Editorial

7 pages, 296 KiB

Open AccessEditorial

Big Data, Decision Models, and Public Health

by Chien-Lung Chan and Chi-Chang Chang

Int. J. Environ. Res. Public Health 2020, 17(18), 6723; https://doi.org/10.3390/ijerph17186723 - 15 Sep 2020

Cited by 8 | Viewed by 2829

Unlike most daily decisions, medical decision making often has substantial consequences and trade-offs. Recently, big data analytics techniques such as statistical analysis, data mining, machine learning and deep learning can be applied to construct innovative decision models. With complex decision making, it can [...] Read more.

Unlike most daily decisions, medical decision making often has substantial consequences and trade-offs. Recently, big data analytics techniques such as statistical analysis, data mining, machine learning and deep learning can be applied to construct innovative decision models. With complex decision making, it can be difficult to comprehend and compare the benefits and risks of all available options to make a decision. For these reasons, this Special Issue focuses on the use of big data analytics and forms of public health decision making based on the decision model, spanning from theory to practice. A total of 64 submissions were carefully blind peer reviewed by at least two referees and, finally, 23 papers were selected for this Special Issue. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

Research

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10 pages, 965 KiB

Open AccessArticle

Increased One-Year Recurrent Ischemic Stroke after First-Ever Ischemic Stroke in Males with Benign Prostatic Hyperplasia

by Chun-Gu Cheng, Hsin Chu, Jiunn-Tay Lee, Wu-Chien Chien and Chun-An Cheng

Int. J. Environ. Res. Public Health 2020, 17(15), 5360; https://doi.org/10.3390/ijerph17155360 - 25 Jul 2020

Cited by 5 | Viewed by 2784

Abstract

(1) Background: Patients with benign prostatic hyperplasia (BPH) were questioned about quality of life and sleep. Most BPH patients were treated with alpha-1 adrenergic receptor antagonists, which could improve cerebral blood flow for 1–2 months. Patients with ischemic stroke (IS) could experience cerebral [...] Read more.

(1) Background: Patients with benign prostatic hyperplasia (BPH) were questioned about quality of life and sleep. Most BPH patients were treated with alpha-1 adrenergic receptor antagonists, which could improve cerebral blood flow for 1–2 months. Patients with ischemic stroke (IS) could experience cerebral autoregulation impairment for six months. The relationship between BPH and recurrent IS remains unclear. The aim of this study was to determine the risk of one-year recurrent IS conferred by BPH. (2) Methods: We used data from the Taiwanese National Health Insurance Database to identify newly diagnosed IS cases entered from 1 January 2008 to 31 December 2008. Patients were followed until the recurrent IS event or 365 days after the first hospitalization. The risk factors associated with one-year recurrent IS were assessed using Cox proportional hazards regression. (3) Results: Patients with BPH had a higher risk of recurrent IS (12.11% versus 8.15%) (adjusted hazard ratio (HR): 1.352; 95% confidence interval (CI): 1.028–1.78, p = 0.031). Other risk factors included hyperlipidemia (adjusted HR: 1.338; 95% CI: 1.022–1.751, p = 0.034), coronary artery disease (adjusted HR: 1.487; 95% CI: 1.128–1.961, p = 0.005), chronic obstructive pulmonary disease (adjusted HR: 1.499; 95% CI: 1.075–2.091, p = 0.017), and chronic kidney disease (adjusted HR: 1.523; 95% CI: 1.033–2.244, p = 0.033). (4) Conclusion: Patients with BPH who had these risk factors had an increased risk of one-year recurrent IS. The modification of risk factors may prevent recurrent IS. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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17 pages, 8136 KiB

Open AccessArticle

Time Series Analysis and Forecasting with Automated Machine Learning on a National ICD-10 Database

by Victor Olsavszky, Mihnea Dosius, Cristian Vladescu and Johannes Benecke

Int. J. Environ. Res. Public Health 2020, 17(14), 4979; https://doi.org/10.3390/ijerph17144979 - 10 Jul 2020

Cited by 16 | Viewed by 5865

Abstract

The application of machine learning (ML) for use in generating insights and making predictions on new records continues to expand within the medical community. Despite this progress to date, the application of time series analysis has remained underexplored due to complexity of the [...] Read more.

The application of machine learning (ML) for use in generating insights and making predictions on new records continues to expand within the medical community. Despite this progress to date, the application of time series analysis has remained underexplored due to complexity of the underlying techniques. In this study, we have deployed a novel ML, called automated time series (AutoTS) machine learning, to automate data processing and the application of a multitude of models to assess which best forecasts future values. This rapid experimentation allows for and enables the selection of the most accurate model in order to perform time series predictions. By using the nation-wide ICD-10 (International Classification of Diseases, Tenth Revision) dataset of hospitalized patients of Romania, we have generated time series datasets over the period of 2008–2018 and performed highly accurate AutoTS predictions for the ten deadliest diseases. Forecast results for the years 2019 and 2020 were generated on a NUTS 2 (Nomenclature of Territorial Units for Statistics) regional level. This is the first study to our knowledge to perform time series forecasting of multiple diseases at a regional level using automated time series machine learning on a national ICD-10 dataset. The deployment of AutoTS technology can help decision makers in implementing targeted national health policies more efficiently. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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11 pages, 620 KiB

Open AccessArticle

Risk Prediction for Early Chronic Kidney Disease: Results from an Adult Health Examination Program of 19,270 Individuals

by Chin-Chuan Shih, Chi-Jie Lu, Gin-Den Chen and Chi-Chang Chang

Int. J. Environ. Res. Public Health 2020, 17(14), 4973; https://doi.org/10.3390/ijerph17144973 - 10 Jul 2020

Cited by 30 | Viewed by 2783

Abstract

Developing effective risk prediction models is a cost-effective approach to predicting complications of chronic kidney disease (CKD) and mortality rates; however, there is inadequate evidence to support screening for CKD. In this study, four data mining algorithms, including a classification and regression tree, [...] Read more.

Developing effective risk prediction models is a cost-effective approach to predicting complications of chronic kidney disease (CKD) and mortality rates; however, there is inadequate evidence to support screening for CKD. In this study, four data mining algorithms, including a classification and regression tree, a C4.5 decision tree, a linear discriminant analysis, and an extreme learning machine, are used to predict early CKD. The study includes datasets from 19,270 patients, provided by an adult health examination program from 32 chain clinics and three special physical examination centers, between 2015 and 2019. There were 11 independent variables, and the glomerular filtration rate (GFR) was used as the predictive variable. The C4.5 decision tree algorithm outperformed the three comparison models for predicting early CKD based on accuracy, sensitivity, specificity, and area under the curve metrics. It is, therefore, a promising method for early CKD prediction. The experimental results showed that Urine protein and creatinine ratio (UPCR), Proteinuria (PRO), Red blood cells (RBC), Glucose Fasting (GLU), Triglycerides (TG), Total Cholesterol (T-CHO), age, and gender are important risk factors. CKD care is closely related to primary care level and is recognized as a healthcare priority in national strategy. The proposed risk prediction models can support the important influence of personality and health examination representations in predicting early CKD. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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8 pages, 735 KiB

Open AccessArticle

40-Year Projections of Disability and Social Isolation of Older Adults for Long-Range Policy Planning in Singapore

by Reuben Ng, Si Qi Lim, Su Ying Saw and Kelvin Bryan Tan

Int. J. Environ. Res. Public Health 2020, 17(14), 4950; https://doi.org/10.3390/ijerph17144950 - 09 Jul 2020

Cited by 31 | Viewed by 6989

Abstract

Against a rapidly aging population, projections are done to size up the demand for long-term care (LTC) services for long-range policy planning. These projections are typically focused on functional factors such as disability. Recent studies indicate the importance of social factors, for example, [...] Read more.

Against a rapidly aging population, projections are done to size up the demand for long-term care (LTC) services for long-range policy planning. These projections are typically focused on functional factors such as disability. Recent studies indicate the importance of social factors, for example, socially isolated seniors living alone are more likely to be institutionalized, resulting in higher demand for LTC services. This is one the first known studies to complete a 40-year projection of LTC demand based on disability and social isolation. The primary micro dataset was the Retirement and Health Survey, Singapore’s first nationally representative longitudinal study of noninstitutionalized older adults aged 45 to 85 with over 15,000 respondents. Disability prevalence across the mild to severe spectrum is projected to increase five-fold over the next 40 years, and the number of socially isolated elders living alone is projected to grow four-fold. Regression models of living arrangements revealed interesting ethnic differences: Malay elders are 2.6 times less likely to live alone than their Chinese counterparts, controlling for marital status, age, and housing type. These projections provide a glimpse of the growing demand for LTC services for a rapidly aging Singapore and underscore the need to shore up community-based resources to enable seniors to age-in-place. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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15 pages, 2923 KiB

Open AccessArticle

Forecasting Weekly Influenza Outpatient Visits Using a Two-Dimensional Hierarchical Decision Tree Scheme

by Tian-Shyug Lee, I-Fei Chen, Ting-Jen Chang and Chi-Jie Lu

Int. J. Environ. Res. Public Health 2020, 17(13), 4743; https://doi.org/10.3390/ijerph17134743 - 01 Jul 2020

Cited by 14 | Viewed by 2485

Abstract

Influenza is a serious public health issue, as it can cause acute suffering and even death, social disruption, and economic loss. Effective forecasting of influenza outpatient visits is beneficial to anticipate and prevent medical resource shortages. This study uses regional data on influenza [...] Read more.

Influenza is a serious public health issue, as it can cause acute suffering and even death, social disruption, and economic loss. Effective forecasting of influenza outpatient visits is beneficial to anticipate and prevent medical resource shortages. This study uses regional data on influenza outpatient visits to propose a two-dimensional hierarchical decision tree scheme for forecasting influenza outpatient visits. The Taiwan weekly influenza outpatient visit data were collected from the national infectious disease statistics system and used for an empirical example. The 788 data points start in the first week of 2005 and end in the second week of 2020. The empirical results revealed that the proposed forecasting scheme outperformed five competing models and was able to forecast one to four weeks of anticipated influenza outpatient visits. The scheme may be an effective and promising alternative for forecasting one to four steps (weeks) ahead of nationwide influenza outpatient visits in Taiwan. Our results also suggest that, for forecasting nationwide influenza outpatient visits in Taiwan, one- and two-time lag information and regional information from the Taipei, North, and South regions are significant. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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10 pages, 1046 KiB

Open AccessArticle

Association between Reflux Esophagitis Incidence and Palmar Hyperhidrosis

by Chun-Gu Cheng, Wu-Chien Chien, Chia-Peng Yu, Chi-Hsiang Chung and Chun-An Cheng

Int. J. Environ. Res. Public Health 2020, 17(12), 4502; https://doi.org/10.3390/ijerph17124502 - 23 Jun 2020

Cited by 3 | Viewed by 2474

Abstract

The autonomic dysfunction in palmar hyperhidrosis (PH) includes not only sympathetic overactivity but also parasympathetic impairment. A decrease of parasympathetic tone has been noted in gastroesophageal reflux disease of neonates and adults. Patients with reflux esophagitis have a defective anti-reflux barrier. The association [...] Read more.

The autonomic dysfunction in palmar hyperhidrosis (PH) includes not only sympathetic overactivity but also parasympathetic impairment. A decrease of parasympathetic tone has been noted in gastroesophageal reflux disease of neonates and adults. Patients with reflux esophagitis have a defective anti-reflux barrier. The association between reflux esophagitis and PH is deliberated in this article. The National Health Insurance Database in Taiwan was used. At first-time visits, PH patients were identified by the International Classification of Disease, 9th Revision, Clinical Modification disease code of 780.8 without endoscopic thoracic sympathectomy. Patients were matched by age and gender as control groups. The reflux esophagitis incidence was assessed using disease codes 530.11, 530.81, and 530.85. The factors related to reflux esophagitis were established by the Cox proportional regression model. The risk of reflux esophagitis in PH patients had a hazard ratio of 3.457 (95% confidence interval: 3.043–3.928) after adjustment of the other factors. We confirmed the association between reflux esophagitis and PH. Health care providers must be alerted to this relationship and other risk factors of reflux esophagitis to support suitable treatments to improve the quality of life of patients. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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14 pages, 361 KiB

Open AccessEditor’s ChoiceArticle

Bone Mineral Density of Femur and Lumbar and the Relation between Fat Mass and Lean Mass of Adolescents: Based on Korea National Health and Nutrition Examination Survey (KNHNES) from 2008 to 2011

by Aram Kim, Seunghui Baek, Seyeon Park and Jieun Shin

Int. J. Environ. Res. Public Health 2020, 17(12), 4471; https://doi.org/10.3390/ijerph17124471 - 22 Jun 2020

Cited by 12 | Viewed by 3186

Abstract

It is most important to reach the maximum bone density in the childhood period to prevent developing osteoporosis; it is widely known that increased body weight has a positive correlation with bone density and that even though both the fat mass and lean [...] Read more.

It is most important to reach the maximum bone density in the childhood period to prevent developing osteoporosis; it is widely known that increased body weight has a positive correlation with bone density and that even though both the fat mass and lean mass have a significant impact on bone density, the latter mass has more importance for adults. Therefore, the study analyzed to identify the relationship between bone density and both fat mass and lean mass of Korean adolescents. Subjects were chosen among 21,303 people from the Korea National Health and Nutrition Examination Survey (KNHNES) between 2008 and 2011 that took a bone density checkup; as a result, 1454 teenagers aged between 12 and 18 were selected. Data analysis was performed in SAS ver. 9.4 (SAS Institute Inc., Cary, NC, USA) following the KNHNES and the weighted complex sample analysis was conducted; body fat mass and lean mass were divided into quintile groups, and to figure out the differences in bone density that were analyzed in six models adjusted by body weight (kg) and walking (yes/no), muscle strengthening exercises (yes/no), nutrition (intake of ca (g), and serum vitamin D (ng/mL)). Then, the generalized linear model (GLM) and trend test were conducted for each gender with a significance level of 0.05. The bone density differences of fat mass and lean mass were analyzed. The result of Model 6 considering all correction variables is as follows; in the case of male adolescents, the total femur and lumbar spine showed a significant difference (F = 13.120, p < 0.001; F = 12.900, p < 0.001) for fat mass, and the trend test showed that the figures significantly decreased (β = −0.030, p < 0.001; −0.035, p < 0.001). Meanwhile, for lean mass, the total femur and lumbar spine had a significant difference (F = 16.740, p < 0.001; F = 20.590, p < 0.001) too, but the trend test showed a significant increase (β = 0.054, p < 0.001; 0.057, p < 0.001). In the case of female adolescents, the lumbar spine (F = 3.600, p < 0.05) for lean mass showed a significant difference, and it also significantly rose in the trend test too (β = 0.020, p < 0.01). To sum up the results, for male adolescents, the bone density differences for fat mass (FM) and lean mass (LM) all had significant differences, but for female adolescents, only the lumbar spine for LM showed such a result. Meanwhile, both genders showed that LM had a more positive impact on bone density than FM. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

14 pages, 720 KiB

Open AccessArticle

Identification of Time-Invariant Biomarkers for Non-Genotoxic Hepatocarcinogen Assessment

by Shan-Han Huang, Ying-Chi Lin and Chun-Wei Tung

Int. J. Environ. Res. Public Health 2020, 17(12), 4298; https://doi.org/10.3390/ijerph17124298 - 16 Jun 2020

Cited by 6 | Viewed by 2224

Abstract

Non-genotoxic hepatocarcinogens (NGHCs) can only be confirmed by 2-year rodent studies. Toxicogenomics (TGx) approaches using gene expression profiles from short-term animal studies could enable early assessment of NGHCs. However, high variance in the modulation of the genes had been noted among exposure styles [...] Read more.

Non-genotoxic hepatocarcinogens (NGHCs) can only be confirmed by 2-year rodent studies. Toxicogenomics (TGx) approaches using gene expression profiles from short-term animal studies could enable early assessment of NGHCs. However, high variance in the modulation of the genes had been noted among exposure styles and datasets. Expanding from our previous strategy in identifying consensus biomarkers in multiple experiments, we aimed to identify time-invariant biomarkers for NGHCs in short-term exposure styles and validate their applicability to long-term exposure styles. In this study, nine time-invariant biomarkers, namely A2m, Akr7a3, Aqp7, Ca3, Cdc2a, Cdkn3, Cyp2c11, Ntf3, and Sds, were identified from four large-scale microarray datasets. Machine learning techniques were subsequently employed to assess the prediction performance of the biomarkers. The biomarker set along with the Random Forest models gave the highest median area under the receiver operating characteristic curve (AUC) of 0.824 and a low interquartile range (IQR) variance of 0.036 based on a leave-one-out cross-validation. The application of the models to the external validation datasets achieved high AUC values of greater than or equal to 0.857. Enrichment analysis of the biomarkers inferred the involvement of chronic inflammatory diseases such as liver cirrhosis, fibrosis, and hepatocellular carcinoma in NGHCs. The time-invariant biomarkers provided a robust alternative for NGHC prediction. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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10 pages, 650 KiB

Open AccessArticle

Physical and Psychological Factors Associated with Poor Self-Reported Health Status in Older Adults with Falls

by Jiyeon Kim, Mikyong Byun and Moonho Kim

Int. J. Environ. Res. Public Health 2020, 17(10), 3548; https://doi.org/10.3390/ijerph17103548 - 19 May 2020

Cited by 7 | Viewed by 2135

Abstract

Background: Previous studies have proposed various physical tests for screening fall risk in older adults. However, older adults may have physical or cognitive impairments that make testing difficult. This study describes the differences in individual, physical, and psychological factors between adults in good [...] Read more.

Background: Previous studies have proposed various physical tests for screening fall risk in older adults. However, older adults may have physical or cognitive impairments that make testing difficult. This study describes the differences in individual, physical, and psychological factors between adults in good and poor self-rated health statuses. Further, we identified the physical or psychological factors associated with self-rated health by controlling for individual variables. Methods: Data from a total of 1577 adults aged 65 years or over with a history of falls were analyzed, using the 2017 National Survey of Older Persons in South Korea. Self-reported health status was dichotomized as good versus poor using the 5-point Likert question: “poor” (very poor and poor) and “good” (fair, good, and very good). Results: Visual/hearing impairments, ADL/IADL restriction, poor nutrition, and depression were more frequently observed in the group with poor self-rated health. Multivariable logistic regression revealed that poor self-reported health was significantly associated with hearing impairments (OR: 1.51, 95% CI 1.12–2.03), ADL limitation (OR: 1.77, 95% CI 1.11–2.81), IADL limitation (OR: 2.27, 95% CI 1.68–3.06), poor nutrition (OR: 1.36, 95% CI 1.05–1.77), and depression (OR 3.77, 95% CI 2.81–5.06). Conclusions: Auditory impairment, ADL/IADL limitations, poor nutrition, and depression were significantly associated with poor self-reported health. A self-rated health assessment could be an alternative tool for older adults who are not able to perform physical tests. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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11 pages, 450 KiB

Open AccessArticle

Incidence and Risk Assessment for Atrial Fibrillation at 5 Years: Hypertensive Diabetic Cohort

by Eulalia Muria-Subirats, Josep Lluis Clua-Espuny, Juan Ballesta-Ors, Blanca Lorman-Carbo, Iñigo Lechuga-Duran, Jose Fernández-Saez, Roger Pla-Farnos and on behalf members of AFRICAT Group

Int. J. Environ. Res. Public Health 2020, 17(10), 3491; https://doi.org/10.3390/ijerph17103491 - 16 May 2020

Cited by 9 | Viewed by 2509

Abstract

(1) Background: The link between diabetes and hypertension is mutual and reciprocal, increasing the risks for the development of atrial fibrillation (AF). The main objective was to develop a prediction model for AF in a population with both diabetes and hypertension at five [...] Read more.

(1) Background: The link between diabetes and hypertension is mutual and reciprocal, increasing the risks for the development of atrial fibrillation (AF). The main objective was to develop a prediction model for AF in a population with both diabetes and hypertension at five years of follow-up. (2) Methods: A multicenter and community-based cohort study was undertaken of 8237 hypertensive diabetic patients without AF between 1 January 2103 and 31 December 2017. Multivariate Cox proportional-hazards regression models were used to identify predictors AF and to stratify risk scores by quartiles. (3) Results: AF incidence was 10.5/1000 people/years (95% confidence interval (CI) 9.5–11.5), higher in men. The independent prognostic factors identified: age (hazard ratio (HR) 1.07 95% CI 1.05–1.09, p < 0.001), weight (HR 1.03 95% CI 1.02–1.04, p < 0.001), CHA₂DS₂VASc score (HR 1.57 95% CI 1.16–2.13, p = 0.003) and female gender (HR 0.55 95% CI 0.37–0.82, p = 0.004). Q4 (highest-risk group for AF) had the highest AF incidence, stroke and mortality, and the smallest number needed to screen to detect one case of AF. (4) Conclusions: Risk-based screening for AF should be used in high cardiovascular risk patients as the hypertensive diabetics, for treatment of modifiable cardiovascular risk, and monitoring AF detection. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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11 pages, 1467 KiB

Open AccessArticle

Cost Effectiveness Analysis and Payment Policy Recommendation—Population-Based Survey with Big Data Methodology for Readmission Prevention of Patients with Paroxysmal Supraventricular Tachycardia treated with Radiofrequency Catheter Ablation

by Chien-Lung Chan, Ai-Hsien Adams Li, Hsiang-An Chung and Dinh-Van Phan

Int. J. Environ. Res. Public Health 2020, 17(7), 2334; https://doi.org/10.3390/ijerph17072334 - 30 Mar 2020

Cited by 6 | Viewed by 2796

Abstract

Recurrence of paroxysmal supraventricular tachycardia (PSVT) has been reported to be lower in patients treated with radiofrequency catheter ablation (RFCA) than in those who are not. Few population-based surveys have stated the cost-effectiveness related to this treatment. We, therefore, performed a nationwide retrospective [...] Read more.

Recurrence of paroxysmal supraventricular tachycardia (PSVT) has been reported to be lower in patients treated with radiofrequency catheter ablation (RFCA) than in those who are not. Few population-based surveys have stated the cost-effectiveness related to this treatment. We, therefore, performed a nationwide retrospective study using National Health Insurance Research Database (NHIRD) data from 2001–2012 in Taiwan. The incidence of PSVT-related admissions was computed from patients’ first admission for a primary PSVT diagnosis. There were 21,086 patients hospitalized due to first-time PSVT, of whom 13,075 underwent RFCA, with 374 recurrences (2.86%). In contrast, 1751 (21.86%) of the remaining 8011 patients who did not receive RFCA, most of whom had financial concerns, experienced PSVT recurrence. The relative PSVT recurrence risk in those who did not receive RFCA was 7.6 times (95% CI: 6.67–8.33) that of those who did undergo RFCA. In conclusion, the PSVT recurrence rate was much higher in patients who did not receive RFCA at their first admission. Furthermore, RFCA proved cost-effective, with the ratio of the incremental cost-effectiveness ratio (ICER) and gross domestic product (GDP) being only 1.15. To prevent readmission and avoid incremental cost, the authority could provide a financial supplement for every patient so that the procedure is performed, reducing the PSVT-recurrence life-years (disease-specific DALY). Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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10 pages, 417 KiB

Open AccessArticle

The Risk of Depression in Patients with Pemphigus: A Nationwide Cohort Study in Taiwan

by Yi-Min Hsu, Hsin-Yu Fang, Cheng-Li Lin and Shwn-Huey Shieh

Int. J. Environ. Res. Public Health 2020, 17(6), 1983; https://doi.org/10.3390/ijerph17061983 - 17 Mar 2020

Cited by 11 | Viewed by 2586

Abstract

Pemphigus is a chronic dermatological disorder caused by an autoimmune response and is associated with a high proportion of comorbidities and fatalities. The aim of this study was to investigate the risk of depression in patients with pemphigus. Data were derived from the [...] Read more.

Pemphigus is a chronic dermatological disorder caused by an autoimmune response and is associated with a high proportion of comorbidities and fatalities. The aim of this study was to investigate the risk of depression in patients with pemphigus. Data were derived from the National Health Insurance Research Database recorded during the period 2000–2010 in Taiwan. Multivariate Cox proportional hazards regression models were used to analyze the data and assess the effects of pemphigus on the risk of depression after adjusting for demographic characteristics and comorbidities. Patients with pemphigus were 1.98 times more likely to suffer from depression than the control group (pemphigus, adjusted HR: 1.99, 95% CI = 1.37–2.86). People aged ≥65 years were 1.69 times more likely to suffer from depression than those aged 20–49 years (≥65 years, adjusted HR: 1.42, 95% CI = 0.92–2.21). Female and male patients with pemphigus were respectively 2.02 and 1.91 times more likely to suffer from depression than the control group (female, adjusted HR: 2.09, 95% CI = 1.24–3.54; male, adjusted HR: 1.87, 95% CI = 0.97–3.60). People with HTN, hyperlipidemia, asthma/COPD, and chronic liver disease were respectively 1.73, 2.3, 2.2, and 1.69 times more likely to suffer from depression than those without these comorbidities (HTN, adjusted HR: 0.75, 95% CI = 0.41–1.42; hyperlipidemia, adjusted HR: 1.48, 95% CI = 0.78–2.82; asthma/COPD, adjusted HR: 1.4, 95% CI = 0.72–2.69; and chronic liver disease, adjusted HR: 1.61, 95% CI = 1.07–2.43). There was a significant association between pemphigus and increased risk of depression. Female patients had a higher incidence of depression. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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13 pages, 1537 KiB

Open AccessArticle

Stroke to Dementia Associated with Environmental Risks—A Semi-Markov Model

by Kung-Jeng Wang, Chia-Min Lee, Gwo-Chi Hu and Kung-Min Wang

Int. J. Environ. Res. Public Health 2020, 17(6), 1944; https://doi.org/10.3390/ijerph17061944 - 16 Mar 2020

Cited by 4 | Viewed by 2587

Abstract

Background: Most stroke cases lead to serious mental and physical disabilities, such as dementia and sensory impairment. Chronic diseases are contributory risk factors for stroke. However, few studies considered the transition behaviors of stroke to dementia associated with chronic diseases and environmental risks. [...] Read more.

Background: Most stroke cases lead to serious mental and physical disabilities, such as dementia and sensory impairment. Chronic diseases are contributory risk factors for stroke. However, few studies considered the transition behaviors of stroke to dementia associated with chronic diseases and environmental risks. Objective: This study aims to develop a prognosis model to address the issue of stroke transitioning to dementia associated with environmental risks. Design: This cohort study used the data from the National Health Insurance Research Database in Taiwan. Setting: Healthcare data were obtained from more than 25 million enrollees and covered over 99% of Taiwan’s entire population. Participants: In this study, 10,627 stroke patients diagnosed from 2000 to 2010 in Taiwan were surveyed. Methods: A Cox regression model and corresponding semi-Markov process were constructed to evaluate the influence of risk factors on stroke, corresponding dementia, and their transition behaviors. Main Outcome Measure: Relative risk and sojourn time were the main outcome measure. Results: Multivariate analysis showed that certain environmental risks, medication, and rehabilitation factors highly influenced the transition of stroke from a chronic disease to dementia. This study also highlighted the high-risk populations of stroke patients against the environmental risk factors; the males below 65 years old were the most sensitive population. Conclusion: Experiments showed that the proposed semi-Markovian model outperformed other benchmark diagnosis algorithms (i.e., linear regression, decision tree, random forest, and support vector machine), with a high R² of 90%. The proposed model also facilitated an accurate prognosis on the transition time of stroke from chronic diseases to dementias against environmental risks and rehabilitation factors. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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7 pages, 273 KiB

Open AccessArticle

A Population-Based Study of Healthcare Resource Utilization in Patients with Mitral Valve Prolapse

by Sin-Cih Chen, Sudha Xirasagar, Ju-Chi Liu, Yi-Wei Kao, Ben-Chang Shia, Tzong-Hann Yang and Herng-Ching Lin

Int. J. Environ. Res. Public Health 2020, 17(5), 1622; https://doi.org/10.3390/ijerph17051622 - 03 Mar 2020

Cited by 3 | Viewed by 2355

Abstract

This study investigated differences in the utilization of healthcare services between subjects with mitral valve prolapse (MVP) and comparison subjects using data from Taiwan’s National Health Insurance population-based database, 138,493 patients with MVP (study group) and 138,493 matched patients without MVP (comparison group). [...] Read more.

This study investigated differences in the utilization of healthcare services between subjects with mitral valve prolapse (MVP) and comparison subjects using data from Taiwan’s National Health Insurance population-based database, 138,493 patients with MVP (study group) and 138,493 matched patients without MVP (comparison group). We calculated the utilization of healthcare services in the year 2016 for each study sample. Patients with MVP had more outpatient cardiological services during the year (5.3 vs. 0.7, p < 0.001) and higher outpatient cardiology costs (US$226.0 vs. US$30.8, p < 0.001) than patients without MVP. As expected, patients with MVP had a longer inpatient stay (0.5 vs. 0.1, p < 0.001) and higher inpatients costs (US$158.0 vs. US$22.9, p < 0.001) than patients without MVP for cardiology services. Furthermore, patients with MVP also had more outpatient non-cardiology services (20.8 vs. 16.5, p < 0.001) and associated costs (US$708.3 vs. US$518.7, p < 0.001) than patients without MVP in the year 2016. Multiple regression analysis indicated that patients with MVP had higher total costs for all healthcare services than patients without MVP after adjusting for the urbanization level, monthly income, and geographic region. This study demonstrated that healthcare utilization by patients with MVP is substantially higher than comparison patients. Future studies are encouraged to explore MVP treatment with less expensive modalities while maintaining care quality and without jeopardizing patient outcomes. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

16 pages, 738 KiB

Open AccessArticle

Hyperlipidemia and Statins Use for the Risk of New Diagnosed Sarcopenia in Patients with Chronic Kidney: A Population-Based Study

by Min-Hua Lin, She-Yu Chiu, Pei-Hsuan Chang, Yu-Liang Lai, Pau-Chung Chen and Wen-Chao Ho

Int. J. Environ. Res. Public Health 2020, 17(5), 1494; https://doi.org/10.3390/ijerph17051494 - 26 Feb 2020

Cited by 23 | Viewed by 3174

Abstract

Background: Previous research found that statins, in addition to its efficiency in treating hyperlipidemia, may also incur adverse drug reactions, which mainly include myopathies and abnormalities in liver function. Aim: This study aims to assess the risk for newly onset sarcopenia among [...] Read more.

Background: Previous research found that statins, in addition to its efficiency in treating hyperlipidemia, may also incur adverse drug reactions, which mainly include myopathies and abnormalities in liver function. Aim: This study aims to assess the risk for newly onset sarcopenia among patients with chronic kidney disease using statins. Material and Method: In a nationwide retrospective population-based cohort study, 75,637 clinically confirmed cases of chronic kidney disease between 1997 and 2011were selected from the National Health Insurance Research Database of Taiwan. The selection of the chronic kidney disease cohort included a discharge diagnosis with chronic kidney disease or more than 3 outpatient visits with the diagnosis of chronic kidney disease found within 1 year. After consideration of patient exclusions, we finally got a total number of 67,001 cases of chronic kidney disease in the study. The Cox proportional hazards model was used to perform preliminary analysis on the effect of statins usage on the occurrence of newly diagnosed sarcopenia; the Cox proportional hazards model with time-dependent covariates was conducted to take into consideration the individual temporal differences in medication usage, and calculated the hazard ratio (HR) and 95% confidence interval after controlling for gender, age, income, and urbanization. Results: Our main findings indicated that patients with chronic kidney disease who use statins seem to effectively prevent patients from occurrences of sarcopenia, high dosage of statins seem to show more significant protective effects, and the results are similar over long-term follow-up. In addition, the risk for newly diagnosed sarcopenia among patients with lipophilic statins treatment was lower than that among patients with hydrophilic statins treatment. Conclusion: It seems that patients with chronic kidney disease could receive statin treatment to reduce the occurrence of newly diagnosed sarcopenia. Additionally, a higher dosage of statins could reduce the incidence of newly diagnosed sarcopenia in patients with chronic kidney disease. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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17 pages, 1793 KiB

Open AccessArticle

Chained Risk Assessment for Life-Long Disease Burden of Early Exposures–Demonstration of Concept Using Prenatal Maternal Smoking

by Isabell K. Rumrich, Kirsi Vähäkangas, Matti Viluksela and Otto Hänninen

Int. J. Environ. Res. Public Health 2020, 17(5), 1472; https://doi.org/10.3390/ijerph17051472 - 25 Feb 2020

Cited by 7 | Viewed by 2878

Abstract

Traditional risk factors and environmental exposures only explain less than half of the disease burden. The developmental origin of the health and disease (DOHaD) concept proposes that prenatal and early postnatal exposures increase disease susceptibility throughout life. The aim of this work is [...] Read more.

Traditional risk factors and environmental exposures only explain less than half of the disease burden. The developmental origin of the health and disease (DOHaD) concept proposes that prenatal and early postnatal exposures increase disease susceptibility throughout life. The aim of this work is to demonstrate the application of the DOHaD concept in a chained risk assessment and to provide an estimate of later in life burden of disease related to maternal smoking. We conducted three systematic literature searches for meta-analysis and reviewed the literature reporting meta-analyses of long-term health outcomes associated with maternal smoking and intermediate risk factors (preterm birth, low birth weight, childhood overweight). In the chained model the three selected risk factors explained an additional 2% (34,000 DALY) of the total non-communicable disease burden (1.4 million DALY) in 2017. Being overweight in childhood was the most important risk factor (28,000 DALY). Maternal smoking was directly associated with 170 DALY and indirectly via the three intermediate risk factors 1000 DALY (1200 DALY in total). The results confirm the potential to explain a previously unattributed part of the non-communicable diseases by the DOHAD concept. It is likely that relevant outcomes are missing, resulting in an underestimation of disease burden. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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11 pages, 3351 KiB

Open AccessArticle

The Association between Metabolically Healthy Obesity, Cardiovascular Disease, and All-Cause Mortality Risk in Asia: A Systematic Review and Meta-Analysis

by Ming-Yuan Huang, Mu-Yi Wang, Yu-Sheng Lin, Chien-Ju Lin, Kai Lo, I-Jen Chang, Ting-Yao Cheng, Szu-Ying Tsai, Hsin-Hao Chen, Chien-Yu Lin, Shu Jung Liu, Kuo-Liong Chien and Tzu-Lin Yeh

Int. J. Environ. Res. Public Health 2020, 17(4), 1320; https://doi.org/10.3390/ijerph17041320 - 19 Feb 2020

Cited by 23 | Viewed by 3695

Abstract

We investigated the association among metabolically healthy obesity (MHO), cardiovascular disease (CVD)risk, and all-cause mortality in the Asian population. We searched databases from inception to 16 November, 2019 and pooled data using a random-effects model. Subgroup analysis was conducted according to the following [...] Read more.

We investigated the association among metabolically healthy obesity (MHO), cardiovascular disease (CVD)risk, and all-cause mortality in the Asian population. We searched databases from inception to 16 November, 2019 and pooled data using a random-effects model. Subgroup analysis was conducted according to the following comparison groups: MHNW (without overweight or underweight participants) and MHNO (non-obese, including overweight and underweight participants). Nineteen studies were included. The mean Newcastle–Ottawa Scale score was 7.8. Participants with MHO had a significantly higher CVD risk (odds ratio (OR) = 1.36, 95% confidence interval (CI) = 1.13–1.63) and significantly lower risk of all-cause mortality (OR = 0.88, 95% CI = 0.78–1.00) than the comparison group. Subgroup analyses revealed participants with MHO had a significantly higher CVD risk than MHNW participants (OR = 1.61; 95% CI = 1.24–2.08; I² = 73%), but there was no significant difference compared with MHNO participants (OR, 1.04; 95% CI, 0.80–1.36; I² = 68%). Participants with MHO had a significantly lower risk of all-cause mortality (OR = 0.83; 95% CI = 0.78–0.88; I² = 9%) than MHNO participants, but a borderline significantly higher risk of all-cause mortality than MHNW participants (OR = 1.30; 95% CI = 0.99–1.72; I² = 0%). The CVD risk and all-cause mortality of the MHO group changed depending on the control group. Thus, future studies should select control groups carefully. Full article

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11 pages, 856 KiB

Open AccessArticle

by Shih-Feng Weng, Hui-Ru Hsu, Yao-Lin Weng, Kai-Jen Tien and Hao-Yun Kao

Int. J. Environ. Res. Public Health 2020, 17(3), 1124; https://doi.org/10.3390/ijerph17031124 - 10 Feb 2020

Cited by 14 | Viewed by 4045

Abstract

Background: Patients with either osteoporosis or depression are prone to develop other diseases and require more medical resources than do the general population. However, there are no studies on health-related quality of life (HRQoL) and medical resource use by osteoporosis patients with [...] Read more.

Background: Patients with either osteoporosis or depression are prone to develop other diseases and require more medical resources than do the general population. However, there are no studies on health-related quality of life (HRQoL) and medical resource use by osteoporosis patients with comorbid depression. We conducted this study for clarifying it. Methods: This cross-sectional study from 2005 to 2010 (6 years) analyzed 9776 National Health and Nutrition Examination Survey (NHANES) patients > 40 years old. Each patient was assigned to one of four groups: osteoporosis-positive⁽⁺⁾ and depression-positive⁽⁺⁾ (O⁺/D⁺); O⁺/D⁻; O⁻/D⁺; O⁻/D⁻. We used multivariate linear and logistic regression model to analyze the HRQoL and medical resource use between groups. Results: The O⁺/D⁺ group reported more unhealthy days of physical health, more unhealthy days of mental health, and more inactive days during a specified 30 days. The adjusted odds ratios (AORs) of O⁺/D⁺ patients who had poor general health (7.40, 95% CI = 4.80–11.40), who needed healthcare (3.25, 95% CI = 2.12–5.00), and who had been hospitalized overnight (2.71, 95% CI = 1.89–3.90) were significantly highest. Conclusions: Low HRQoL was significantly more prevalent in D⁺/O⁺ patients. We found that depression severity more significantly affected HRQoL than did osteoporosis. However, both diseases significantly increased the risk of high medical resource use. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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14 pages, 1081 KiB

Open AccessArticle

Estimation of Occupational Exposure to Asbestos in Italy by the Linkage of Mesothelioma Registry (ReNaM) and National Insurance Archives. Methodology and Results

by Chiara Airoldi, Daniela Ferrante, Lucia Miligi, Sara Piro, Giorgia Stoppa, Enrica Migliore, Elisabetta Chellini, Antonio Romanelli, Carlo Sciacchitano, Carolina Mensi, Domenica Cavone, Elisa Romeo, Stefania Massari, Alessandro Marinaccio and Corrado Magnani

Int. J. Environ. Res. Public Health 2020, 17(3), 1020; https://doi.org/10.3390/ijerph17031020 - 06 Feb 2020

Cited by 4 | Viewed by 3208

Abstract

The identification and monitoring of occupational cancer is an important aspect of occupational health protection. The Italian law on the protection of workers (D. Leg. 81/2008) includes different cancer monitoring systems for high and low etiologic fraction tumors. Record linkage between cancer registries [...] Read more.

The identification and monitoring of occupational cancer is an important aspect of occupational health protection. The Italian law on the protection of workers (D. Leg. 81/2008) includes different cancer monitoring systems for high and low etiologic fraction tumors. Record linkage between cancer registries and administrative data is a convenient procedure for occupational cancer monitoring. We aim to: (i) Create a list of industries with asbestos exposure and (ii) identify cancer cases who worked in these industries. The Italian National Mesothelioma Registry (ReNaM) includes information on occupational asbestos exposure of malignant mesothelioma (MM) cases. We developed using data from seven Italian regions a methodology for listing the industries with potential exposure to asbestos linking ReNaM to Italian National Social Security Institute (INPS) data. The methodology is iterative and adjusts for imprecision and inaccuracy in reporting firm names at interview. The list of asbestos exposing firms was applied to the list of cancer cases (all types associated or possibly associated with asbestos according to International Agency for Research on Cancer (IARC) monograph 100C) in two Italian regions for the indication of possible asbestos exposure. Eighteen percent of the cancer cases showed at least one work period in firms potentially exposing to asbestos, 48% of which in regions different from where the cases lived at diagnosis. The methodology offers support for the preliminary screening of asbestos exposing firms in the occupational history of cancer cases. Full article

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12 pages, 599 KiB

Open AccessArticle

Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke

by Yi-Ju Tseng, Ru-Fang Hu, Shin-Tyng Lee, Yu-Li Lin, Chien-Lung Hsu, Shih-Wei Lin, Chia-Wei Liou, Jiann-Der Lee, Tsung-I Peng and Tsong-Hai Lee

Int. J. Environ. Res. Public Health 2020, 17(2), 618; https://doi.org/10.3390/ijerph17020618 - 18 Jan 2020

Cited by 15 | Viewed by 3160

Abstract

Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic [...] Read more.

Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagnosed with acute ischemic stroke and treated for rt-PA at Chang Gung Memorial Hospitals from 2006 to 2016. In-hospital death, intensive care unit (ICU) stay, or prolonged hospitalization were defined as unfavorable treatment outcomes. Medical history variables and laboratory test results were considered variables of interest to determine risk factors. Among 643 eligible patients, 537 (83.5%) and 106 (16.5%) patients had favorable and poor outcomes, respectively. In the multivariable analysis, risk factors associated with poor outcomes were female gender, higher stroke severity index (SSI), higher serum glucose levels, lower mean corpuscular hemoglobin concentration (MCHC), lower platelet counts, and anemia. The risk factors found in this research could help us study the treatment strategy for ischemic stroke. Full article

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10 pages, 307 KiB

Open AccessArticle

APOE Variant (rs405509) might Modulate the Effect of Sex and Educational Level on Cognitive Impairment Risk in a Taiwanese Population

by Tsui-Wen Hsu, Disline Manli Tantoh, Pang-Li Liu, Pei-Hsin Chen, Oswald Ndi Nfor, Ming-Chih Chou, Long-Yau Lin and Yung-Po Liaw

Int. J. Environ. Res. Public Health 2019, 16(10), 1732; https://doi.org/10.3390/ijerph16101732 - 16 May 2019

Cited by 2 | Viewed by 2608

Abstract

Education, sex, and the APOE-rs405509 variant are associated with Alzheimer’s disease and cognitive performance. We investigated if the rs405509 TT, TG, and GG genotypes modulate the effect of sex and education on cognitive impairment in Taiwanese adults. Data on cognitive health (defined by [...] Read more.

Education, sex, and the APOE-rs405509 variant are associated with Alzheimer’s disease and cognitive performance. We investigated if the rs405509 TT, TG, and GG genotypes modulate the effect of sex and education on cognitive impairment in Taiwanese adults. Data on cognitive health (defined by Mini-Mental State Examination (MMSE) scores) and rs405509 were from Taiwan Biobank. Participants included 2105 men and 2027 women with a mean age of 64 years. Education below university level was significantly associated with lower MMSE scores. The odds ratios (ORs) were 1.82; 95% confidence interval (CI) 1.38–2.41 for senior high school, 3.39; 95% CI 2.50–4.59 for junior high school, and 11.94; 95% CI 9.91–15.50 for elementary school and below (p-trend < 0.05). The association between MMSE score and sex was significant only in the lowest educational group (elementary and below), with lower odds of having a low MMSE score in men compared to women (OR = 0.51; 95% CI 0.34–0.77). After stratification by rs405509 genotypes, this association was significant only among TT genotype carriers (OR = 0.481; CI = 0.253–0.915). In conclusion, a significant association between MMSE score and sex was observed in the lowest educational group, especially among carriers of rs405509 TT genotypes. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

11 pages, 320 KiB

Open AccessArticle

Interleukin-3 Polymorphism is Associated with Miscarriage of Fresh in Vitro Fertilization Cycles

by Cheng-Hsuan Wu, Tsung-Hsien Lee, Shun-Fa Yang, Hui-Mei Tsao, Yu-Jun Chang, Chia-Hsuan Chou and Maw-Sheng Lee

Int. J. Environ. Res. Public Health 2019, 16(6), 995; https://doi.org/10.3390/ijerph16060995 - 19 Mar 2019

Cited by 8 | Viewed by 2672

Abstract

The aim of this study was to examine the association between interleukin (IL) genes polymorphisms and in vitro fertilization (IVF) outcome. A prospective cohort analysis was performed at a Women’s Hospital IVF centre of 1015 female patients undergoing fresh non-donor IVF cycles. The [...] Read more.

The aim of this study was to examine the association between interleukin (IL) genes polymorphisms and in vitro fertilization (IVF) outcome. A prospective cohort analysis was performed at a Women’s Hospital IVF centre of 1015 female patients undergoing fresh non-donor IVF cycles. The effects of the following six single nucleotide polymorphisms (SNPs) in five IL genes on IVF outcomes were explored: IL-1α (rs1800587 C/T), IL-3 (rs40401 C/T), IL-6 (rs1800795 C/G), IL-15 (rs3806798 A/T), IL-18 (rs187238 C/G) and IL-18 (rs1946518 G/T). The main outcome measures included clinical pregnancy, embryo implantation, abortion and live birth rates. There were no statistically significant differences in clinical pregnancy, embryo implantation and live birth rates in the analysis of 1015 patients attempting their first cycle of IVF. Infertile women with IL-3 homozygous major genotype had a higher abortion rate than those with heterozygous and homozygous minor genotype (16.5% vs. 7.9%, P = 0.025). In conclusion, our results indicated that the IL-3 rs40401 polymorphism is associated with increased risk of abortion of IVF patients. Future studies with inclusion of other ethnic populations must be conducted to confirm the findings of this study. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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10 pages, 1353 KiB

Open AccessBrief Report

The Outcome and Implications of Public Precautionary Measures in Taiwan–Declining Respiratory Disease Cases in the COVID-19 Pandemic

by Chih-Chia Hsieh, Chih-Hao Lin, William Yu Chung Wang, David J. Pauleen and Jengchung Victor Chen

Int. J. Environ. Res. Public Health 2020, 17(13), 4877; https://doi.org/10.3390/ijerph17134877 - 06 Jul 2020

Cited by 38 | Viewed by 5126

Abstract

With the rapid development of the COVID-19 pandemic, countries are trying to cope with increasing medical demands, and, at the same time, to reduce the increase of infected numbers by implementing a number of public health measures, namely non-pharmaceutical interventions (NPIs). These public [...] Read more.

With the rapid development of the COVID-19 pandemic, countries are trying to cope with increasing medical demands, and, at the same time, to reduce the increase of infected numbers by implementing a number of public health measures, namely non-pharmaceutical interventions (NPIs). These public health measures can include social distancing, frequent handwashing, and personal protective equipment (PPE) at the personal level; at the community and the government level, these measures can range from canceling activities, avoiding mass gatherings, closing facilities, and, at the extreme, enacting national or provincial lockdowns. Rather than completely stopping the infectious disease, the major purpose of these NPIs in facing an emerging infectious disease is to reduce the contact rate within the population, and reduce the spread of the virus until the time a vaccine or reliable medications become available. The idea is to avoid a surge of patients with severe symptoms beyond the capacity of the hospitals’ medical resources, which would lead to more mortality and morbidity. While many countries have experienced steep curves in new cases, some, including Hong Kong, Vietnam, South Korea, New Zealand, and Taiwan, seem to have controlled or even eliminated the infection locally. From its first case of COVID-19 on the 21 January until the 12 May, Taiwan had 440 cases, including just 55 local infections, and seven deaths in total, representing 1.85 cases per 100,000 population and a 1.5% death rate (based on the Worldometer 2020 statistics of Taiwan’s population of 23.8 million). This paper presents evidence that spread prevention involving mass masking and universal hygiene at the early stage of the COVID-19 pandemic resulted in a 50% decline of infectious respiratory diseases, based on historical data during the influenza season in Taiwan. These outcomes provide potential support for the effectiveness of widely implementing public health precaution measures in controlling COVID-19 without a lockdown policy. Full article

(This article belongs to the Special Issue Big Data, Decision Models, and Public Health)

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