Publications by authors named "Usman Iqbal"

109 Publications

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18073759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038466PMC
April 2021

Impact of DSMES app interventions on medication adherence in type 2 diabetes mellitus: systematic review and meta-analysis.

BMJ Health Care Inform 2021 Apr;28(1)

Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei, Taiwan

Objectives: To conduct systematic review and meta-analysis of interventional studies to investigate the impact of diabetes self-management education and support (DSMES) apps on adherence in patients with type 2 diabetes mellitus (T2D).

Methods: PubMed, Embase, CENTRAL, Web of Science, Scopus and ProQuest were searched, in addition to references of identified articles and similar reviews. Experimental studies, reported in English, assessing DSMES app intervention's impact on adherence and clinical outcomes of patients with T2D compared with usual care were included. Study bias was assessed using Cochrane Risk of Bias V.2.0 tool. Analysis plan involved narrative synthesis, moderator and meta-analysis.

Results: Six randomised controlled trials were included, involving 696 participants (average age 57.6 years, SD 10.59). Mobile apps were mostly used for imputing clinical data, dietary intake or physical activity, and transmitting information to the provider. At 3 months, DSMES apps proved effective in improving medication adherence (standardized mean difference (SMD)=0.393, 95% CI 0.17 to 0.61), glycated haemoglobin (HbA1c) (mean difference (MD)=-0.314, 95% CI -0.477 to -0.151) and Body Mass Index (BMI) (MD=-0.28, 95% CI -0.545 to -0.015). All pooled estimates had low heterogeneity ( 0%). Four studies had moderate risk of bias while one each was judged to be low and high risks, respectively.

Conclusion: DSMES apps had significant small to moderate effects on medication adherence, HbA1c and BMI of patients with T2D compared with usual care. Apps were described as reliable, easy to use and convenient, though participants were required to be phone literate. Evidence comes from feasibility trials with generally moderate risk of bias. Larger trials with longer follow-up periods using theory-based interventions are required to improve current evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjhci-2020-100291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054079PMC
April 2021

Risk of cancer in long-term levothyroxine users: Retrospective population-based study.

Cancer Sci 2021 Apr 1. Epub 2021 Apr 1.

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

Levothyroxine is a widely prescribed medication for the treatment of an underactive thyroid. The relationship between levothyroxine use and cancer risk is largely underdetermined. To investigate the magnitude of the possible association between levothyroxine use and cancer risk, this retrospective case-control study was conducted using Taiwan's Health and Welfare Data Science Center database. Cases were defined as all patients who were aged ≥20 years and had a first-time diagnosis for cancer at any site for the period between 2001 and 2011. Multivariable conditional logistic regression models were used to calculate an adjusted odds ratio (AOR) to reduce potential confounding factors. A total of 601 733 cases and 2 406 932 controls were included in the current study. Levothyroxine users showed a 50% higher risk of cancer at any site (AOR: 1.50, 95% CI: 1.46-1.54; P < .0001) compared with non-users. Significant increased risks were also observed for brain cancer (AOR: 1.90, 95% CI: 1.48-2.44; P < .0001), skin cancer (AOR: 1.42, 95% CI: 1.17-1.72; P < .0001), pancreatic cancer (AOR: 1.27, 95% CI: 1.01-1.60; P = .03), and female breast cancer (AOR: 1.24, 95% CI: 1.15-1.33; P < .0001). Our study results showed that levothyroxine use was significantly associated with an increased risk of cancer, particularly brain, skin, pancreatic, and female breast cancers. Levothyroxine remains a highly effective therapy for hypothyroidism; therefore, physicians should carefully consider levothyroxine therapy and monitor patients' condition to avoid negative outcomes. Additional studies are needed to confirm these findings and to evaluate the potential biological mechanisms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cas.14908DOI Listing
April 2021

Assessment of knowledge, attitudes, and practices towards Zika virus among healthcare workers in St. Kitts.

BMC Infect Dis 2021 Mar 5;21(1):237. Epub 2021 Mar 5.

Global Health & Development Department, College of Public Health, Taipei Medical University, No. 172-1, Sec. 2, Keelung Rd, Daan District, Taipei City, 106, Taiwan.

Background: Healthcare workers are usually the first responders during outbreaks and are instrumental in educating the populace about the prevention of different diseases and illnesses. The aim of this study was to assess the association between healthcare workers' characteristics and knowledge, attitudes and practices toward Zika virus.

Methods: This was a cross-sectional study that collected data from healthcare workers at 3 medical facilities using a validated self-administered questionnaire between July 2017 - September 2017. Logistic regression models were used to examine the association between sociodemographic and knowledge, attitudes, and practices.

Results: A total of 190 healthcare workers were analyzed. Of these, 60, 72.6 and 64.7% had good knowledge, positive attitudes, and good practices toward Zika virus, respectively. Healthcare workers without a formal degree were less likely to have good knowledge of Zika virus (adjusted odds ratio (AOR) = 0:49; 95% confidence interval (CI) = 0.24-0.99) compared to those with a formal degree. Reduced odds for positive attitude towards Zika virus were observed in healthcare workers with low income as compared to those with high income (AOR = 0.31; 95% CI =0.13-0.75). Being younger than 40 years old was associated with poor Zika virus practices (AOR = 0:34; 95% CI = 0.15-0.79).

Conclusions: Significant association between healthcare workers' sociodemographic characteristics and Zika virus knowledge, attitudes and practices were observed. Public health interventions that seek to increase Zika virus awareness should aim to train healthcare workers who are younger, without formal degree and those earning low income.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12879-021-05932-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934413PMC
March 2021

Correction: How Can Artificial Intelligence Make Medicine More Preemptive?

J Med Internet Res 2020 08 26;22(8):e23645. Epub 2020 Aug 26.

International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan.

[This corrects the article DOI: .].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/23645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481867PMC
August 2020

Reply to: Antidepressants and Fracture Risk: Is There a Real Connection?

J Am Geriatr Soc 2020 09 13;68(9):2142-2143. Epub 2020 Aug 13.

International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jgs.16724DOI Listing
September 2020

How Can Artificial Intelligence Make Medicine More Preemptive?

J Med Internet Res 2020 08 11;22(8):e17211. Epub 2020 Aug 11.

International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan.

In this paper we propose the idea that Artificial intelligence (AI) is ushering in a new era of "Earlier Medicine," which is a predictive approach for disease prevention based on AI modeling and big data. The flourishing health care technological landscape is showing great potential-from diagnosis and prescription automation to the early detection of disease through efficient and cost-effective patient data screening tools that benefit from the predictive capabilities of AI. Monitoring the trajectories of both in- and outpatients has proven to be a task AI can perform to a reliable degree. Predictions can be a significant advantage to health care if they are accurate, prompt, and can be personalized and acted upon efficiently. This is where AI plays a crucial role in "Earlier Medicine" implementation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/17211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448175PMC
August 2020

Strengthening Behavior and Social Functioning Among Persons with Autism Spectrum Conditions Using Artificial Intelligence and Behavioral Activation: Protocol for the Well-Being and Health for Loved onEs with ASD (WHOLE) Psychosocial Pilot Randomized Controlled Trial.

Stud Health Technol Inform 2020 Jun;270:1399-1400

Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan.

Although a proportion of families and communities in low resource settings continue to provide care to loved ones with autism spectrum conditions, many of the affected persons remain undiagnosed and without access to proven therapies due to high treatment cost and cultural pressures, in particular. Use of conversational agents on mobile phones in combination with behavior activation home care may provide an innovative, culturally appropriate and affordable platform for strengthening behavior and social functioning outcomes, in addition to an opportunity for participation of the persons with autism spectrum conditions in the intervention development process. We aim to assess the effectiveness of an intervention that incorporates artificial intelligence conversational agent technologies and behavioral activation therapy techniques.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/SHTI200461DOI Listing
June 2020

Digital Health Interventions for Diabetes Self-Management Education/Support in Type 1 & 2 Diabetes Mellitus.

Stud Health Technol Inform 2020 Jun;270:1263-1264

Masters' Program in Global Health & Development, College of Public Health, Taipei Medical University.

Introduction: Diabetes Mellitus is a major global concern. DSME (Diabetes Self-Management Education and Support) helps improve outcomes. Over the years, newer technologies have delivered DSME warranting an update of evidence.

Objectives: Describe current digital health interventions employed in DSMES and their effectiveness in improving glycemic control and quality of life of Diabetes Mellitus (DM) patients compared to usual care.

Methods: Systematic review design and meta-analysis. We will search data from 2010 to 2019. The review will only include randomized control trials (RCTs) with digital health interventions (mobile health, social media, e-health) as the main intervention to deliver DSMES.

Expected Results: We expect digital health intervention-led DSMES to improve target outcomes compared to usual care. This study will aggregate information on usage and challenges for these tools. It will also suggest the direction of effect of such tools in different populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/SHTI200393DOI Listing
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijmedinf.2020.104155DOI Listing
August 2020

The global challenges for quality improvement and patient safety.

Int J Qual Health Care 2021 Mar;33(1)

International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan No. 172-1, Sec. 2, Keelung Rd, Daan District, Taipei City 106, Taiwan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/intqhc/mzaa046DOI Listing
March 2021

Meta-analysis of proton pump inhibitors induced risk of community-acquired pneumonia.

Int J Qual Health Care 2020 Jun;32(5):292-299

International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, 11031 Taipei, Taiwan.

Purpose: Proton pump inhibitors (PPIs), one of the most widely used medications, are commonly used to suppress several acid-related upper gastrointestinal disorders. Acid-suppressing medication use could be associated with increased risk of community-acquired pneumonia (CAP), although the results of clinical studies have been conflicting.

Data Sources: A comprehensive search of MEDLINE, EMBASE and Cochrane library and Database of Systematic Reviews from the earliest available online year of indexing up to October 2018.

Study Selection: We performed a systematic review and meta-analysis of observational studies to evaluate the risk of PPI use on CAP outcomes.

Data Extraction: Included study location, design, population, the prevalence of CAP, comparison group and other confounders. We calculated pooled odds ratio (OR) using a random-effects meta-analysis.

Results Of Data Synthesis: Of the 2577 studies screening, 11 papers were included in the systematic review and 7 studies with 65 590 CAP cases were included in the random-effects meta-analysis. In current PPI users, pooled OR for CAP was 1.86 (95% confidence interval (CI), 1.30-2.66), and in the case of recent users, OR for CAP was 1.66 (95% CI, 1.22-2.25). In the subgroup analysis of CAP, significance association is also observed in both high-dose and low-dose PPI therapy. When stratified by duration of exposure, 3-6 months PPIs users group was associated with increased risk of developing CAP (OR, 2.05; 95% CI, 1.22-3.45). There was a statistically significant association between the PPI users and the rate of hospitalization (OR, 2.59; 95% CI, 1.83-3.66).

Conclusion: We found possible evidence linking PPI use to an increased risk of CAP. More randomized controlled studies are warranted to clarify an understanding of the association between PPI use and risk of CAP because observational studies cannot clarify whether the observed epidemiologic association is a causal effect or a result of unmeasured/residual confounding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/intqhc/mzaa041DOI Listing
June 2020

Use of mobile applications to improve nutrition behaviour: A systematic review.

Comput Methods Programs Biomed 2020 Aug 19;192:105459. Epub 2020 Mar 19.

International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Department of Public Health and Community Medicine, Shaikh Zayed Medical Complex, Lahore, Pakistan; Master's Program in Global Health & Development Dept., PhD Program in Global Health & Health Security Dept., College of Public Health, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background And Objective: Mobile applications could be effectively used for dietary intake assessment, physical activity monitoring, behavior improvement, and nutrition education. The aim of this review is to determine the effectiveness of mobile applications in improving nutrition behaviors through a systematic review of literature.

Methods: The review protocol was registered with PROSPERO: registration number CRD42018118809, and followed PRISMA guidelines. We involved original articles including mobile electronic devices for improving dietary intake, physical activity, and weight management in adult populations in this review. Data were retrieved from January 2010 to December 2018 with PubMed, Web of Science, Excerpta Medica Database (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) as data sources. Authors individually screened the titles and abstracts, then full articles in order to obtain papers that met inclusion criteria.

Results: The database search yielded 2962 records. After removing the duplicates and analyzing the full text papers a total of 8 original articles were reviewed. Two articles showed obvious bias and were not included in our results or discussion. The remaining six articles with low to moderate bias risk were included in this systematic review. Three selected studies were randomized control trials (RCTs) with over 180 participants each. The other three studies were a nested trial, a case-control trial, and a pilot RCT with 36, 162, and 24 participants respectively. All larger RCTs and the small case control trail showed significant improvements in some nutritional-health objectives measured. The other two trials showed insignificant improvements in outcomes measured between groups.

Conclusion: This study highlights the potential significant health benefits acquirable through mobile health application-assisted nutrition interventions. Some of these studies required significant financial and time input from providers for the application's utilization. Further studies, perhaps with multiple intervention arms, are required to compare across programs the elements that are essential for health benefits observed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cmpb.2020.105459DOI Listing
August 2020

Multinational Investigation of Fracture Risk with Antidepressant Use by Class, Drug, and Indication.

J Am Geriatr Soc 2020 07 17;68(7):1494-1503. Epub 2020 Mar 17.

Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.

Objectives: Antidepressants increase the risk of falls and fracture in older adults. However, risk estimates vary considerably even in comparable populations, limiting the usefulness of current evidence for clinical decision making. Our aim was to apply a common protocol to cohorts of older antidepressant users in multiple jurisdictions to estimate fracture risk associated with different antidepressant classes, drugs, doses, and potential treatment indications.

Design: Retrospective (2009-2014) cohort study.

Setting: Five jurisdictions in the United States, Canada, United Kingdom, and Taiwan.

Participants: Older antidepressant users-subjects were followed from first antidepressant prescription or dispensation to first fracture or until the end of follow-up.

Measurements: The risk of fractures with antidepressants was estimated by multivariable Cox proportional hazards models using time-varying measures of antidepressant dose and use vs nonuse, adjusting for patient characteristics.

Results: Between 42.9% and 55.6% of study cohorts were 75 years and older, and 29.3% to 45.4% were men. Selective serotonin reuptake inhibitors (SSRIs) (48.4%-60.0%) were the predominant class used in North America compared with tricyclic antidepressants (TCAs) in the United Kingdom and Taiwan (49.6%-53.6%). Fracture rates varied from 37.67 to 107.18 per 1,000. The SSRIs citalopram (hazard ratio [HR] = 1.23; 95% confidence interval [CI] = 1.11-1.36 to HR = 1.43; 95% CI = 1.11-1.84) and sertraline (HR = 1.36; 95% CI = 1.10-1.68), the SNRI duloxetine (HR = 1.41; 95% CI = 1.06-1.88), TCAs doxepin (HR = 1.36; 95% CI = 1.00-1.86) and imipramine (HR = 1.16; 95% CI = 1.05-1.28), and atypicals (HR = 1.34; 95% CI = 1.14-1.58) increased fracture risk in some but not all jurisdictions. In the United States and the United Kingdom, fracture risk with all classes was higher when prescribed for depression than chronic pain, a trend that is likely explained by drug choice.

Conclusion: The fracture risk for patients may be reduced by selecting paroxetine, an SSRI with lower risk than citalopram, the SNRI venlafaxine over duloxetine, and the TCA amitriptyline over imipramine or doxepin. There is uncertainty about the risk associated with the atypical antidepressants. J Am Geriatr Soc 68:1494-1503, 2020.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jgs.16404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383967PMC
July 2020

Girls' Empowerment and Adolescent Pregnancy: A Systematic Review.

Int J Environ Res Public Health 2020 03 4;17(5). Epub 2020 Mar 4.

Master Program in Global Health and Development Department, College of Public Health, Taipei Medical University, Daan District, Taipei 106, Taiwan.

: 21 million girls get pregnant every year. Many initiatives are empowering girls. Various studies have looked at girl empowerment, however, there is contradicting evidence, and even less literature from developing countries. : We searched articles published between January 2000 to January 2019. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered our protocol on the International Prospective Register of Systematic Reviews PROSPERO (CRD42019117414). Nine articles were selected for review. Quality appraisal was done using separate tools for qualitative studies, cohort and cross-sectional studies and randomized control trials. : Eight studies included educational empowerment, four studies included community empowerment, three studies included economic empowerment, while two studies discussed policy empowerment. Three studies were of fair quality; two qualitative and one cross-sectional study were of high quality, while three studies had low quality. . Studies showed a favorable impact of girl empowerment on adolescent pregnancies and risky sexual behaviors. Education empowerment came through formal education or health systems such as in family planning clinics. Community empowerment was seen as crucial in girls' development, from interactions with parents to cultural practices. Economic empowerment was direct like cash transfer programs or indirect through benefits of economic growth. Policies such as contraceptive availability or compulsory school helped reduce pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17051664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084341PMC
March 2020

Is care safe today?

Int J Qual Health Care 2019 10;31(8):575-576

International Center for Health Information Technology (ICHIT), Taipei Medical University, No. 172-1, Sec. 2, Keelung Rd, Daan District, Taipei City 106, Taiwan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/intqhc/mzz117DOI Listing
October 2019

Application of a Common Data Model (CDM) to rank the paediatric user and prescription prevalence of 15 different drug classes in South Korea, Hong Kong, Taiwan, Japan and Australia: an observational, descriptive study.

BMJ Open 2020 01 13;10(1):e032426. Epub 2020 Jan 13.

Epidemiology Analytics, Janssen Research and Development, Titusville, New Jersey, USA.

Objective: To measure the paediatric user and prescription prevalence in inpatient and ambulatory settings in South Korea, Hong Kong, Taiwan, Japan and Australia by age and gender. A further objective was to list the most commonly used drugs per drug class, per country.

Design And Setting: Hospital inpatient and insurance paediatric healthcare data from the following databases were used to conduct this descriptive drug utilisation study: (i) the South Korean Ajou University School of Medicine database; (ii) the Hong Kong Clinical Data Analysis and Reporting System; (iii) the Japan Medical Data Center; (iv) Taiwan's National Health Insurance Research Database and (v) the Australian Pharmaceutical Benefits Scheme. Country-specific data were transformed into the Observational Medical Outcomes Partnership Common Data Model.

Patients: Children (≤18 years) with at least 1 day of observation in any of the respective databases from January 2009 until December 2013 were included.

Main Outcome Measures: For each drug class, we assessed the per-protocol overall user and prescription prevalence rates (per 1000 persons) per country and setting.

Results: Our study population comprised 1 574 524 children (52.9% male). The highest proportion of dispensings was recorded in the youngest age category (<2 years) for inpatients (45.1%) with a relatively high user prevalence of analgesics and antibiotics. Adrenergics, antihistamines, mucolytics and corticosteroids were used in 10%-15% of patients. For ambulatory patients, the highest proportion of dispensings was recorded in the middle age category (2-11 years, 67.1%) with antibiotics the most dispensed drug overall.

Conclusions: Country-specific paediatric drug utilisation patterns were described, ranked and compared between four East Asian countries and Australia. The widespread use of mucolytics in East Asia warrants further investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-032426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044847PMC
January 2020

Incidences of Hypothyroidism Associated With Surgical Procedures for Thyroid Disorders: A Nationwide Population-Based Study.

Front Pharmacol 2019 12;10:1378. Epub 2019 Dec 12.

School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.

Limited information available about different types of thyroid surgeries with risk for postoperative hypothyroidism. This study aimed to investigate the risk of developing early and late-onset postoperative hypothyroidism in patients with thyroid disorders. We used a large cohort data from the Taiwan National Health Insurance Research Data Base (NHIRDB) and identified 9,693 (9, 348) patients from January 1998 to December 2010, admitted for thyroid disorder surgeries. We used the surgical procedures time as the index date. Our observational retrospective cohort study excluded the subjects diagnosed with hypoparathyroidism and hypothyroidism before any surgeries. We analyzed the data using the Cox regression model to calculate the hazard ratio. Postoperative hypothyroidism associated with bilateral-total (HR, 4.27; 95% CI, 3.32-5.50), one-side total and another subtotal (HR, 3.16; 95% CI, 2.59-3.86), bilateral-subtotal (HR, 1.65; 95% CI, 1.37-1.98), and unilateral-total (HR, 1.17; 95% CI, 0.95-1.44) surgical procedures. The time intervals for thyroid disorders were 320 cases developed postoperative hypoparathyroidism in eight weeks, 480 cases the second month, and 1000 cases in the first year after surgery. Findings suggest that thyroidectomy was associated with transient postoperative hypothyroidism in thyroid disorder patients. The bilateral-total surgical procedure was strongly associated with temporary postoperative hypothyroidism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fphar.2019.01378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920095PMC
December 2019

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Nature 2019 10 16;574(7778):353-358. Epub 2019 Oct 16.

School of Health Sciences, Madda Walabu University, Bale Goba, Ethiopia.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41586-019-1545-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800389PMC
October 2019

Does long-term use of antidiabetic drugs changes cancer risk?

Medicine (Baltimore) 2019 Oct;98(40):e17461

Department of Public Health and Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Medical Complex, Lahore, Pakistan.

Antidiabetic medications are commonly used around the world, but their safety is still unclear. The aim of this study was to investigate whether long-term use of insulin and oral antidiabetic medications is associated with cancer risk.We conducted a well-designed case-control study using 12 years of data from Taiwan's National Health Insurance Research Database and investigated the association between antidiabetic medication use and cancer risk over 20 years. We identified 42,500 patients diagnosed with cancer and calculated each patient's exposure to antidiabetic drugs during the study period. We matched cancer and noncancer subjects matched 1:6 by age, gender, and index date, and used Cox proportional hazard regression and conditional logistic regression, adjusted for potential confounding factors, that is, medications and comorbid diseases that could influence cancer risk during study period.Pioglitazone (adjusted odds ratio [AOR], 1.20; 95% confidence interval [CI], 1.05-1.38); and insulin and its analogs for injection, intermediate or long acting combined with fast acting (AOR, 1.22; 95% CI, 1.05-1.43) were significantly associated with a higher cancer risk. However, metformin (AOR, 1.00; 95% CI, 0.93-1.07), glibenclamide (AOR, 0.98; 95% CI, 0.92-1.05), acarbose (AOR, 1.06; 95% CI, 0.96-1.16), and others do not show evidence of association with cancer risk. Moreover, the risk for specific cancers among antidiabetic users as compared with nonantidiabetic medication users was significantly increased for pancreas cancer (by 45%), liver cancer (by 32%), and lung cancer (by 18%).Antidiabetic drugs do not seem to be associated with an increased cancer risk incidence except for pioglitazone, insulin and its analogs for injection, intermediate or long acting combined with fast acting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000017461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6783244PMC
October 2019

Corrigendum to "Cloud-based BP system integrated with CPOE improves self-management of the hypertensive patients: A randomized controlled trial" Comput Methods Programs Biomed 2016;132:105-113.

Comput Methods Programs Biomed 2019 07 30;176:237-238. Epub 2019 May 30.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cmpb.2019.04.031DOI Listing
July 2019

Health care quality challenges in low- and middle-income countries.

Int J Qual Health Care 2019 Apr;31(3):165

International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/intqhc/mzz031DOI Listing
April 2019

Healthcare quality-improvement and measurement strategies and its challenges ahead.

Int J Qual Health Care 2019 Feb;31(1)

International Center for Health Information Technology (ICHIT), Taipei Medical University, 250-Wuxing Street, Xinyi District, Taipei, Taiwan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/intqhc/mzz009DOI Listing
February 2019

Patient satisfaction with dermatology teleconsultation by using MedX.

Comput Methods Programs Biomed 2018 Dec 18;167:37-42. Epub 2018 Oct 18.

Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan; School of Health Care Administration, 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. Electronic address:

Background: The development of telecommunication has strongly affected comprehensive scientific disciplines, including medical sciences.

Objective: This study aims to assess the patient satisfaction of the teleconsultation system used for the consultation of dermatological follow-up care.

Methods: The study was performed cross sectional patient satisfaction survey method conducted between February and April 2017 to determine patient satisfaction using MedX teleconsultation system. The patient sample of the current study was recruited from cosmetic laser clinic, Wanfang and Taipei Medical University hospital. The study was performed on 32 patient (n = 32) participants. All of them were at least university graduate. Consultants and patients were handled using the Android-based MedX mobile application, which is available through an application for Google Android cellular telephones. Its application consists of a demographic information, structured step-by-step questionnaire, essential medical information about each patient, and digital images of skin lesions.

Results: 28 patients completed the questionnaire. The mean ± SD age of the patients was 27.25 ± 4.039 years; 78.6% were women. The study shows that respondents have reported a high level (85.8%) of mean overall satisfaction for the teleconsultation service. The usability of the system has highest satisfaction rate of 90.5% among the other subscales especially in terms of data transfer and data displayed. Responses of the patient satisfaction questionnaire were analyzed by age and gender, no statistically significant difference between the variables was found.

Conclusion: Patients have shown high satisfaction with teleconsultation service and it is well accepted in the management of cosmetic dermatology service. In the future, MedX application can be integrated into other instant messaging applications such as Line, thus allowing doctors and patients to easily communicate with each other.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cmpb.2018.10.015DOI Listing
December 2018

AI in Medicine: Big Data Remains a Challenge.

Comput Methods Programs Biomed 2018 Oct;164:A1

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cmpb.2018.08.015DOI Listing
October 2018

A hackathon promoting Taiwanese health-IoT innovation.

Comput Methods Programs Biomed 2018 Sep 18;163:29-32. Epub 2018 May 18.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cmpb.2018.05.020DOI Listing
September 2018

A positive legacy of trauma? A study on the impact of natural disasters on medical utilization.

Int J Qual Health Care 2019 Feb;31(1):64-69

Executive Master Program of Business Administration in Biotechnology, College of Management, Taipei Medical University, 250 WuHsing St., Taipei, Taiwan.

Objective: The impact of natural disasters on medical utilization is largely unknown and often overlooked how it affects bereaving and non-bereaving survivors. The aim of this study is to determine the medical utilization between both survivor groups and long-term effects.

Study Design: A 10-year 1999-2009 population-based retrospective study by using the National Health Insurance claim database and the Household Registration database from the Department of Health, Executive Yuan, Taiwan.

Settings: Taiwan 1999 Chi-Chi earthquake-affected areas.

Participants: A total of 49 834 individuals which included 1183 bereaving survivors and 48 651 non-bereaving earthquake survivors.

Intervention(s): None.

Main Outcome Measures: Medical utilization of bereaving and non-bereaving survivors.

Results: The results showed that bereaving survivors had significantly more outpatient visits before the earthquake, within 3-month period and 1 year after earthquake (odds ratio (OR) = 1.11, 1.16 and 1.08). However, after 1 year after earthquake their outpatient visits were not significantly different from non-bereaving, and even significantly less in some years. Inpatient visits of bereaving survivors had similar trend to outpatient visits, i.e. visits were more both before earthquake and within 3-month period after earthquake (OR = 1.59 and 1.89), however, they were not significantly higher than non-bereaving survivors for the following years of the study.

Conclusion: Our study reveals that compared to non-bereaving survivors, bereaving survivors slightly had higher medical utilization in the beginning stage of earthquake, i.e. for the first 3-month period or 1 year after earthquake. However, there were no differences between these two groups in medical utilization including outpatient and inpatient visits in long run.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/intqhc/mzy130DOI Listing
February 2019

Levothyroxine use and the risk of breast cancer: a nation-wide population-based case-control study.

Arch Gynecol Obstet 2018 08 30;298(2):389-396. Epub 2018 Jun 30.

International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.

Purpose: To investigate whether the use of levothyroxine was associated with breast cancer risk.

Methods: We conducted a population-based case-control study in Taiwan. Cases consisted of all patients who were aged 20 years and older, and had a first-time diagnosis of breast cancer for the period between 2001 and 2011. The controls were matched to the cases by age, sex, year, and month of diagnosis. Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) were estimated by a conditional logistic regression.

Results: We examined 65,491 breast cancer cases and 261,964 controls. We found that use of levothyroxine was associated with a significant increase in breast cancer risk (OR 1.24, 95% CI 1.15-1.33; P < 0.001). Compared with no use levothyroxine, the adjusted odd ratio was 1.22 (95% CI 1.11-1.35; P = 0.01) for the group having been prescribed levothyroxine 2 months to 1 year, and 1.26 (95% CI 1.12-1.41; P < 0.01) for the group with more than 1 year. When stratified by age, the adjusted odd ratio was 1.45 (95% CI 1.23-1.71; P < 0.01) for the patients aged 65 years or more and 1.19 (95% CI 1.09-1.29, P < 0.01) for the patients aged less than 65 years.

Conclusion: The results of the present study are the first to suggest that levothyroxine use increased the risk of breast cancer. However, a larger long-term prospective randomized-controlled trial specifically designed to assess the effect of levothyroxine use on the risk of developing breast cancer is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-018-4837-yDOI Listing
August 2018

Dimensions of service quality in healthcare: a systematic review of literature.

Int J Qual Health Care 2019 Feb;31(1):11-29

Institute of Quality and Technology Management, University of the Punjab, Lahore, Pakistan.

Purpose: Various dimensions of healthcare service quality were used and discussed in literature across the globe. This study presents an updated meaningful review of the extensive research that has been conducted on measuring dimensions of healthcare service quality.

Data Sources: Systematic review method in current study is based on PRISMA guidelines. We searched for literature using databases such as Google, Google Scholar, PubMed and Social Science, Citation Index.

Study Selection: In this study, we screened 1921 identified papers using search terms/phrases. Snowball strategies were adopted to extract published articles from January 1997 till December 2016.

Data Extraction: Two-hundred and fourteen papers were identified as relevant for data extraction; completed by two researchers, double checked by the other two to develop agreement in discrepancies. In total, 74 studies fulfilled our pre-defined inclusion and exclusion criteria for data analysis.

Data Synthesis: Service quality is mainly measured as technical and functional, incorporating many sub-dimensions. We synthesized the information about dimensions of healthcare service quality with reference to developed and developing countries. 'Tangibility' is found to be the most common contributing factor whereas 'SERVQUAL' as the most commonly used model to measure healthcare service quality.

Conclusion: There are core dimensions of healthcare service quality that are commonly found in all models used in current reviewed studies. We found a little difference in these core dimensions while focusing dimensions in both developed and developing countries, as mostly SERVQUAL is being used as the basic model to either generate a new one or to add further contextual dimensions. The current study ranked the contributing factors based on their frequency in literature. Based on these priorities, if factors are addressed irrespective of any context, may lead to contribute to improve healthcare quality and may provide an important information for evidence-informed decision-making.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/intqhc/mzy125DOI Listing
February 2019