Publications by authors named "Suleman Atique"

27 Publications

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Health Service Access among Indonesian Migrant Domestic Workers in Taiwan.

Int J Environ Res Public Health 2021 Apr 4;18(7). Epub 2021 Apr 4.

Master Program in Global Health & Development Department, College of Public Health, Taipei Medical University, Taipei City 110, Taiwan.

The number of migrant workers in Taiwan increases annually. The majority is from Indonesia and most of them are female caregivers. This study aims to determine the access to health services and the associated factors among Indonesian female domestic workers in Taiwan. In this cross-sectional study, data were collected from February to May 2019, using a structured questionnaire. Subsequently, multiple logistic regression was used to examine the association between socio-demographic factors and health service access. Two hundred and eighty-four domestic migrant workers were interviewed. Eighty-five percent of the respondents declared sickness at work, but only 48.8% seek health care services. Factors associated with health service access were marital status, income, and the availability of an attendant to accompany the migrant workers to the healthcare facilities. Language barrier and time flexibility were the main obstacles. Further research and an effective health service policy are needed for the domestic migrant workers to better access health care services.
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http://dx.doi.org/10.3390/ijerph18073759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038466PMC
April 2021

Clinical Characteristics and Neonatal Outcomes of Pregnant Patients With COVID-19: A Systematic Review.

Front Med (Lausanne) 2020 3;7:573468. Epub 2020 Dec 3.

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

Coronavirus disease 2019 (COVID-19) characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created serious concerns about its potential adverse effects. There are limited data on clinical, radiological, and neonatal outcomes of pregnant women with COVID-19 pneumonia. This study aimed to assess clinical manifestations and neonatal outcomes of pregnant women with COVID-19. We conducted a systematic article search of PubMed, EMBASE, Scopus, Google Scholar, and Web of Science for studies that discussed pregnant patients with confirmed COVID-19 between January 1, 2020, and April 20, 2020, with no restriction on language. Articles were independently evaluated by two expert authors. We included all retrospective studies that reported the clinical features and outcomes of pregnant patients with COVID-19. Forty-seven articles were assessed for eligibility; 13 articles met the inclusion criteria for the systematic review. Data is reported for 235 pregnant women with COVID-19. The age range of patients was 25-40 years, and the gestational age ranged from 8 to 40 weeks plus 6 days. Clinical characteristics were fever [138/235 (58.72%)], cough [111/235 (47.23%)], and sore throat [21/235 (8.93%)]. One hundred fifty six out of 235 (66.38%) pregnant women had cesarean section, and 79 (33.62%) had a vaginal delivery. All the patients showed lung abnormalities in CT scan images, and none of the patients died. Neutrophil cell count, C-reactive protein (CRP) concentration, ALT, and AST were increased but lymphocyte count and albumin levels were decreased. Amniotic fluid, neonatal throat swab, and breastmilk samples were taken to test for SARS-CoV-2 but all found negativ results. Recent published evidence showed the possibility of vertical transmission up to 30%, and neonatal death up to 2.5%. Pre-eclampsia, fetal distress, PROM, pre-mature delivery were the major complications of pregnant women with COVID-19. Our study findings show that the clinical, laboratory and radiological characteristics of pregnant women with COVID-19 were similar to those of the general populations. The possibility of vertical transmission cannot be ignored but C-section should not be routinely recommended anymore according to latest evidences and, in any case, decisions should be taken after proper discussion with the family. Future studies are needed to confirm or refute these findings with a larger number of sample sizes and a long-term follow-up period.
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http://dx.doi.org/10.3389/fmed.2020.573468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772992PMC
December 2020

Deep Learning for Accurate Diagnosis of Glaucomatous Optic Neuropathy Using Digital Fundus Image: A Meta-Analysis.

Stud Health Technol Inform 2020 Jun;270:153-157

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

We conducted a study to evaluate the algorithms based on deep learning to automatically diagnosis of GON from digital fundus images. A systematic articles search was conducted in PubMed, EMBASE, Google Scholar for the study that investigated the performance of deep learning algorithms for the detection of GON. A total of eight studies were included in this study, of which 5 studies were used to conduct our meta-analysis. The pooled AUROC for detecting GON was 0.98. However, the sensitivity and specificity of deep learning to detect GON were 0.90 (95% CI: 0.90-0.91), and 0.94 (95%CI: 0.93-0.94), respectively.
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http://dx.doi.org/10.3233/SHTI200141DOI Listing
June 2020

Hajj in the Time of COVID-19.

Infect Dis Health 2020 08 15;25(3):219-221. Epub 2020 Apr 15.

Department of Health Management, College of Public Health and Health Informatics, University of Ha'il, Ha'il, 2440, Saudi Arabia.

The recent outbreak of the novel COVID-19 is posing a severe public health risk across the globe. The Kingdom of Saudi Arabia (KSA) is one of the greatest destinations of religious congregations of Muslims. One of the largest religious gatherings is the Hajj that is anticipated to produce serious challenges of mass level exposures and spread to every corner of the world. Therefore, it is highly recommended that the Ministry of Hajj and Umrah (KSA), must regularly analyze the prevailing situation of COVID-19, and involve the religious scholars to make appropriate decisions about Hajj 2020. Although the Saudi government has been continuously taking all possible measures to contain the pandemic, people's cooperation is crucial in the fight against COVID-19.
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http://dx.doi.org/10.1016/j.idh.2020.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158770PMC
August 2020

Predicting skilled delivery service use in Ethiopia: dual application of logistic regression and machine learning algorithms.

BMC Med Inform Decis Mak 2019 11 5;19(1):209. Epub 2019 Nov 5.

Leibniz Institute for Prevention Research and Epidemiology -BIPS, Achterstraße, 30, Bremen, Germany.

Background: Skilled assistance during childbirth is essential to reduce maternal deaths. However, in Ethiopia, which is among the six countries contributing to more than half of the global maternal deaths, the coverage of births attended by skilled health personnel remains very low. The aim of this study was to identify determinants and develop a predictive model for skilled delivery service use in Ethiopia by applying logistic regression and machine-learning techniques.

Methods: Data from the 2016 Ethiopian Demographic and Health Survey (EDHS) was used for this study. Statistical Package for Social Sciences (SPSS) and Waikato Environment for Knowledge Analysis (WEKA) tools were used for logistic regression and model building respectively. Classification algorithms namely J48, Naïve Bayes, Support Vector Machine (SVM), and Artificial Neural Network (ANN) were used for model development. The validation of the predictive models was assessed using accuracy, sensitivity, specificity, and area under Receiver Operating Characteristics (ROC) curve.

Results: Only 27.7% women received skilled delivery assistance in Ethiopia. First antenatal care (ANC) [AOR = 1.83, 95% CI (1.24-2.69)], birth order [AOR = 0.22, 95% CI (0.11-0.46)], television ownership [AOR = 6.83, 95% CI (2.52-18.52)], contraceptive use [AOR = 1.92, 95% CI (1.26-2.97)], cost needed for healthcare [AOR = 2.17, 95% CI (1.47-3.21)], age at first birth [AOR = 1.96, 95% CI (1.31-2.94)], and age at first sex [AOR = 2.72, 95% CI (1.55-4.76)] were determinants for utilizing skilled delivery services during the childbirth. Predictive models were developed and the J48 model had superior predictive accuracy (98%), sensitivity (96%), specificity (99%) and, the area under ROC (98%).

Conclusions: First ANC and contraceptive uses were among the determinants of utilization of skilled delivery services. A predictive model was developed to forecast the likelihood of a pregnant woman seeking skilled delivery assistance; therefore, the predictive model can help to decide targeted interventions for a pregnant woman to ensure skilled assistance at childbirth. The model developed through the J48 algorithm has better predictive accuracy. Web-based application can be build based on results of this study.
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http://dx.doi.org/10.1186/s12911-019-0942-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6833149PMC
November 2019

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

JAMA Oncol 2019 12;5(12):1749-1768

Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions And Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.
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http://dx.doi.org/10.1001/jamaoncol.2019.2996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777271PMC
December 2019

Investigating spatio-temporal distribution and diffusion patterns of the dengue outbreak in Swat, Pakistan.

J Infect Public Health 2018 Jul - Aug;11(4):550-557. Epub 2017 Dec 26.

Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Introduction: Dengue has been endemic to Pakistan in the last two decades. There was a massive outbreak in the Swat valley in 2013. Here we demonstrate the spatio-temporal clustering and diffusion patterns of the dengue outbreak.

Methods: Dengue case data were acquired from the hospital records in the Swat district of Pakistan. Ring maps visualize the distribution and diffusion of the number of cases and incidence of dengue at the level of the union council. We applied space-time scan statistics to identify spatio-temporal clusters. Ordinary least squares and geographically weighted regression models were used to evaluate the impact of elevation, population density, and distance to the river.

Results: The results show that dengue distribution is not random, but clustered in space and time in the Swat district. Males constituted 68% of the cases while females accounted for about 32%. A majority of the cases (>55%) were younger than 40 years of age. The southern part was a major hotspot affected by the dengue outbreak in 2013. There are two space-time clusters in the spatio-temporal analysis. GWR and OLS show that population density is a significant explanatory variable for the dengue outbreak, while GWR exhibits better performance in terms of 'R=0.49 and AICc=700'.

Conclusion: Dengue fever is clustered in the southern part of the Swat district. This region is relatively urban in character, with most of the population of the district residing here. There is a need to strengthen the surveillance system for reporting dengue cases in order to respond to future outbreaks in a robust way.
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http://dx.doi.org/10.1016/j.jiph.2017.12.003DOI Listing
November 2018

The usefulness and actual use of wearable devices among the elderly population.

Comput Methods Programs Biomed 2018 Jan 14;153:137-159. Epub 2017 Oct 14.

Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background And Objective: Elderly populations are more prone to diseases and need continuous monitoring of parameters to ensure good health. Wearable devices (WDs) can be helpful in the early detection and management of medical conditions. However, less is known about the use of currently available WDs among elderly populations. The objectives of this study were to determine the usefulness and actual use of wearable devices among the elderly population.

Methods: Our methodology was based on a systematic review and a survey questionnaire. In the systematic review, search was conducted in four databases PubMed, MDPI, Sage, and Scopus with search terms "wearable device" and "elderly", "wearable sensor" and "elderly". The inclusion criteria were the studies which described health-related wearable devices, its use as the outcome, conducted on a minimum of ten participants and published in the last five years. The survey was conducted on the MOOCs (Massive Open Online Course) platform. The questionnaire was related to the use of technology, intention to use, security and privacy concerns, and willingness to pay.

Results: The review identified 4915 articles, of which, 31 studies eventually met the inclusion criteria. All studies reported positive impacts after assessing devices, despite certain drawbacks. The majority of the samples were males. The survey revealed responses from 233 individuals out of the 1100 participants of the course. The survey results were categorized into two age groups: 54.3% were elderly (>65 years) and 45.49% were non-elderly (≤65 years). Very few elderly people were currently using WD. More than 60% of elderly people were interested in the future use of wearable devices, and preferred future use to improve physical and mental activities. A majority of the respondents were female.

Conclusions: This study suggests awareness should be created among elderly populations regarding the use of WDs for the early detection and prevention of complications and emergencies. Elderly populations are more prone to benefits from using WDs. The review concluded that devices should be tested on elderly groups as well, considering sex equality, and on both healthy and sick participants for better insights. The survey determined the elderly as frequent users of technology, but lack of knowledge of WD and demonstrated female interest in the use of WD. In future research on WDs, it is suggested that clinical studies be conducted for longer durations, and standard protocols such as age and sex equality should be considered. Requirements from both users and physicians should be acknowledged for better cognizance of WDs.
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http://dx.doi.org/10.1016/j.cmpb.2017.10.008DOI Listing
January 2018

The impact of different surgical procedures on hypoparathyroidism after thyroidectomy: A population-based study.

Medicine (Baltimore) 2017 Oct;96(43):e8245

Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan School of Health Care Administration, Taipei Medical University, Taipei, Taiwan Faculty of Health Sciences, Macau University of Science and Technology, Macau, China Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan.

The main objective of this study is to investigate the outcome between surgical procedures and the risk of development of hypoparathyroidism followed by surgical procedure in patients with thyroid disorders.We analyzed the data acquired from Taiwan's Bureau of National Health Insurance (BNHI) research database from 1998 to 2011 and found 9316 patients with thyroid surgery. Cox regression model was used to calculate the hazard ratio (HR).A count of 314 cases (3.4%) of hypoparathyroidism was identified. The 9 years cumulated incidence of hypoparathyroidism was the highest in patient undergone bilateral total thyroidectomy (13.5%) and the lowest in the patient with unilateral subtotal thyroidectomy (1.2%). However, in the patients who had undergone unilateral subtotal, the risk was the highest in bilateral total (HR: 11.86), followed by radical thyroidectomy with unilateral neck lymph node dissection (HR: 8.56), unilateral total (HR, 4.39), and one side total and another side subtotal (HR: 2.80).The extent of thyroid resection determined the risk of development of hypoparathyroidism. It is suggested that the association of these factors is investigated in future studies.
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http://dx.doi.org/10.1097/MD.0000000000008245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5671821PMC
October 2017

Benzodiazepines use and breast cancer risk: A population-based study and gene expression profiling evidence.

J Biomed Inform 2017 10 26;74:85-91. Epub 2017 Aug 26.

International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan; Department of Dermatology, Wan-Fang Hospital, Taipei, Taiwan. Electronic address:

The aim of this study was to investigate whether long-term use of Benzodiazepines (BZDs) is associated with breast cancer risk through the combination of population-based observational and gene expression profiling evidence. We conducted a population-based case-control study by using 1998 to 2009year Taiwan National Health Insurance Research Database and investigated the association between BZDs use and breast cancer risk. We selected subjects age of >20years old and six eligible controls matched for age, sex and the index date (i.e., free of any cancer at the case diagnosis date) by using propensity scores. A bioinformatics analysis approach was also performed for the identification of oncogenesis effects of BZDs on breast cancer. We used breast cancer gene expression data from the Cancer Genome Atlas and perturbagen signatures of BZDs from the Library of Integrated Cellular Signatures database in order to identify the oncogenesis effects of BZDs on breast cancer. We found evidence of increased breast cancer risk for diazepam (OR, 1.16; 95%CI, 0.95-1.42; connectivity score [CS], 0.3016), zolpidem (OR, 1.11; 95%CI, 0.95-1.30; CS, 0.2738), but not for lorazepam (OR, 1.04; 95%CI, 0.89-1.23; CS, -0.2952) consistently in both methods. The finding for alparazolam was contradictory from the two methods. Diazepam and zolpidem trends showed association, although not statistically significant, with breast cancer risk in both epidemiological and bioinformatics analyses outcomes. The methodological value of our study is in introducing the way of combining epidemiological and bioinformatics approaches in order to answer a common scientific question. Combining the two approaches would be a substantial step towards uncovering, validation and further application of previously unknown scientific knowledge to the emerging field of precision medicine informatics.
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http://dx.doi.org/10.1016/j.jbi.2017.08.008DOI Listing
October 2017

A Commentary on Telerehabilitation Services in Pakistan: Current Trends and Future Possibilities.

Int J Telerehabil 2017 29;9(1):71-76. Epub 2017 Jun 29.

DEPARTMENT OF ORTHOTICS & PROSTHETICS, RAWALPINDI MEDICAL COLLEGE, RAWALPINDI, PAKISTAN.

A 2014 World Health Organization (WHO) study reported that almost 27 million people with disability live in Pakistan with fewer than one allied rehabilitation professional per 10,000 people. The current study sought to determine the attitudes toward telerehabilitation via a survey administered to 329 Pakistani rehabilitation professionals. Study results indicate that rehabilitation professionals in Pakistan are knowledgeable about telerehabilitation and Information and Communication Technology (ICT), and are receptive to employing telerehabilitation programs and applications. Therefore, we can infer that the future of telerehabilitation can be bright in Pakistan but requires the attention of policy makers and non-government organizations to launch an appropriate program nationwide. The authors suggest that a range of telerehabilitation services (e.g., consultation, assessment, and therapy) could alleviate the shortage of rehabilitation personnel in Pakistan.
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http://dx.doi.org/10.5195/ijt.2017.6224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546563PMC
June 2017

The Concomitant Association of Thyroid Disorders and Myasthenia Gravis.

Transl Neurosci 2017 30;8:27-30. Epub 2017 Apr 30.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.

Background: Some of the thyroid disorders (TD) and Myasthenia gravis (MG) are autoimmune related disease. The purpose of the study to evaluate the relationship of MG with all morphological and functional thyroid disorders.

Methods: We constructed a population-based cohort study during the period from January 2000-December 2002 by using reimbursement data from the Bureau National Health Insurance (NHI) system in Taiwan. Patients with TD and MG were identified by referring to the ICD-9-CM codes. (ICD-10-CM as reference) .The association of TD with MG occurred only in the same person within the study period. The Q value was used to measure the strength of disease-disease associations.

Results: We obtained 520628 TD and 7965 MG records for analysis. Diffuse toxic goiter had highest association rate, followed by nontoxic nodular goiter, simple goiter, chronic lymphocytic thyroiditis, thyroid cancer, and toxic nodular goiter. Female and older patients had a higher rate than their male and younger counterparts, respectively. Functional abnormalities revealed higher incidence of thyrotoxicosis and hypothyroidism in both sexes. We also found the strongest association in men with chronic thyroiditis, diffuse toxic goiter, thyrotoxicosis, acquired hypothyroidism, thyroid cancer, and simple goiter. While an intermediate association was observed in female with diffuse toxic goiter, in a male with toxic and nontoxic nodular/multinodular goiters, in female with thyrotoxicosis, thyroid cancer and acquired hypothyroidism.

Conclusion: This population based cohort study showed potential association of all types of TD with MG, and observed a higher association rate in female autoimmune TD whereas males showed a higher strength of association.
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http://dx.doi.org/10.1515/tnsci-2017-0006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443889PMC
April 2017

Viral warts (Human Papilloma Virus) as a potential risk for breast cancer among younger females.

Comput Methods Programs Biomed 2017 Jun 6;144:203-207. Epub 2017 Apr 6.

Graduate Institute of Biomedical Informatics, College of Medical Science and Technology (CoMST), Taipei Medical University Taiwan, Wuxing Street 250, Xinyi 11031, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan. Electronic address:

Introduction: There have been several reports on the role of human papillomavirus (HPV) in the etiology of breast cancer. To our knowledge, this is first study to use disease-disease association data-mining approach to analyzing viral warts and breast cancer to be conducted in Taiwanese population.

Materials And Methods: We analyzed the Taiwan's National Health Insurance database (NHIDM data comprising of 23 million patient data) to examine the association between viral warts and female breast carcinoma. The patients were categorized into three groups: breast cancer only, viral warts only, and those with both breast cancer and viral warts. The Cox proportion hazard regression analysis was used to measure the effect of HPV on the time to breast cancer diagnosis. Multivariable analyzes and stratified analyzes using hazard ratios (HRs) were presented with 95% confidence intervals (CIs) after adjusting for age, and CCI.

Result: Among 807,578 HPV population, we identified 6014 breast cancer cases. The HPV group was associated with a significantly higher risk of developing breast cancer (HR, 1.18; 95% CI, 1.15-1.21; p< 0.001) compared with the non-HPV group. HPV patients with age group 18-39 was slightly higher risk of breast cancer occurrence (HR, 1.07; 95% CI, 1.01-1.13; p<.05). The risk of breast cancer in 10-year incidence was 7% higher for females less than 40 years and 23% for over 40 year's patients when compared with non-HPV patients of the same age group.

Conclusion: Our study indicates that women who develop viral warts are at a significantly higher risk of developing breast cancer than women who have not diagnosed with viral warts. Thus, the presence of viral warts is a potential risk to breast cancer. Therefore, we suggest patients diagnosed with viral warts may get early screening for breast cancer.
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http://dx.doi.org/10.1016/j.cmpb.2017.03.024DOI Listing
June 2017

Gender-based personalized pharmacotherapy: a systematic review.

Arch Gynecol Obstet 2017 Jun 4;295(6):1305-1317. Epub 2017 Apr 4.

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

Purpose: In general, male and female are prescribed the same amount of dosage even if most of the cases female required less dosage than male. Physicians are often facing problem on appropriate drug dosing, efficient treatment, and drug safety for a female in general. To identify and synthesize evidence about the effectiveness of gender-based therapy; provide the information to patients, providers, and health system intervention to ensure safety treatment; and minimize adverse effects.

Methods: We performed a systematic review to evaluate the effect of gender difference on pharmacotherapy. Published articles from January 1990 to December 2015 were identified using specific term in MEDLINE (PubMed), EMBASE, and the Cochrane library according to search strategies that strengthen the reporting of observational and clinical studies.

Results: Twenty-six studies fulfilled the inclusion criteria for this systematic review, yielding a total of 6309 subjects. We observed that female generally has a lower the gastric emptying time, gastric PH, lean body mass, and higher plasma volume, BMI, body fat, as well as reduce hepatic clearance, difference in activity of Cytochrome P450 enzyme, and metabolize drugs at different rate compared with male. Other significant factors such as conjugation, protein binding, absorption, and the renal elimination could not be ignored. However, these differences can lead to adverse effects in female especially for the pregnant, post-menopausal, and elderly women.

Conclusion: This systematic review provides an evidence for the effectiveness of dosage difference to ensure safety and efficient treatment. Future studies on the current topic are, therefore, recommended to reduce the adverse effect of therapy.
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http://dx.doi.org/10.1007/s00404-017-4363-3DOI Listing
June 2017

Lessons learnt from a MOOC about social media for digital health literacy.

Annu Int Conf IEEE Eng Med Biol Soc 2016 Aug;2016:5636-5639

Nowadays, the Internet and social media represent prime channels for health information seeking and peer support. However, benefits of health social media can be reduced by low digital health literacy. We designed a massive open online course (MOOC) course about health social media to increase the students' digital health literacy. In this course, we wanted to explore the difficulties confronted by the MOOC users in relation to accessing quality online health information and to propose methods to overcome the issues. An online survey was carried out to assess the students' digital health literacy. This survey was one of the activities for the enrolled learners in an online course entitled "Social Media in Health Care" on "FutureLearn", one of the popular MOOC platforms. The course was hosted by Taipei Medical University, Taiwan. Data from a total of 300 respondents were collected through the online survey from 14 December 2015 to 10 January 2016. Most participants (61%) considered finding online health information is easy or very easy, while 39% were unsure or found it difficult to retrieve online health information. Most (63%) were not sure about judging whether available information can be used for making health decisions. This study indicates a demand for more training to increase skills to improve the capability of health consumers to identify trustworthy, useful health information. More research to understand the health information seeking process will be crucial in identifying the skillsets that need to be further developed. MOOCs about digital health can be a great source of knowledge when it comes to studying patients' needs.
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http://dx.doi.org/10.1109/EMBC.2016.7592005DOI Listing
August 2016

Determinants and development of a web-based child mortality prediction model in resource-limited settings: A data mining approach.

Comput Methods Programs Biomed 2017 Mar 28;140:45-51. Epub 2016 Nov 28.

University of Gondar, College of Medicine and Health Science, Institute of Public Health, Gondar, Ethiopia; Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, Germany; University of Bremen, Health Sciences, Bremen, Germany.

Background: Improving child health and reducing child mortality rate are key health priorities in developing countries. This study aimed to identify determinant sand develop, a web-based child mortality prediction model in Ethiopian local language using classification data mining algorithm.

Methods: Decision tree (using J48 algorithm) and rule induction (using PART algorithm) techniques were applied on 11,654 records of Ethiopian demographic and health survey data. Waikato Environment for Knowledge Analysis (WEKA) for windows version 3.6.8 was used to develop optimal models. 8157 (70%) records were randomly allocated to training group for model building while; the remaining 3496 (30%) records were allocated as the test group for model validation. The validation of the model was assessed using accuracy, sensitivity, specificity and area under Receiver Operating Characteristics (ROC) curve. Using Statistical Package for Social Sciences (SPSS) version 20.0; logistic regressions and Odds Ratio (OR) with 95% Confidence Interval (CI) was used to identify determinants of child mortality.

Results: The child mortality rate was 72 deaths per 1000 live births. Breast-feeding (AOR= 1.46, (95% CI [1.22. 1.75]), maternal education (AOR= 1.40, 95% CI [1.11, 1.81]), family planning (AOR= 1.21, [1.08, 1.43]), preceding birth interval (AOR= 4.90, [2.94, 8.15]), presence of diarrhea (AOR= 1.54, 95% CI [1.32, 1.66]), father's education (AOR= 1.4, 95% CI [1.04, 1.78]), low birth weight (AOR= 1.2, 95% CI [0.98, 1.51]) and, age of the mother at first birth (AOR= 1.42, [1.01-1.89]) were found to be determinants for child mortality. The J48 model had better performance, accuracy (94.3%), sensitivity (93.8%), specificity (94.3%), Positive Predictive Value (PPV) (92.2%), Negative Predictive Value (NPV) (94.5%) and, the area under ROC (94.8%). Subsequent to developing an optimal prediction model, we relied on this model to develop a web-based application system for child mortality prediction.

Conclusion: In this study, nearly accurate results were obtained by employing decision tree and rule induction techniques. Determinants are identified and a web-based child mortality prediction model in Ethiopian local language is developed. Thus, the result obtained could support child health intervention programs in Ethiopia where trained human resource for health is limited. Advanced classification algorithms need to be tested to come up with optimal models.
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http://dx.doi.org/10.1016/j.cmpb.2016.11.013DOI Listing
March 2017

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

Ann Rheum Dis 2017 Aug 16;76(8):1365-1373. Epub 2017 Feb 16.

Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.

Objectives: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR).

Methods: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs).

Results: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries.

Conclusions: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.
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http://dx.doi.org/10.1136/annrheumdis-2016-210146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738600PMC
August 2017

Benzodiazepine Use and Risk of Dementia in the Elderly Population: A Systematic Review and Meta-Analysis.

Neuroepidemiology 2016 24;47(3-4):181-191. Epub 2016 Dec 24.

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

Background: Benzodiazepines are a widely used medication in developed countries, particularly among elderly patients. However, benzodiazepines are known to affect memory and cognition and might thus enhance the risk of dementia. The objective of this review is to synthesize evidence from observational studies that evaluated the association between benzodiazepines use and dementia risk.

Summary: We performed a systematic review and meta-analysis of controlled observational studies to evaluate the risk of benzodiazepines use on dementia outcome. All control observational studies that compared dementia outcome in patients with benzodiazepine use with a control group were included. We calculated pooled ORs using a random-effects model. Ten studies (of 3,696 studies identified) were included in the systematic review, of which 8 studies were included in random-effects meta-analysis and sensitivity analyses. Odds of dementia were 78% higher in those who used benzodiazepines compared with those who did not use benzodiazepines (OR 1.78; 95% CI 1.33-2.38). In subgroup analysis, the higher association was still found in the studies from Asia (OR 2.40; 95% CI 1.66-3.47) whereas a moderate association was observed in the studies from North America and Europe (OR 1.49; 95% CI 1.34-1.65 and OR 1.43; 95% CI 1.16-1.75). Also, diabetics, hypertension, cardiac disease, and statin drugs were associated with increased risk of dementia but negative association was observed in the case of body mass index. There was significant statistical and clinical heterogeneity among studies for the main analysis and most of the sensitivity analyses. There was significant statistical and clinical heterogeneity among the studies for the main analysis and most of the sensitivity analyses. Key Messages: Our results suggest that benzodiazepine use is significantly associated with dementia risk. However, observational studies cannot clarify whether the observed epidemiologic association is a causal effect or the result of some unmeasured confounding variable. Therefore, more research is needed.
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http://dx.doi.org/10.1159/000454881DOI Listing
December 2017

Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013.

Am J Trop Med Hyg 2016 Dec 10;95(6):1319-1329. Epub 2016 Oct 10.

Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran.

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.
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http://dx.doi.org/10.4269/ajtmh.16-0339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154365PMC
December 2016

Meteorological influences on dengue transmission in Pakistan.

Asian Pac J Trop Med 2016 10 10;9(10):954-961. Epub 2016 Aug 10.

Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Objective: To identify the influences of local and regional climate phenomena on dengue transmission in Lahore District of Pakistan, from 2006 to 2014.

Methods: Time-series models were applied to analyze associations between reported cases of dengue and climatic parameters. The coherence trend of regional climate phenomena (IOD and ENSO) was evaluated with wavelet analysis.

Results: The minimum temperature 4 months before the dengue outbreak played the most important role in the Lahore District (P = 0.03). A NINO 3.4 index 9 months before the outbreaks exhibited a significant negative effect on dengue transmission (P = 0.02). The IOD exhibited a synchronized pattern with dengue outbreak from 2010 to 2012. The ENSO effect (NINO 3.4 index) might have played a more important role after 2012.

Conclusions: This study provides preliminary results of climate influences on dengue transmission in the Lahore District of Pakistan. An increasing dengue transmission risk accompanied by frequent climate changes should be noted. Integrating the influences of climate variability into disease prevention strategies should be considered by public health authorities.
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http://dx.doi.org/10.1016/j.apjtm.2016.07.033DOI Listing
October 2016

Organizational Benefits of Computerized Physican Order Entry (CPOE) System in Pakistan.

Stud Health Technol Inform 2016 ;225:903-4

Graduate Institute of Biomedical Informatics, Taipei Medical University, Taiwan.

Electronic prescribing is also known as Computerized Physician Order Entry (CPOE). It is a computer-aided system which offers the health professionals a robust platform for entering the prescription electronically. Due to paucity of facilities in Pakistan which are available around the world, there is an observable overburden on the health professionals and practitioners. CPOE system has shown to be very effective in minimizing medication errors. CPOE is beneficial for both patient and health organizations. There is great deal of interest in the adoption of this system in our healthcare system. The results state clearly that this system is equally beneficial for organizations who want to adopt this system as perceived by the health professionals. It supports the idea of adoption and implementation of CPOE in healthcare facilities healthcare institutes. CPOE must be adopted to ease and optimize nursing services in Pakistani healthcare system.
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April 2017

Telerehabilitation Services in Pakistan: A Rehabilitation Professional's Perspective.

Stud Health Technol Inform 2016 ;225:901-2

Taipei Medical University, Taiwan.

Disabled community spending a miserable life and having no or very less access to basic health and rehabilitation care across Pakistan. WHO developed objectives for the provision of standard health and rehabilitation care to disables and emphasizes to achieve them till 2021. The Purpose of this study was to assess the future of tele-rehabilitation services in Pakistan. It was quantitative study with Sample size of 100 rehabilitation professionals across the country. Result showed that Telerehabilitation Services are strongly needed in Pakistan and professionals rated it as a best alternate of facility based rehabilitation services. We can provide a wide range of services through Telerehabilitation Services ranging from simple consultation to delivery of different therapeutic sessions and online monitoring.
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April 2017

Development of a web-based liver cancer prediction model for type II diabetes patients by using an artificial neural network.

Comput Methods Programs Biomed 2016 Mar 27;125:58-65. Epub 2015 Nov 27.

Department of Information Management, Ministry of Health and Welfare and Taipei Medical University, Taiwan. Electronic address:

Background: Diabetes mellitus is associated with an increased risk of liver cancer, and these two diseases are among the most common and important causes of morbidity and mortality in Taiwan.

Purpose: To use data mining techniques to develop a model for predicting the development of liver cancer within 6 years of diagnosis with type II diabetes.

Methods: Data were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan, which covers approximately 22 million people. In this study, we selected patients who were newly diagnosed with type II diabetes during the 2000-2003 periods, with no prior cancer diagnosis. We then used encrypted personal ID to perform data linkage with the cancer registry database to identify whether these patients were diagnosed with liver cancer. Finally, we identified 2060 cases and assigned them to a case group (patients diagnosed with liver cancer after diabetes) and a control group (patients with diabetes but no liver cancer). The risk factors were identified from the literature review and physicians' suggestion, then, chi-square test was conducted on each independent variable (or potential risk factor) for a comparison between patients with liver cancer and those without, those found to be significant were selected as the factors. We subsequently performed data training and testing to construct artificial neural network (ANN) and logistic regression (LR) prediction models. The dataset was randomly divided into 2 groups: a training group and a test group. The training group consisted of 1442 cases (70% of the entire dataset), and the prediction model was developed on the basis of the training group. The remaining 30% (618 cases) were assigned to the test group for model validation.

Results: The following 10 variables were used to develop the ANN and LR models: sex, age, alcoholic cirrhosis, nonalcoholic cirrhosis, alcoholic hepatitis, viral hepatitis, other types of chronic hepatitis, alcoholic fatty liver disease, other types of fatty liver disease, and hyperlipidemia. The performance of the ANN was superior to that of LR, according to the sensitivity (0.757), specificity (0.755), and the area under the receiver operating characteristic curve (0.873). After developing the optimal prediction model, we base on this model to construct a web-based application system for liver cancer prediction, which can provide support to physicians during consults with diabetes patients.

Conclusion: In the original dataset (n=2060), 33% of diabetes patients were diagnosed with liver cancer (n=515). After using 70% of the original data to training the model and other 30% for testing, the sensitivity and specificity of our model were 0.757 and 0.755, respectively; this means that 75.7% of diabetes patients can be predicted correctly to receive a future liver cancer diagnosis, and 75.5% can be predicted correctly to not be diagnosed with liver cancer. These results reveal that this model can be used as effective predictors of liver cancer for diabetes patients, after discussion with physicians; they also agreed that model can assist physicians to advise potential liver cancer patients and also helpful to decrease the future cost incurred upon cancer treatment.
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http://dx.doi.org/10.1016/j.cmpb.2015.11.009DOI Listing
March 2016

Screening Mammography Efficacy: A Comparison Between Screen-Film, Computed Radiography and Digital Mammography in Taiwan.

Stud Health Technol Inform 2015 ;216:914

Graduate Institute of Bio-medical Informatics, Taipei Medical University, Taiwan.

Breast cancer screening has been proven effective in Western countries, and our National Health Bureau also started to offer free screening mammography for women aged between 50 and 69, since July 2004. This study aims to compare the efficacy between distinctive mammography screening modalities. Prompting the assessment of digital screening in the radiological sciences, we provide insight into the practical informatics application of such tools.
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December 2016

Central trends in nursing informatics: students' reflections from International Congress on Nursing Informatics 2014 (Taipei, Taiwan).

Comput Inform Nurs 2015 Mar;33(3):85-9

Division of General Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA (Dr Topaz); University of British Columbia, School of Nursing, Vancouver Canada (Ms Ronquillo); School of Nursing, University of Minnesota, Minneapolis (Ms Pruinelli and Dr Hamann); School of Nursing, Columbia University, New York (Ms Ramos); Department of Nursing Science, University of Turku, and Turku University Hospital, Finland (Mss Peltonen and Siirala); Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei (Dr Atique); Minneapolis VA Health Care System, Minneapolis (Dr Hamann); and University of Wisconsin-Milwaukee College of Nursing (Ms Badger).

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http://dx.doi.org/10.1097/CIN.0000000000000139DOI Listing
March 2015