant in PCA-derived dietary pattern scores.

Conclusions: Our findings suggest that RRR gives better results when studying behavior related dietary patterns in association with MetS. RRR may be more preferable to provide dietary information for developing dietary guidelines among people with MetS. Further studies with prospective measurements are needed to verify whether RRR is a useful analytic tool for the association between dietary patterns and other chronic diseases.
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http://dx.doi.org/10.1186/s12874-020-01142-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559471PMC
October 2020

Urinary tract infection is associated with hypokalemia: a case control study.

BMC Urol 2020 Jul 20;20(1):108. Epub 2020 Jul 20.

Division of Nephrology, Asia University Hospital, NO 222, Fuxin Rd, Wufeng Dist, Taichung, 413, Taiwan.

Background: Hypokalemia is a common clinical problem. The association between urinary tract infection (UTI) and hypokalemia is not clear. Hypokalemia is common in patients with UTI in clinical observation. The aim of the study is to determine if UTI is associated with hypokalemia.

Methods: Patients hospitalized with UTI and the control group were retrieved from the Longitudinal Health Insurance Database 2005. The control group was patients hospitalized with other reasons and were matched for the confoundings of UTI and hypokalemia. We analyze the risk of hypokalemia using logistic regression and calculate the odds ratio (OR) and 95% confidence interval (CI) of OR.

Results: We analyzed 43,719 UTI patients and control patients. Hypokalemia was found in 4540 (10.4%) patients with UTI and 1842 (4.2%) control patients. The percentage of patients with hypokalemia was higher in UTI patients (chi-square, p < 0.001). UTI was associated with hypokalemia and the odds ratio (OR) was 2.27 [95% confidence interval (CI): 2.17-2.41]. Cerebrovascular accident, chronic obstructive pulmonary disease, hypertension, congestive heart failure, diarrhea, medications including thiazides, sulfonamides, xanthines, and laxatives were independently associated with hypokalemia. Recurrent UTI was associated with hypokalemia in UTI patients (OR: 1.13, 95% CI: 1.05-1.23, p < 0.001).

Conclusions: Urinary tract infection is associated with hypokalemia among inpatients. The association is independent of patients' comorbidities and medications. Recurrent UTI is associated with increased hypokalemia in UTI patients.
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http://dx.doi.org/10.1186/s12894-020-00678-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372809PMC
July 2020

Development and validation of an instrument for measuring competencies on public health informatics of primary health care worker (PHIC4PHC) in Indonesia.

Prim Health Care Res Dev 2020 07 6;21:e22. Epub 2020 Jul 6.

College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan.

Because of the increasing adoption and use of technology in primary health care (PHC), public health informatics competencies (PHIC) are becoming essential for public health workers. Unfortunately, no studies have measured PHIC in resource-limited setting. This paper describes the process of developing and validating Public Health Informatics Competencies for Primary Health Care (PHIC4PHC), an instrument for measuring PHC workers' competencies in public health informatics. Method: This study developed a questionnaire that had three stages: the Delphi technique, a pretest, and field test. Eleven academicians from a university and 13 PHC workers joined 2 rounds of group discussion in the first stage. The second stage comprised two pilot studies with 75 PHC workers in Semarang Municipality. The third stage involved validating the questionnaire with 462 PHC workers in Kendal District. This study used Pearson's product-moment correlation for the validity check and Cronbach's alpha coefficient for determining the internal consistency. This study used the K-means algorithm for clustering the results of the PHIC4PHC questionnaire. Results and Conclusion: PHIC4PHC is the first comprehensive PHIC questionnaire administered in a resource-limited setting, consisting of 11 indicators and 42 measurement items concerning knowledge of health information systems, skills required for health data management, ethical aspects of data sharing and health information literacy. The final results of PHIC4PHC were clustered into three classes based on the K-means algorithm. Overall, 45.7% PHC workers achieved medium competency, whereas 25.6% and 27.7% achieved low and high competency, respectively. Men had higher competency than women. The higher the worker's level of education, the higher the PHIC level; the longer the worker's work experience, the lower the PHIC score; and the greater the worker's age, the lower the PHIC score. Measuring and monitoring PHIC is vital to support successful health IT adoption in PHC.
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http://dx.doi.org/10.1017/S1463423620000018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372181PMC
July 2020

An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study.

J Med Internet Res 2020 06 9;22(6):e16748. Epub 2020 Jun 9.

Taiwan e-Health Association, Taipei, Taiwan.

Background: Personal health record (PHR) security, correctness, and protection are essential for health and medical services. Blockchain architecture can provide efficient data retrieval and security requirements. Exchangeable PHRs and the self-management of patient health can offer many benefits to traditional medical services by allowing people to manage their own health records for disease prevention, prediction, and control while reducing resource burdens on the health care infrastructure and improving population health and quality of life.

Objective: This study aimed to build a blockchain-based architecture for an international health record exchange platform to ensure health record confidentiality, integrity, and availability for health management and used Health Level 7 Fast Healthcare Interoperability Resource international standards as the data format that could allow international, cross-institutional, and patient/doctor exchanges of PHRs.

Methods: The PHR architecture in this study comprised 2 main components. The first component was the PHR management platform, on which users could upload PHRs, view their record content, authorize PHR exchanges with doctors or other medical health care providers, and check their block information. When a PHR was uploaded, the hash value of the PHR would be calculated by the SHA-256 algorithm and the PHR would be encrypted by the Rivest-Shamir-Adleman encryption mechanism before being transferred to a secure database. The second component was the blockchain exchange architecture, which was based on Ethereum to create a private chain. Proof of authority, which delivers transactions through a consensus mechanism based on identity, was used for consensus. The hash value was calculated based on the previous hash value, block content, and timestamp by a hash function.

Results: The PHR blockchain architecture constructed in this study is an effective method for the management and utilization of PHRs. The platform has been deployed in Southeast Asian countries via the Asia eHealth Information Network (AeHIN) and has become the first PHR management platform for cross-region medical data exchange.

Conclusions: Some systems have shown that blockchain technology has great potential for electronic health record applications. This study combined different types of data storage modes to effectively solve the problems of PHR data security, storage, and transmission and proposed a hybrid blockchain and data security approach to enable effective international PHR exchange. By partnering with the AeHIN and making use of the network's regional reach and expert pool, the platform could be deployed and promoted successfully. In the future, the PHR platform could be utilized for the purpose of precision and individual medicine in a cross-country manner because of the platform's provision of a secure and efficient PHR sharing and management architecture, making it a reasonable base for future data collection sources and the data analytics needed for precision medicine.
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http://dx.doi.org/10.2196/16748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312212PMC
June 2020

The implementation of an integrated e-leprosy framework in a leprosy control program at primary health care centers in Indonesia.

Int J Med Inform 2020 08 11;140:104155. Epub 2020 May 11.

Faculty of Computer Science, Universitas Dian Nuswantoro, No 127, Imam Bonjol Street, Semarang City, Central Java, 50131, Indonesia. Electronic address:

Background And Objective: The implementation of health information systems (HIS) could overcome obstacles in human resources and infrastructure at primary health care centers (PHCs). This study involved an e-Leprosy framework being integrated into the real setting of a leprosy control program in Indonesia. The objectives of this implementation study were to integrate e-Leprosy into a leprosy control program at 27 PHCs in Pekalongan District. Central Java Province, Indonesia to explore factors related the success or failure of such an implementation regarding the usability, involvement, and acceptance of e-Leprosy by PHC staff and to evaluate the effect of the implementation on leprosy patient attendance at PHCs. This paper is based on the Standards for Reporting Implementation Studies (StaRI) statement.

Method: This study used mixed methods implementation research with longitudinal analysis and involved two groups of participants: Leprosy Surveillance Officers (LSOs), patients, and the relatives of patients. This study involved four phases consisting of preparation, baseline assessment, intervention, and evaluation. The qualitative study conducted focus group discussions and in-depth interviews. The e-Leprosy program automatically sent SMS reminders regarding leprosy treatment to the LSOs, patients, and patients' relatives every month.

Findings: This study determined that LSO had difficulties related to their workloads in PHCs while managing information and monitoring treatment and contact after release from treatment. The baseline assessment phase found that LSOs in Pekalongan District were unfamiliar with email but familiar using the internet. Overall, LSOs had a positive perception of the e-Leprosy program. The usability of this e-Leprosy program tended to increase over time, while acceptance of the e-Leprosy exhibited a significant relationship with computer and internet fluency (r = 0.48, p < 0.05) and age (r = 0.621, p < 0.01). The responsible patients correlated (r = 0.67, p < 0.01) with involvement in the e-Leprosy program. This study revealed that patient reminders increased on-time attendance by 13.9 % (p < 0.01 with OR = 2.41).

Conclusion: Factors that should be considered during implementation HIS included the digital gap, PHC's staff workload, as well as the level of commitment and leadership in the health office.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104155DOI Listing
August 2020

Gender difference in the association of dietary patterns and metabolic parameters with obesity in young and middle-aged adults with dyslipidemia and abnormal fasting plasma glucose in Taiwan.

Nutr J 2019 11 16;18(1):75. Epub 2019 Nov 16.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan.

Background: The increasing prevalence of obesity has become a pandemic problem, and dietary patterns are one of the important factors causing obesity. Although the correlation between dietary patterns and obesity has been well explored, the gender difference on the association between dietary patterns and obesity remains unclear. The objective of this study examined whether gender difference existed in the relationship of dietary patterns with metabolic parameters and specific indices of adiposity among young and middle-aged adults with dyslipidemia and abnormal fasting plasma glucose (FPG) in Taiwan.

Methods: A total of 14,087 subjects aged between 20 and 50 years with dyslipidemia and abnormal FPG were recruited in Taiwan between 2001 and 2010 for a cross-sectional study. Dyslipidemia was defined primarily according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with minor modification. Abnormal FPG level was defined by the American Diabetes Association. Principal component analysis was conducted to identify dietary patterns. Multivariate logistic regression analysis was performed to evaluate the association of dietary patterns and metabolic parameters with different indices of adiposity including general obesity, central obesity, and high body fat, stratified by gender.

Results: Two dietary patterns derived from principal component analysis were the prudent dietary pattern and the western dietary pattern. Both men and women in the highest quartile of the western dietary pattern had a significantly increased odds ratio of general obesity, central obesity, and high body fat. However, only male subjects in the higher quartiles of the prudent dietary pattern had a significantly decreased odds ratio of all indices of obesity. Both men and women with higher high-density lipoprotein cholesterol and total cholesterol levels had a significantly reduced odds ratio of general and central obesity, while those with higher triglycerides and FPG levels had a significantly increased odds ratio of general and central obesity. Higher low-density lipoprotein cholesterol level was significantly associated with an elevated odds ratio of high body fat, while higher total cholesterol level was significantly correlated with a reduced odds ratio of high body fat only in women.

Conclusions: Gender difference exists in the association of dietary patterns and metabolic parameters with obesity and body fat in young and middle-aged adults with dyslipidemia and abnormal FPG in Taiwan.
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http://dx.doi.org/10.1186/s12937-019-0503-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858632PMC
November 2019

Association of lifestyle factors with blood lipids and inflammation in adults aged 40 years and above: a population-based cross-sectional study in Taiwan.

BMC Public Health 2019 Oct 22;19(1):1346. Epub 2019 Oct 22.

Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan.

Background: Lifestyle factors were associated with an increased risk of cardiovascular disease (CVD) occurrence. We explored the associations between lifestyle factors and CVD risk factors, and assessed the interactive effects of lifestyle factors on CVD risk factors.

Methods: A cross-sectional data of 114,082 (57,680 men and 56,402 women) middle-aged adults and elderly in Taiwan were collected from 2001 to 2010. Logistic regression analysis was used to assess the associations between lifestyle factors and CVD risk factors. The relative excess risk due to interaction (RERI) and the attributable proportion due to interaction were used to explore the interactive effect of lifestyle factors on CVD risk factors.

Results: The interaction between alcohol consumption and smoking exhibited an excess risk of high triglycerides (RERI = 0.21; 95% CI: 0.14-0.29), and that of alcohol consumption and physical activity had an excess risk of high LDL-cholesterol (RERI = 0.11; 95% CI: 0.06-0.16) and high blood glucose (RERI = 0.05; 95% CI: 0.01-0.11). Alcohol consumption and vegetable-rich diet (intake of high vegetables with no or low meat) had an excess risk of high LDL-cholesterol and low HDL-cholesterol, but a reduced risk of high triglycerides (RERI = - 0.10; 95% CI: - 0.17 - -0.04). Smoking and physical activity had an increased risk of high blood glucose and a reduced risk of low HDL-cholesterol. Smoking and vegetable-rich diet reduced the risk of high triglycerides (RERI = - 0.11; 95% CI: - 0.18 - - 0.04), high blood glucose (RERI = - 0.14; 95% CI: - 0.21 - - 0.07) and low HDL-cholesterol (RERI = - 0.10; 95% CI: - 0.19 - -0.01).

Conclusions: The interaction between smoking, alcohol consumption, physical activity and diet were associated with lipid profile and blood glucose, hence there was an interaction between these lifestyle factors in an additive scale. Public health promotion should therefore consider multifaceted promotional activities that are likely to make a positive impact on the health status of the Taiwanese population.
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http://dx.doi.org/10.1186/s12889-019-7686-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805612PMC
October 2019

Developing an Indonesia's health literacy short-form survey questionnaire (HLS-EU-SQ10-IDN) using the feature selection and genetic algorithm.

Comput Methods Programs Biomed 2019 Dec 26;182:105047. Epub 2019 Aug 26.

Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University 15F, No. 172-1, Sec. 2 Keelung Rd, Da'an District, Taipei City 106, Taiwan; Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background And Objective: Measuring health literacy becomes more important because its association with health status and healthcare outcomes. Studies have developed at least 133 measurement tools for health literacy. HLS-EU-Q47 is a questionnaire consisting of 12 sub-dimensions and 47 questions developed by the Europe Health Literacy Consortium. Many countries in Europe and Asia have used HLS-EU-Q47 as a tool for measuring health literacy in the general public. Indonesia has conducted general health literacy survey using HLS-EU-Q47 but finding the difficulties because of the time-consuming interview. A shorter version of HLS-EU-Q47 is needed to apply in health literacy researches in Indonesia. This paper reports the results of feature reduction to develop a short Indonesian version HLS-EU questionnaire and measures the accuracy of the model compared with other short form like HLS-EU-SQ16 or HLS-SF12.

Method: The analysis was performed on a population-based dataset from Indonesia-Semarang Health Literacy Survey for which there were specific target variables as the classification of health literacy level. All attributes were assessed as potential targets in the models derived from the full dataset and its subsets. The feature selection methods with genetic algorithm were used as the filter as well as validation (cross validation) and classification (k-NN:k-nearest neighbor). The predictive accuracy of health literacy level and the complexity of models based on the reduced datasets were compared among the methods and other short versions such as HLS-EU-SQ16, HLS-SF12.

Result: The accuracy of the existing short form models were 90.64% with the HLS-EU-SQ16 and 88.67% with the HLS-SF12. This study proposed a model with 10 features as the construct of a short Indonesian-version (proposed as the HLS-EU-SQ10-IDN) since the model was with higher accuracy than the HLS-SF12, but fewer features for measuring general health literacy index. Moreover, the short version only completed part of 12 dimensions of the full questionnare.

Conclusion: A data mining technique using feature selection with combination of genetic algorithm and k-NN algorithm was applied to develop a short version questionnaire and proved to have better accuracy, as compared with the short version developed by traditional statistical technique.
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http://dx.doi.org/10.1016/j.cmpb.2019.105047DOI Listing
December 2019

Inflammatory Dietary Pattern Predicts Dyslipidemia and Anemia in Middle-Aged and Older Taiwanese Adults with Declined Kidney Function: A Cross-Sectional Population Study from 2008 to 2010.

Nutrients 2019 Sep 2;11(9). Epub 2019 Sep 2.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.

Dyslipidemia, anemia, and inflammation are associated with declined kidney function. This study investigated the association of inflammatory dietary pattern with dyslipidemia, anemia, and kidney function biomarkers among middle-aged and older Taiwanese adults with declined kidney function. Biochemical data and food frequency questionnaire were obtained from 41,128 participants with estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m and positive urinary protein. Inflammatory dietary pattern was identified by reduced rank regression with C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (N/L) as response variables. Males had higher prevalence of dyslipidemia and higher inflammatory markers, but lower prevalence of anemia and lower eGFR levels compared to females. Inflammatory dietary pattern characterized with low intakes of seafood, grains, vegetables, and fruits but high intakes of meat, eggs, preserved/processed foods, and sugary drinks was associated with an increased risk of dyslipidemia by 21% in males and an increased risk of anemia by 28-47% in both genders. Furthermore, high consumption of inflammatory dietary pattern was associated with reduced eGFR (males β = -0.85, 95% CI -1.26 to -0.43, females β = -0.53, 95% CI -0.98 to -0.08) and increased N/L and/or CRP in both genders. In conclusion, inflammatory dietary pattern is positively associated with dyslipidemia, anemia, and decreased kidney function in middle-aged and older adults with declined kidney function.
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http://dx.doi.org/10.3390/nu11092052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770658PMC
September 2019

Association of Sleep Duration and Insomnia Symptoms with Components of Metabolic Syndrome and Inflammation in Middle-Aged and Older Adults with Metabolic Syndrome in Taiwan.

Nutrients 2019 Aug 9;11(8). Epub 2019 Aug 9.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.

The study determined the association of sleep duration and insomnia symptoms with the components of metabolic syndrome and inflammation in middle-aged and older adults with metabolic syndrome in Taiwan. This cross-sectional study used the database compiled in Taiwan between 2004-2013. A total of 26,016 volunteers aged 35 years and above were selected. Metabolic syndrome was defined according to the International Diabetes Federation. Compared with regular sleep duration (6-8 h/day), short (<6 h/day) or long sleep duration (>8 h/day) and insomnia symptoms significantly increased the odds ratios of high waist circumference, high blood pressure, low high-density lipoprotein-cholesterol, high triglycerides, high fasting blood glucose, and high C-reactive protein. Insomnia symptoms did not modify the effects of sleep duration on the components of metabolic syndrome and inflammation. Our study suggests that short or long sleep duration and insomnia symptoms may have an adverse effect on metabolic syndrome and inflammation.
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http://dx.doi.org/10.3390/nu11081848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723777PMC
August 2019

Dietary patterns in relation to testosterone levels and severity of impaired kidney function among middle-aged and elderly men in Taiwan: a cross-sectional study.

Nutr J 2019 07 27;18(1):42. Epub 2019 Jul 27.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan.

Background: Chronic Kidney Disease (CKD), characterized by an impaired kidney function, is associated with low testosterone levels. This study investigated the association between dietary patterns, testosterone levels, and severity of impaired kidney function among middle-aged and elderly men.

Methods: This cross-sectional study used the database from a private health-screening institute in Taiwan between 2008 and 2010. Men aged 40 years old and older (n = 21,376) with estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m and proteinuria were selected. Among 21,376 men, 256 men had available measurements of testosterone levels. Dietary assessment was conducted using a food frequency questionnaire and three dietary patterns (fried-processed, vege-seafood, and dairy-grain dietary patterns) were identified using principal component analysis.

Results: Men in the lower tertiles (T1 and T2) of eGFR had significantly decreased testosterone levels by 0.8 (95% CI: - 1.40, - 0.20) and 0.9 nmol/L (95% CI: - 1.43, - 0.33). Furthermore, serum triglycerides (TG) levels were inversely associated with testosterone levels (β = - 0.51, 95% CI: - 0.77, - 0.24). Men in the higher tertile of fried-processed dietary pattern scores were associated with decreased testosterone levels by 0.8 nmol/L (95% CI: - 1.40, - 0.16), reduced testosterone-to-TG (T/TG) ratio by 1.8 units (95% CI: - 2.99, - 0.53), and increased risk of moderate/severe impaired kidney function (eGFR < 60 mL/min/1.73 m) and proteinuria severity by 1.35 (95% CI: 1.15, 1.58) and 1.18 (95% CI: 1.02, 1.37) times respectively. In contrast, the vege-seafood dietary pattern was negatively associated with severity of impaired kidney function and proteinuria after multivariable adjustment, but had no association with testosterone levels and T/TG ratio.

Conclusions: The fried-processed dietary pattern is negatively associated with testosterone levels but positively associated with the severity of impaired kidney function. However, the vege-seafood and dairy-grain dietary patterns appear to have beneficial effects.
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http://dx.doi.org/10.1186/s12937-019-0467-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660671PMC
July 2019

Impact of socio-demographic factors, lifestyle and health status on nutritional status among the elderly in Taiwan.

Nutr Res Pract 2019 Jun 31;13(3):222-229. Epub 2019 May 31.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan.

Background/objectives: Aging is an imperative problem for many countries in this century, and presents several challenges for the maintenance of good nutritional status. This study aims to assess the impact of socio-demographic factors, lifestyle and health status on the nutritional status among the elderly in Taiwan.

Subjects/methods: A cross-sectional study was carried out in Taiwan. Data were obtained from the Mei Jau Health Management Institution, which is a private health evaluation provider with multiple health screening centers in Taiwan and Asia. This study included 7947 adults aged 65 years or above. The data were extracted between 2001 to 2010. Nutritional status was assessed using anthropometric data, biochemical data and dietary intake information.

Results: Among the 7947 participants with mean age of 70.1 (SD = 4.5) years, 20.2%, 6.6%, 10.5% and 52.5% experienced underweight, protein malnutrition, anemia and inadequate dietary intake in the past month, respectively. Age was negatively correlated with body weight (r = -0.19, = 0.02), body mass index (r = -0.41, < 0.001), albumin level (r = -0.93, < 0.001) and hemoglobin level (r = -0.30, = 0.008). Age above 70 years, gender, unmarried status, retirement, lack of education, low family income, smoking, alcohol drinking, sleep duration of 6-8 hours, vegetarian diet, multiple medications, comorbidity and dysphagia were positively associated with malnutrition in older adults.

Conclusions: Underweight and inadequate dietary intake are prevalent among the elderly in Taiwan. Vegetarian diet, multiple medications, comorbidity, dysphagia and lifestyle factors such as smoking, alcohol drinking and sleep duration of 6-8 hours are risk factors for undernutrition in older adults.
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http://dx.doi.org/10.4162/nrp.2019.13.3.222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548706PMC
June 2019

Encouraging On-Time Completion of Leprosy Patients Treatment: Implementing E-Leprosy Framework to Primary Health Care in Indonesia.

Asia Pac J Public Health 2019 05 18;31(4):296-305. Epub 2019 May 18.

1 Taipei Medical University, Taipei City, Taiwan.

Low adherence to leprosy treatment is the main challenge in Indonesia. This is a quasi-experimental observational study in a real setting of a leprosy control program in Indonesia. The study is aimed at evaluating an e-leprosy framework in increasing the rate of on-time attendance at primary health care and on-time completion of treatment of leprosy patients. This study has implemented an e-leprosy framework for primary health care at Pekalongan District. The intervention was conducted for 19 months to observe a 1-episode long-term treatment of leprosy patients. The study collected data of 391 registered patients from June 2012 to March 2016. Based on the inclusion and exclusion criteria, this study selected 188 patients. The SMS (short message service) reminders proved to be effective in increasing on-time completion and on-time attendance rates by 21% and 14.6%, respectively. There is a trend for late collections of the drugs at the 3rd, 8th, and 11th multidrug therapy drug collections.
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http://dx.doi.org/10.1177/1010539519847355DOI Listing
May 2019

Dietary Patterns in Relation to Components of Dyslipidemia and Fasting Plasma Glucose in Adults with Dyslipidemia and Elevated Fasting Plasma Glucose in Taiwan.

Nutrients 2019 Apr 14;11(4). Epub 2019 Apr 14.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.

Dietary patterns have been proposed to be related to dyslipidemia and hyperglycemia. This study investigated the correlation of dietary patterns with components of dyslipidemia and fasting plasma glucose (FPG) among young and middle-aged adults (aged between 20 and 50 years) with dyslipidemia and abnormal FPG in Taiwan. This cross-sectional study used the database compiled in Taiwan between 2001 to 2010. A total of 13,609 subjects aged between 20 and 50 years were selected. Dyslipidemia was defined primarily according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with minor modification. Elevated FPG level was defined according to the American Diabetes Association. The factor analysis was conducted to identify three dietary patterns. Higher scores of the meat-convenience dietary pattern (high intake of deep-fried and processed food, sauces, sugar-added beverages, meat and organ meats, instant noodles, rice or flour cooked in oil, and eggs) had no association with components of dyslipidemia and abnormal FPG. Higher scores of the vegetables-fruits-seafood dietary pattern (high intake of vegetables, vegetables with oil or dressing, fruits, seafood, legumes, soy products, and rice or flour products) was inversely associated with hypercholesterolemia and positively associated with hyperglycemia. Higher scores of the dairy-complex carbohydrate dietary pattern (high intake of dairy products, milk, root crops, jam or honey, and whole grains) was inversely correlated with hypertriglycemia and low high-density lipoprotein cholesterol level. Our results support that the dietary pattern may have a role in the prevention and management of dyslipidemia and abnormal fasting plasma glucose.
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http://dx.doi.org/10.3390/nu11040845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520691PMC
April 2019

Association of kidney function-related dietary pattern, weight status, and cardiovascular risk factors with severity of impaired kidney function in middle-aged and older adults with chronic kidney disease: a cross-sectional population study.

Nutr J 2019 04 22;18(1):27. Epub 2019 Apr 22.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan.

Background: Chronic Kidney Disease (CKD), characterized by impaired kidney function, affects over 1.5 million individuals in Taiwan. Cardiovascular disease (CVD) is commonly found in patients with CKD, and the increased prevalence of obesity can have some implications for the risk of both CKD and CVD. Since diet plays an important role in the development of obesity, CVD and CKD, our study was designed to investigate the association of kidney function-related dietary pattern with weight status, cardiovascular risk factors, and the severity of impaired kidney function in middle-aged and older adults in Taiwan.

Methods: A total of 41,128 participants aged 40 to 95 years old with an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m and proteinuria were recruited from Mei Jau Health Institute between 2008 and 2010. The kidney function-related dietary pattern was identified using reduced rank regression (RRR) and was known as high consumption of preserved or processed food, meat, organ meats, rice/flour products, and, low consumption of fruit, dark-colored vegetables, bread, and beans. A multivariable logistic regression analysis was used to identify the association of weight status and cardiovascular risk factors with moderately/severely impaired kidney function (eGFR < 60 mL/min/1.73 m) and the association of dietary pattern with the outcomes aforementioned.

Results: Moderately/severely impaired kidney function participants were heavier and had higher abnormality of cardiovascular risk factors compared with those with mildly impaired kidney function. Weight status (OR = 1.28, 95% CI 1.12-1.45, P <  0.001 for obesity) and cardiovascular risk factors (OR = 1.52, 95% CI 1.31-1.77, P <  0.001 for high total cholesterol/HDL-C ratio and OR = 1.56, 95% CI 1.41-1.72, P <  0.001 for hypercalcemia) were positively associated with increased risk of moderately/severely impaired kidney function. The kidney function-related dietary pattern was correlated with overweight or obese (OR = 2.07, 95% CI 1.89-2.27, P <  0.01) weight status, increased cardiovascular risk by 10-31%, and the risk of moderately/severely impaired kidney function (OR = 1.15, 95% CI 1.02-1.29, P <  0.05).

Conclusions: The RRR-derived kidney function-related dietary pattern, characterized by high intake of processed and animal foods and low intake of plant foods, predicts the risks for developing cardiovascular disease and moderately/severely impaired kidney function among middle-aged and older adults.
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http://dx.doi.org/10.1186/s12937-019-0452-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477746PMC
April 2019

Association of dietary patterns, anthropometric measurements, and metabolic parameters with C-reactive protein and neutrophil-to-lymphocyte ratio in middle-aged and older adults with metabolic syndrome in Taiwan: a cross-sectional study.

Nutr J 2018 11 19;17(1):106. Epub 2018 Nov 19.

School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan.

Background: Metabolic syndrome is commonly associated with inflammation. The underlying factors of inflammation in metabolic syndrome are not fully understood. The objective of the study was to determine the association of dietary patterns, anthropometric measurements, and metabolic parameters with inflammatory markers in middle-aged and older adults with metabolic syndrome in Taiwan.

Methods: A total of 26,016 subjects aged ≥35 y with metabolic syndrome were recruited from Mei Jau institution between 2004 and 2013 for a cross sectional study. Metabolic syndrome was defined by the International Diabetes Federation. Multivariate logistic regression was performed to evaluate the association of dietary patterns, anthropometric measurements, and metabolic parameters with C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in men and women with metabolic syndrome. Crude and adjusted models were analyzed by gender.

Results: The western dietary pattern, obesity, high body fat, high waist or hip circumference, and high waist-to-hip ratio were significantly associated with increased odds ratios of high CRP and NLR in both genders. High systolic or diastolic blood pressure (BP), low high-density lipoprotein-cholesterol (HDL-C), high low-density lipoprotein-cholesterol (LDL-C), high total cholesterol (TC), high serum triglycerides (TG), and high fasting blood glucose (FBG) were significantly correlated with increased odds ratios of high CRP in both genders. Low HDL-C, high LDL-C, high serum TG, and high FBG were significantly associated with increased odds ratios of high NLR in both genders. However, high systolic (OR = 1.124, 95% CI 1.047-1.206, P < 0.01) or diastolic BP (OR = 1.176, 95% CI 1.087-1.273, P < 0.001) and high TC (OR = 1.138, 95% CI 1.062-1.220, P < 0.001) were significantly correlated with increased odds ratios of high NLR only in men.

Conclusions: The western dietary pattern, obese-related anthropometric parameters, and most components of metabolic syndrome are positively associated with CRP levels and NLR in men and women with metabolic syndrome.
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http://dx.doi.org/10.1186/s12937-018-0417-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240947PMC
November 2018

Vitamin D and bisphosphonates therapies for osteoporosis are associated with different risks of atrial fibrillation in women: A nationwide population-based analysis.

Medicine (Baltimore) 2018 Oct;97(43):e12947

Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital.

Osteoporosis and atrial fibrillation (AF) are common in post-menopausal women. Vitamin D and bisphosphonates are widely used to treat osteoporosis, and these may have different effects on the risk of AF.The goal of this study was to evaluate whether different agents for treating osteoporosis modulate the risk of AF in a population-based database.We identified 20,788 female patients suffering from osteoporosis who were or were not treated with vitamin D or bisphosphonates using the Taiwan National Health Insurance nationwide database from 2000 to 2008 and followed them up for 5 consecutive years to determine if they had a new diagnosis of AF after the diagnosis of osteoporosis.There were 14 (2.67%) new AF diagnoses in osteoporosis patients treated with bisphosphonates, one (0.28%) new AF diagnosis in patients treated with vitamin D, and 279 (1.40%) new AF diagnoses in patients who were not treated with vitamin D or bisphosphonates (neither group). Osteoporosis patients who received bisphosphonates showed a higher incidence of AF occurrence than those that were not treated with bisphosphonates (P = .015). In contrast, 1 patient who received vitamin D had a new diagnosis of AF during the study period; thus, the incidence was significantly lower than that in the patients treated with bisphosphonates (P = .007). In addition, the patients who were treated with vitamin D had a lower incidence of AF than did those who were not treated with either vitamin D or bisphosphonates (P = .074). Kaplan-Meier analysis also showed a significant difference in AF occurrence in different groups during the 5-year follow-up (P = .010).Different treatment for osteoporosis may carry diverse risks of AF occurrence. Vitamin D may have potential beneficial effects of reducing AF occurrence in osteoporosis patients.
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http://dx.doi.org/10.1097/MD.0000000000012947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221698PMC
October 2018

Renal transplantation delays major adverse cardiac events (MACEs) in patients with end-stage renal disease: A nationwide population-based study.

J Chin Med Assoc 2018 Sep 30;81(9):766-771. Epub 2018 Jun 30.

Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address:

Background: Whether renal transplantation (RT) influences the risk of cardiovascular events remains controversial.

Methods: This nationwide population-based study investigated the risk of major adverse cardiac events (MACEs) and stroke after RT in patients with end-stage renal disease (ESRD), using data obtained from the National Health Insurance Research Database in Taiwan. A total of 164 ESRD patients who underwent RT formed the study cohort, and an age- and sex-matched control group comprised 164 patients without RT selected from 6976 ESRD patients. All patients were enrolled between January 1, 2000 and December 31, 2009. Those who developed MACEs and/or stroke during the study period were identified according to the International Classification of Diseases, Ninth Revision, Clinical Modification. A Kaplan-Meier MACEs-free curve was used to compare MACEs episodes between the study and control groups.

Results: The mean age was similar between RT and non-RT patients, with most between 30 and 50 years old. In this age range, MACEs developed in 47.5% of the RT group and in 52.5% of the non-RT group (p = 0.0882). The survival rate among all ESRD patients was significant higher in the RT group than in non-RT group (p < 0.001). The MACEs-free, stroke-free and MACEs-or-stroke-free rates were significantly higher in the RT group than in the non-RT group (p = 0.0134, 0.035 and 0.005, respectively) as demonstrated by Kaplan-Meier curves.

Conclusion: RT seemed not to reduce the risk of MACEs directly, but it could have dramatically delayed MACEs and stroke episodes in the ESRD patients. Furthermore, a lower mortality rate was observed in the ESRD patients who received RT than in those undergoing chronic dialysis. Further in-depth investigation is necessary to identify other protective factors against MACEs or stroke in ESRD.
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http://dx.doi.org/10.1016/j.jcma.2018.04.003DOI Listing
September 2018

UTAUT for HSS: initial framework to study health IT adoption in the developing countries.

F1000Res 2018 23;7:101. Epub 2018 Jan 23.

Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

Unified Theory of Acceptance and Use of Technology (UTAUT) is an integrative concept that has been used widely to measure IT adoption. However, a recent study in a developing country concluded that UTAUT is not adequate in predicting IT adoption within the context of health system strengthening (HSS). It has been suggested that context-specific dimensions to modify UTAUT should be considered. The objective of this paper is to propose an extension of the theory, called UTAUT for HSS, as a reference for contextualizing health system variables for health IT adoption studies in the developing countries. We combined the multi-level framework of UTAUT with WHO health system building blocks. Modification of the original multi-level framework was performed on the 3 levels. i.e:  the higher-level contextual factors, middle-level, and individual-level contextual factors. Based on this, we propose a modified multi-level framework of technology acceptance and use for health system strengthening setting (UTAUT for HSS).  Given the complexities of health systems, more thoughts regarding the methodologies will be useful to enrich this initial framework.  Commentaries and discussions are invited for improvement, before implementation to obtain more complete story of health IT adoption in the low resources setting.
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http://dx.doi.org/10.12688/f1000research.13798.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069728PMC
August 2019

Association of thiazolidinedione with a lower risk of Parkinson's disease in a population with newly-diagnosed diabetes mellitus.

Ann Med 2018 08 21;50(5):430-436. Epub 2018 Jul 21.

f Department of Information Management , National Taipei University of Nursing and Health Sciences , Taipei , Taiwan.

Objectives: We investigated the association of thiazolidinedione and its dose effect with the risk of Parkinson's disease (PD) in patients with diabetes mellitus (DM).

Methods: This study enrolled 38,521 patients with newly-diagnosed DM, between 2001 and 2013, and compared them to the matched subjects without DM. The hazard ratios (HRs) for PD were compared between the thiazolidinedione-treated and non-thiazolidinedione-treated groups of the study cohort, and between subgroups who received different cumulative dosages of thiazolidinedione.

Results: We observed that 544 (1.4%) patients developed PD during the follow-up median duration of 6.2 years in patients with newly-diagnosed DM or had a higher risk for PD than patients without DM (HR = 1.150). In the study cohort, the risk of PD was significantly lower in the thiazolidinedione-treated group (HR = 0.399) compared to the non-thiazolidinedione-treated group. Thiazolidinedione reduced the risk of PD in a dose-dependent manner, with HRs ranging from 0.613 to 0.081 with defined daily doses of 0-90 to >720, respectively.

Conclusions: Thiazolidinedione use was associated with a significantly reduced risk of PD in patients with newly-diagnosed DM. Further studies to elucidate the common mechanism of PD and DM may provide novel therapies for these two diseases. Key messages Newly-diagnosed diabetes mellitus slightly increases the risk for Parkinson's disease. Thiazolidinedione is associated with a lower risk of Parkinson's disease in a dose-dependent manner in patients with newly-diagnosed diabetes mellitus.
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http://dx.doi.org/10.1080/07853890.2018.1488083DOI Listing
August 2018

A Cloud Based Potentially Inappropriate Medication Management System Using Patient Owned Personal Health Records.

Stud Health Technol Inform 2018 ;250:208-212

Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

Taiwan has been confronted with a serious problem of aging in recent years. The prevalence of the chronic diseases caused by aging is increased continuously, which has led to a high percentage of comorbidity and polypharmacy. The proportion of the elderly people with polypharmacy (over three to five kinds of drugs) is 81%. Under the situation of high comorbidity, the potentially inappropriate drug for the elderly have become a series problem. However, in order to promote personal health management, Taiwan's Ministry of Health and Welfare has released a service of "My Health Bank", which contains all the personal medical information issued by the National Health Insurance Department and can be downloaded by any individual person. This study designs a cloud-based personal health management platform to parse and store the information of "My Health Bank", establishes two databases, one for the health insurance drug table and one for the inappropriate medications. A warning of inappropriate personal medication will be generated based on a checking process. We expect that the application will enhance the safety of medication and improve the self-health management of the elderly.
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October 2018