International Journal of Environmental Research and Public Health

Editorial

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9 pages, 316 KiB

Open AccessEditorial

Big Data, Decision Models, and Public Health

by Chien-Lung Chan and Chi-Chang Chang

Int. J. Environ. Res. Public Health 2022, 19(14), 8543; https://doi.org/10.3390/ijerph19148543 - 13 Jul 2022

Cited by 2 | Viewed by 1569

Abstract

As the digital era unfolds, the volume and velocity of environmental, population, and public health data are rapidly increasing [...] Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

Research

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17 pages, 373 KiB

Open AccessArticle

Study on the Impact of Income Gap on Health Level of Rural Residents in China

by Hongpeng Guo, Yang Yang, Chulin Pan, Shuang Xu, Nan Yan and Qingyong Lei

Int. J. Environ. Res. Public Health 2022, 19(13), 7590; https://doi.org/10.3390/ijerph19137590 - 21 Jun 2022

Cited by 8 | Viewed by 1824

Abstract

With the rapid development of the social economy, health has increasingly become the focus of attention. Therefore, based on the balanced panel data of the China Household Tracking Survey (CFPS) from 2010 to 2018, the Probit model was used to investigate the impact [...] Read more.

With the rapid development of the social economy, health has increasingly become the focus of attention. Therefore, based on the balanced panel data of the China Household Tracking Survey (CFPS) from 2010 to 2018, the Probit model was used to investigate the impact of the income gap in rural areas on residents’ health level, and the relevant influencing mechanism was discussed in this paper. Results: (1) The income gap has a significant negative effect on the health level of rural residents, and the expansion of the income gap will have a more significant impact on the health level of rural residents. (2) The income gap will restrain the health level of rural residents by affecting the family income level and mobility constraints. (3) The restraining effect of the income gap on health formation mainly affects the families of young rural residents, rural male residents, residents with no rental income, and residents with low social capital. This paper analyzes and discusses, from the perspective of income gap, the impact of the income gap on the health status of rural residents in China. Based on the above conclusions, this paper puts forward some feasible suggestions to improve the health level of rural residents. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

10 pages, 1344 KiB

Open AccessArticle

Deep Learning for Infant Cry Recognition

by Yun-Chia Liang, Iven Wijaya, Ming-Tao Yang, Josue Rodolfo Cuevas Juarez and Hou-Tai Chang

Int. J. Environ. Res. Public Health 2022, 19(10), 6311; https://doi.org/10.3390/ijerph19106311 - 23 May 2022

Cited by 14 | Viewed by 2790

Abstract

Recognizing why an infant cries is challenging as babies cannot communicate verbally with others to express their wishes or needs. This leads to difficulties for parents in identifying the needs and the health of their infants. This study used deep learning (DL) algorithms [...] Read more.

Recognizing why an infant cries is challenging as babies cannot communicate verbally with others to express their wishes or needs. This leads to difficulties for parents in identifying the needs and the health of their infants. This study used deep learning (DL) algorithms such as the convolutional neural network (CNN) and long short-term memory (LSTM) to recognize infants’ necessities such as hunger/thirst, need for a diaper change, emotional needs (e.g., need for touch/holding), and pain caused by medical treatment (e.g., injection). The classical artificial neural network (ANN) was also used for comparison. The inputs of ANN, CNN, and LSTM were the features extracted from 1607 10 s audio recordings of infants using mel-frequency cepstral coefficients (MFCC). Results showed that CNN and LSTM both provided decent performance, around 95% in accuracy, precision, and recall, in differentiating healthy and sick infants. For recognizing infants’ specific needs, CNN reached up to 60% accuracy, outperforming LSTM and ANN in almost all measures. These results could be applied as indicators for future applications to help parents understand their infant’s condition and needs. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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26 pages, 5452 KiB

Open AccessArticle

Challenges and Drawbacks of the EU Medical System Generated by the COVID-19 Pandemic in the Field of Health Systems’ Digitalization

by Alexandra-Mădălina Țăran, Lavinia Mustea, Sorana Vătavu, Oana-Ramona Lobonț and Magda-Mihaela Luca

Int. J. Environ. Res. Public Health 2022, 19(9), 4950; https://doi.org/10.3390/ijerph19094950 - 19 Apr 2022

Cited by 12 | Viewed by 2691

Abstract

The COVID-19 pandemic and the digitalization of medical services present significant challenges for the medical sector of the European Union, with profound implications for health systems and the provision of high-performance public health services. The sustainability and resilience of health systems are based [...] Read more.

The COVID-19 pandemic and the digitalization of medical services present significant challenges for the medical sector of the European Union, with profound implications for health systems and the provision of high-performance public health services. The sustainability and resilience of health systems are based on the introduction of information and communication technology in health processes and services, eliminating the vulnerability that can have significant consequences for health, social cohesion, and economic progress. This research aims to assess the impact of digitalization on several dimensions of health, introducing specific implications of the COVID-19 pandemic. The research methodology consists of three procedures: cluster analysis performed through vector quantization, agglomerative clustering, and an analytical approach consisting of data mapping. The main results highlight the importance of effective national responses and provide recommendations, various priorities, and objectives to strengthen health systems at the European level. Finally, the results reveal the need to reduce the gaps between the EU member states and a new approach to policy, governance, investment, health spending, and the performing provision of digital services. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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26 pages, 14230 KiB

Open AccessArticle

Integrated Analysis of Behavioural and Health COVID-19 Data Combining Bayesian Networks and Structural Equation Models

by Ron S. Kenett, Giancarlo Manzi, Carmit Rapaport and Silvia Salini

Int. J. Environ. Res. Public Health 2022, 19(8), 4859; https://doi.org/10.3390/ijerph19084859 - 16 Apr 2022

Cited by 5 | Viewed by 2502

Abstract

The response to the COVID-19 pandemic has been highly variable. Governments have applied different mitigation policies with varying effect on social and economic measures, over time. This article presents a methodology for examining the effect of mobility restriction measures and the association between [...] Read more.

The response to the COVID-19 pandemic has been highly variable. Governments have applied different mitigation policies with varying effect on social and economic measures, over time. This article presents a methodology for examining the effect of mobility restriction measures and the association between health and population activity data. As case studies, we refer to the pre-vaccination experience in Italy and Israel. Facing the pandemic, Israel and Italy implemented different policy measures and experienced different population behavioral patterns. Data from these countries are used to demonstrate the proposed methodology. The analysis we introduce in this paper is a staged approach using Bayesian Networks and Structural Equations Models. The goal is to assess the impact of pandemic management and mitigation policies on pandemic spread and population activity. The proposed methodology models data from health registries and Google mobility data and then shows how decision makers can conduct scenario analyses to help design adequate pandemic management policies. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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9 pages, 996 KiB

Open AccessArticle

A Machine Learning Classifier for Predicting Stable MCI Patients Using Gene Biomarkers

by Run-Hsin Lin, Chia-Chi Wang and Chun-Wei Tung

Int. J. Environ. Res. Public Health 2022, 19(8), 4839; https://doi.org/10.3390/ijerph19084839 - 15 Apr 2022

Cited by 7 | Viewed by 2349

Abstract

Alzheimer’s disease (AD) is a neurodegenerative disorder with an insidious onset and irreversible condition. Patients with mild cognitive impairment (MCI) are at high risk of converting to AD. Early diagnosis of unstable MCI patients is therefore vital for slowing the progression to AD. [...] Read more.

Alzheimer’s disease (AD) is a neurodegenerative disorder with an insidious onset and irreversible condition. Patients with mild cognitive impairment (MCI) are at high risk of converting to AD. Early diagnosis of unstable MCI patients is therefore vital for slowing the progression to AD. However, current diagnostic methods are either highly invasive or expensive, preventing their wide applications. Developing low-invasive and cost-efficient screening methods is desirable as the first-tier approach for identifying unstable MCI patients or excluding stable MCI patients. This study developed feature selection and machine learning algorithms to identify blood-sample gene biomarkers for predicting stable MCI patients. Two datasets obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database were utilized to conclude 29 genes biomarkers (31 probes) for predicting stable MCI patients. A random forest-based classifier performed well with area under the receiver operating characteristic curve (AUC) values of 0.841 and 0.775 for cross-validation and test datasets, respectively. For patients with a prediction score greater than 0.9, an excellent concordance of 97% was obtained, showing the usefulness of the proposed method for identifying stable MCI patients. In the context of precision medicine, the proposed prediction model is expected to be useful for identifying stable MCI patients and providing medical doctors and patients with new first-tier diagnosis options. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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20 pages, 2480 KiB

Open AccessArticle

Exploring the Relationship between Urban Youth Sentiment and the Built Environment Using Machine Learning and Weibo Comments

by Sutian Duan, Zhiyong Shen and Xiao Luo

Int. J. Environ. Res. Public Health 2022, 19(8), 4794; https://doi.org/10.3390/ijerph19084794 - 15 Apr 2022

Cited by 7 | Viewed by 2402

Abstract

As the relationship between the built environment and the sense of human experience becomes increasingly important, emotional geography has begun to focus on sentiments in space and time and improving the quality of urban construction from the perspective of public emotion and mental [...] Read more.

As the relationship between the built environment and the sense of human experience becomes increasingly important, emotional geography has begun to focus on sentiments in space and time and improving the quality of urban construction from the perspective of public emotion and mental health. While youth is a powerful force in urban construction, there are no studies on the relationship between urban youth sentiments and the built environment. With the development of the Internet, social media has provided a large source of data for the metrics of youth sentiment. Based on data from more than 10,000 geolocated Sina Weibo comments posted over one week (from 19 to 25 July 2021) in Shanghai and using a machine learning algorithm for attention mechanism, this study calculates the sentiment label and sentiment intensity of each comment. Ten elements in five aspects were selected to assess the built environment at different scales and also to explore the correlations between built environment elements and sentiment intensity at different scales. The study finds that the overall sentiment of Shanghai youth tends to be negative. Sentiment intensity is significantly associated with most built environment elements at smaller scales. Urban youth have a higher proportion of both happy and sad sentiments, within which sad sentiments are more closely related to the built environment and are significantly related to all built environment elements. This study uses a deep learning algorithm to improve the accuracy of sentiment classification and confirms that the built environment has a great impact on sentiment. This research can help cities develop built environment optimization measures and policies to create positive emotional environments and enhance the well-being of urban youth. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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12 pages, 903 KiB

Open AccessArticle

Risk Assessment of Early Lung Cancer with LDCT and Health Examinations

by Hou-Tai Chang, Ping-Huai Wang, Wei-Fang Chen and Chen-Ju Lin

Int. J. Environ. Res. Public Health 2022, 19(8), 4633; https://doi.org/10.3390/ijerph19084633 - 12 Apr 2022

Cited by 6 | Viewed by 2023

Abstract

Early detection of lung cancer has a higher likelihood of curative treatment and thus improves survival rate. Low-dose computed tomography (LDCT) screening has been shown to be effective for high-risk individuals in several clinical trials, but has high false positive rates. To evaluate [...] Read more.

Early detection of lung cancer has a higher likelihood of curative treatment and thus improves survival rate. Low-dose computed tomography (LDCT) screening has been shown to be effective for high-risk individuals in several clinical trials, but has high false positive rates. To evaluate the risk of stage I lung cancer in the general population not limited to smokers, a retrospective study of 133 subjects was conducted in a medical center in Taiwan. Regularized regression was used to build the risk prediction model by using LDCT and health examinations. The proposed model selected seven variables related to nodule morphology, counts and location, and ten variables related to blood tests and medical history, achieving an area under the curve (AUC) value of 0.93. The higher the age, white blood cell count (WBC), blood urea nitrogen (BUN), diabetes, gout, chronic obstructive pulmonary disease (COPD), other cancers, and the presence of spiculation, ground-glass opacity (GGO), and part solid nodules, the higher the risk of lung cancer. Subjects with calcification, solid nodules, nodules in the middle lobes, more nodules, and diseases related to thyroid, liver, and digestive systems were at a lower risk. The selected variables did not indicate causation. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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9 pages, 2538 KiB

Open AccessArticle

Suburban Road Networks to Explore COVID-19 Vulnerability and Severity

by Shahadat Uddin, Arif Khan, Haohui Lu, Fangyu Zhou and Shakir Karim

Int. J. Environ. Res. Public Health 2022, 19(4), 2039; https://doi.org/10.3390/ijerph19042039 - 11 Feb 2022

Cited by 7 | Viewed by 3134

Abstract

The Delta variant of COVID-19 has been found to be extremely difficult to contain worldwide. The complex dynamics of human mobility and the variable intensity of local outbreaks make measuring the factors of COVID-19 transmission a challenge. The inter-suburb road connection details provide [...] Read more.

The Delta variant of COVID-19 has been found to be extremely difficult to contain worldwide. The complex dynamics of human mobility and the variable intensity of local outbreaks make measuring the factors of COVID-19 transmission a challenge. The inter-suburb road connection details provide a reliable proxy of the moving options for people between suburbs for a given region. By using such data from Greater Sydney, Australia, this study explored the impact of suburban road networks on two COVID-19-related outcomes measures. The first measure is COVID-19 vulnerability, which gives a low score to a more vulnerable suburb. A suburb is more vulnerable if it has the first COVID-19 case earlier and vice versa. The second measure is COVID-19 severity, which is proportionate to the number of COVID-19-positive cases for a suburb. To analyze the suburban road network, we considered four centrality measures (degree, closeness, betweenness and eigenvector) and core–periphery structure. We found that the degree centrality measure of the suburban road network was a strong and statistically significant predictor for both COVID-19 vulnerability and severity. Closeness centrality and eigenvector centrality were also statistically significant predictors for COVID-19 vulnerability and severity, respectively. The findings of this study could provide practical insights to stakeholders and policymakers to develop timely strategies and policies to prevent and contain any highly infectious pandemics, including the Delta variant of COVID-19. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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15 pages, 393 KiB

Open AccessArticle

Factors Associated with Cardiovascular Disease Risk among Employees at a Portuguese Higher Education Institution

by Maria Piedade Brandão, Pedro Sa-Couto, Gonçalo Gomes, Pedro Beça and Juliana Reis

Int. J. Environ. Res. Public Health 2022, 19(2), 848; https://doi.org/10.3390/ijerph19020848 - 13 Jan 2022

Cited by 4 | Viewed by 2160

Abstract

This study aimed to estimate the prevalence of risk factors for cardiovascular disease (CVD) and to assess the CVD risk (CVDRisk) in a sample of workers at a specific workplace: a higher education institution in Portugal. Data were collected using a questionnaire (e.cuidHaMUs.QueST [...] Read more.

This study aimed to estimate the prevalence of risk factors for cardiovascular disease (CVD) and to assess the CVD risk (CVDRisk) in a sample of workers at a specific workplace: a higher education institution in Portugal. Data were collected using a questionnaire (e.cuidHaMUs.QueST^®) with 345 HEI workers from June 2017–June 2018 with a high response rate (93.3%). Two constructs of risks for CVD were considered: (i) metabolic risk and hypertension (CVDRisk1); and (ii) modifiable behavioural risk (CVDRisk2). Logistic regression analyses were used to establish a relationship between risk indexes/constructs (CVDRisk1 and CVDRisk2) and groups of selected variables. The most prevalent CVD risk factor was hypercholesterolaemia (43.2%). Sixty-eight percent of participants were in the construct CVDRisk1 while almost half of the respondents were in CVDRisk2 (45.2%). The consumption of soft drinks twice a week or more contributed to a significantly increased risk of CVD in CVDRisk1. Lack of regular exercise and lack of daily fruit consumption significantly increased the risk of CVD in CVDRisk2. The challenge to decision makers and the occupational medical community is to incorporate this information into the daily practices of health surveillance with an urgent need for health promotional education campaigns in the workplace. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

13 pages, 1448 KiB

Open AccessArticle

Development of a Longitudinal Diagnosis and Prognosis in Patients with Chronic Kidney Disease: Intelligent Clinical Decision-Making Scheme

by Chin-Chuan Shih, Ssu-Han Chen, Gin-Den Chen, Chi-Chang Chang and Yu-Lin Shih

Int. J. Environ. Res. Public Health 2021, 18(23), 12807; https://doi.org/10.3390/ijerph182312807 - 04 Dec 2021

Cited by 3 | Viewed by 2064

Abstract

Previous studies on CKD patients have mostly been retrospective, cross-sectional studies. Few studies have assessed the longitudinal assessment of patients over an extended period. In consideration of the heterogeneity of CKD progression. It’s critical to develop a longitudinal diagnosis and prognosis for CKD [...] Read more.

Previous studies on CKD patients have mostly been retrospective, cross-sectional studies. Few studies have assessed the longitudinal assessment of patients over an extended period. In consideration of the heterogeneity of CKD progression. It’s critical to develop a longitudinal diagnosis and prognosis for CKD patients. We proposed an auto Machine Learning (ML) scheme in this study. It consists of four main parts: classification pipeline, cross-validation (CV), Taguchi method and improve strategies. This study includes datasets from 50,174 patients, data were collected from 32 chain clinics and three special physical examination centers, between 2015 and 2019. The proposed auto-ML scheme can auto-select the level of each strategy to associate with a classifier which finally shows an acceptable testing accuracy of 86.17%, balanced accuracy of 84.08%, sensitivity of 90.90% and specificity of 77.26%, precision of 88.27%, and F1 score of 89.57%. In addition, the experimental results showed that age, creatinine, high blood pressure, smoking are important risk factors, and has been proven in previous studies. Our auto-ML scheme light on the possibility of evaluation for the effectiveness of one or a combination of those risk factors. This methodology may provide essential information and longitudinal change for personalized treatment in the future. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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11 pages, 1066 KiB

Open AccessArticle

Use of Antibiotic Treatment in Pregnancy and the Risk of Several Neonatal Outcomes: A Population-Based Study

by Anna Cantarutti, Federico Rea, Matteo Franchi, Benedetta Beccalli, Anna Locatelli and Giovanni Corrao

Int. J. Environ. Res. Public Health 2021, 18(23), 12621; https://doi.org/10.3390/ijerph182312621 - 30 Nov 2021

Cited by 12 | Viewed by 2165

Abstract

Background: Limited evidence is available on the safety and efficacy of antimicrobials during pregnancy, with even less according to the trimester of their use. Objective: This study aimed to evaluate the association between exposure to antibiotics therapy (AT) during pregnancy and short-term neonatal [...] Read more.

Background: Limited evidence is available on the safety and efficacy of antimicrobials during pregnancy, with even less according to the trimester of their use. Objective: This study aimed to evaluate the association between exposure to antibiotics therapy (AT) during pregnancy and short-term neonatal outcomes. Methods: We considered 773,237 deliveries that occurred between 2007–2017 in the Lombardy region of Italy. We evaluated the risk of neonatal outcomes among infants that were born to mothers who underwent AT during pregnancy. The odds ratios and the hazard ratios, with the 95% confidence intervals, were estimated respectively for early (first/second trimester) and late (third trimester) exposure. The propensity score was used to account for potential confounders. We also performed subgroup analysis for the class of AT. Results: We identified 132,024 and 76,921 singletons that were exposed to AT during early and late pregnancy, respectively. Infants born to mothers with early exposure had 17, 11, and 16% increased risk of preterm birth, low birth weight, and low Apgar score, respectively. Infants that were exposed in late pregnancy had 25, 11, and 13% increased risk of preterm birth, low birth weight, and low Apgar score, respectively. The results were consistent in the subgroup analysis. Conclusion: Our results suggested an increased risk of several neonatal outcomes in women exposed to ATs during pregnancy, albeit we were not able to assess to what extent the observed effects were due to the infection itself. To reduce the risk of neonatal outcomes, women that are prescribed AT during pregnancy should be closely monitored. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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16 pages, 1488 KiB

Open AccessArticle

Effects of Mobile Application Program (App)-Assisted Health Education on Preventive Behaviors and Cancer Literacy among Women with Cervical Intraepithelial Neoplasia

by Yi-Hui Lee, Lian-Hua Huang, Su-Hui Chen, Jung-Hua Shao, Chyong-Huey Lai and Nan-Ping Yang

Int. J. Environ. Res. Public Health 2021, 18(21), 11603; https://doi.org/10.3390/ijerph182111603 - 04 Nov 2021

Cited by 7 | Viewed by 2842

Abstract

Objective: This study aimed (1) to study the effects of health education on preventive behaviors and cancer literacy among women with cervical intraepithelial neoplasia (CIN); (2) to compare the effects of mobile application program (App)-assisted health education with traditional book-form health education. Participants: [...] Read more.

Objective: This study aimed (1) to study the effects of health education on preventive behaviors and cancer literacy among women with cervical intraepithelial neoplasia (CIN); (2) to compare the effects of mobile application program (App)-assisted health education with traditional book-form health education. Participants: A total of 132 women ages 20 to 69 years women. Methods: This prospective longitudinal study enrolled 132 CIN women who were evaluated three times. Propensity score matching was used by controlling subjects’ age strata, body mass index, education level, occupation, and type of surgery. Results: The influences of various educational tools were investigated. Four domains were assessed, including health behavior, attitude towards behavior change, self-efficacy of behavior, and cervical cancer (CCa) literacy. Significant improvements in behavior change and CCa literacy due to a health education program were observed (p ≤ 0.002). The App combined with a traditional booklet had the highest score for behavior change and was significantly greater than the booklet-only learning (p = 0.002). The App-assisted form, either App alone or combined with booklet, had a significantly better impact on health promotion when compared to the booklet alone (p = 0.045 and 0.005, respectively). App-only learning had the highest score of CCa literacy (p = 0.004). Conclusion: Health education interventions can have positive effects in terms of change of behavior and CCa literacy. App-assisted learning could be used as a supportive technology, and App learning alone or combined with a traditional booklet may be an innovative model of clinical health promotion for women with CIN. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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13 pages, 3441 KiB

Open AccessFeature PaperArticle

Incorporating Patient Preferences into a Decision-Making Model of Hand Trauma Reconstruction

by Dun-Hao Chang, Yu-Hsiang Wang, Chi-Ying Hsieh, Che-Wei Chang, Ke-Chung Chang and Yo-Shen Chen

Int. J. Environ. Res. Public Health 2021, 18(21), 11081; https://doi.org/10.3390/ijerph182111081 - 21 Oct 2021

Cited by 4 | Viewed by 1961

Abstract

Background: Few studies have addressed patient preferences in emergent surgical decision making. Aim of the study: Analyzing patient preferences for hand trauma reconstruction to propose a decision-making model. Methods: A conjoint analysis survey was developed with Sawtooth Software. Three common flaps—i.e., a cross-finger [...] Read more.

Background: Few studies have addressed patient preferences in emergent surgical decision making. Aim of the study: Analyzing patient preferences for hand trauma reconstruction to propose a decision-making model. Methods: A conjoint analysis survey was developed with Sawtooth Software. Three common flaps—i.e., a cross-finger flap (CFF), a dorsal metacarpal artery perforator flap (DMAPF), and an arterialized venous flap (AVF)—were listed as treatment alternatives. Five attributes corresponding to these flaps were recovery time, total procedure, postoperative care methods, postoperative scar condition, and complication rate. Utility and importance scores were generated from the software, and preference characteristics were evaluated using cluster analysis. Results: The survey was completed by 197 participants with hand trauma. Complication risk received the highest importance score (42.87%), followed by scar condition (21.55%). Cluster analysis classified the participants as “conservative,” “practical,” and “dual-concern”. The dual-concern and conservative groups had more foreign laborers and highly educated participants, respectively, than the other groups. Most participants in the conservative and practical groups preferred DMAPF, whereas those in the dual-concern group favored CFF. Our proposed model consisted of shared decision-making and treatment recommendation pathways. Conclusion: Incorporating patient preferences into the decision-making model can strengthen patient-centered care. Further research on the applications of the proposed model is warranted. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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19 pages, 3872 KiB

Open AccessArticle

Deep Ensemble Learning Approaches in Healthcare to Enhance the Prediction and Diagnosing Performance: The Workflows, Deployments, and Surveys on the Statistical, Image-Based, and Sequential Datasets

by Duc-Khanh Nguyen, Chung-Hsien Lan and Chien-Lung Chan

Int. J. Environ. Res. Public Health 2021, 18(20), 10811; https://doi.org/10.3390/ijerph182010811 - 14 Oct 2021

Cited by 16 | Viewed by 2910

Abstract

With the development of information and technology, especially with the boom in big data, healthcare support systems are becoming much better. Patient data can be collected, retrieved, and stored in real time. These data are valuable and meaningful for monitoring, diagnosing, and further [...] Read more.

With the development of information and technology, especially with the boom in big data, healthcare support systems are becoming much better. Patient data can be collected, retrieved, and stored in real time. These data are valuable and meaningful for monitoring, diagnosing, and further applications in data analysis and decision-making. Essentially, the data can be divided into three types, namely, statistical, image-based, and sequential data. Each type has a different method of retrieval, processing, and deployment. Additionally, the application of machine learning (ML) and deep learning (DL) in healthcare support systems is growing more rapidly than ever. Numerous high-performance architectures are proposed to optimize decision-making. As reliability and stability are the most important factors in the healthcare support system, enhancing the predicted performance and maintaining the stability of the model are always the top priority. The main idea of our study comes from ensemble techniques. Numerous studies and data science competitions show that by combining several weak models into one, ensemble models can attain outstanding performance and reliability. We propose three deep ensemble learning (DEL) approaches, each with stable and reliable performance, that are workable on the above-mentioned data types. These are deep-stacked generalization ensemble learning, gradient deep learning boosting, and deep aggregation learning. The experiment results show that our proposed approaches achieve more vigorous and reliable performance than traditional ML and DL techniques on statistical, image-based, and sequential benchmark datasets. In particular, on the Heart Disease UCI dataset, representing the statistical type, the gradient deep learning boosting approach dominates the others with accuracy, recall, F1-score, Matthews correlation coefficient, and area under the curve values of 0.87, 0.81, 0.83, 0.73, and 0.91, respectively. On the X-ray dataset, representing the image-based type, the deep aggregation learning approach shows the highest performance with values of 0.91, 0.97, 0.93, 0.80, and 0.94, respectively. On the Depresjon dataset, representing the sequence type, the deep-stacked generalization ensemble learning approach outperforms the others with values of 0.91, 0.84, 0.86, 0.8, and 0.94, respectively. Overall, we conclude that applying DL models using our proposed approaches is a promising method for the healthcare support system to enhance prediction and diagnosis performance. Furthermore, our study reveals that these approaches are flexible and easy to apply to achieve optimal performance. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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9 pages, 307 KiB

Open AccessArticle

Application of Standardized Proportional Mortality Ratio to the Assessment of Health Risk in Relatively Healthy Populations: Using a Study of Cancer Risk in Telecommunication Workers with Excess Exposure to Acid Mists as an Example

by Ying-Fong Ker, Perng-Jy Tsai and How-Ran Guo

Int. J. Environ. Res. Public Health 2021, 18(18), 9870; https://doi.org/10.3390/ijerph18189870 - 19 Sep 2021

Cited by 2 | Viewed by 1647

Abstract

When a study population is relatively healthy, such as an occupational population, epidemiological studies are likely to underestimate risk. We used a case study on the cancer risk of workers with exposure to acid mists, a well-documented carcinogen, to demonstrate that using proportional [...] Read more.

When a study population is relatively healthy, such as an occupational population, epidemiological studies are likely to underestimate risk. We used a case study on the cancer risk of workers with exposure to acid mists, a well-documented carcinogen, to demonstrate that using proportional mortality ratios (PMRs) is more appropriate than mortality ratios in assessing risk in terms of mortality. The study included 10,229 employees of a telecommunication company who worked in buildings with battery rooms. In these buildings, the battery rooms had the highest levels of sulfuric acid in the air (geometric mean = 10.7 μg/m³). With the general population in Taiwan as a reference, a decreased standardized mortality ratio (0.42, p < 0.01) from all causes combined, between 1 January 1985 and 31 December 1996, was observed, indicating a healthy worker effect. When we reanalyzed the data using standardized PMR, elevated risks were observed for all cancers combined (1.46, p = 0.01) and cancers of the digestive organs and peritoneum (1.61, p = 0.02), especially stomach cancer (2.94, p = 0.01). The results showed that PMR can detect increases in mortality when a study population is generally healthier than the comparison population and call for further studies on the possible carcinogenic effects of low-level acid mist exposures on the stomach. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

9 pages, 752 KiB

Open AccessArticle

Exploration of Preventable Hospitalizations for Colorectal Cancer with the National Cancer Control Program in Taiwan

by Yu-Han Hung, Yu-Chieh Chung, Pi-Yueh Lee and Hao-Yun Kao

Int. J. Environ. Res. Public Health 2021, 18(17), 9327; https://doi.org/10.3390/ijerph18179327 - 03 Sep 2021

Cited by 2 | Viewed by 1890

Abstract

Background: Causing more than 40,000 deaths each year, cancer is one of the leading causes of mortality and preventable hospitalizations (PH) in Taiwan. To reduce the incidence and severity of cancer, the National Cancer Control Program (NCCP) includes screening for various types of [...] Read more.

Background: Causing more than 40,000 deaths each year, cancer is one of the leading causes of mortality and preventable hospitalizations (PH) in Taiwan. To reduce the incidence and severity of cancer, the National Cancer Control Program (NCCP) includes screening for various types of cancer. A cohort study was conducted to explore the long-term trends in PH/person-years following NCCP intervention from 1997 to 2013. Methods: Trend analysis was carried out for long-term hospitalization. The Poisson regression model was used to compare PH/person-years before (1997–2004) and after intervention (2005–2013), and to explore the impact of policy intervention. Results: The policy response reduced 26% for the risk of hospitalization; in terms of comorbidity, each additional point increased the risk of hospitalization by 2.15 times. The risk of hospitalization doubled for each 10-year increase but was not statistically significant. Trend analysis validates changes in the number of hospitalizations/person-years in 2005. Conclusions: PH is adopted as an indicator for monitoring primary care quality, providing governments with a useful reference for which to gauge the adequacy, accessibility, and quality of health care. Differences in PH rates between rural and urban areas can also be used as a reference for achieving equitable distribution of medical resources. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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7 pages, 298 KiB

Open AccessArticle

Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals

by Reuben Ng and Kelvin Bryan Tan

Int. J. Environ. Res. Public Health 2021, 18(16), 8700; https://doi.org/10.3390/ijerph18168700 - 17 Aug 2021

Cited by 21 | Viewed by 2544

Abstract

Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all [...] Read more.

Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (N = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the “number of days from previous non-elective admission”, which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission—a key predictor in other models—since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation—an “art” that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

10 pages, 1947 KiB

Open AccessArticle

Absence of Association between Previous Mycoplasma pneumoniae Infection and Subsequent Myasthenia Gravis: A Nationwide Population-Based Matched Cohort Study

by Kuan Chen, James Cheng-Chung Wei, Hei-Tung Yip, Mei-Chia Chou and Renin Chang

Int. J. Environ. Res. Public Health 2021, 18(14), 7677; https://doi.org/10.3390/ijerph18147677 - 19 Jul 2021

Cited by 1 | Viewed by 2053

Abstract

Mycoplasma pneumoniae (M. pneumoniae) is not only one of the most common pathogenic bacteria for respiratory infection but also a trigger for many autoimmune diseases. Its infection process shared many similarities with the pathogenesis of myasthenia gravis (MG) at cellular and [...] Read more.

Mycoplasma pneumoniae (M. pneumoniae) is not only one of the most common pathogenic bacteria for respiratory infection but also a trigger for many autoimmune diseases. Its infection process shared many similarities with the pathogenesis of myasthenia gravis (MG) at cellular and cytokine levels. Recent case reports demonstrated patients present with MG after M. pneumoniae infection. However, no epidemiological studies ever looked into the association between the two. Our study aimed to investigate the relationship between M. pneumoniae infection and subsequent development of MG. In this population-based retrospective cohort study, the risk of MG was analyzed in patients who were newly diagnosed with M. pneumoniae infection between 2000 and 2013. A total of 2428 M. pneumoniae patients were included and matched with the non-M. pneumoniae control cohort at a 1:4 ratio by age, sex, and index date. Cox proportional hazards regression analysis was applied to analyze the risk of MG development after adjusting for sex, age, and comorbidities, with hazard ratios and 95% confidence intervals. The incidence rates of MG in the non-M. pneumoniae and M. pneumoniae cohorts were 0.96 and 1.97 per 10,000 person-years, respectively. Another case–control study of patients with MG (n = 515) was conducted to analyze the impact of M. pneumoniae on MG occurrence as a sensitivity analysis. The analysis yielded consistent absence of a link between M. pneumoniae and MG. Although previous studies have reported that M. pneumoniae infection and MG may share associated immunologic pathways, we found no statistical significance between M. pneumoniae infection and subsequent development of MG in this study. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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18 pages, 1044 KiB

Open AccessArticle

Exploring the Effect of Social Support and Empathy on User Engagement in Online Mental Health Communities

by Yixin Chen and Yang Xu

Int. J. Environ. Res. Public Health 2021, 18(13), 6855; https://doi.org/10.3390/ijerph18136855 - 26 Jun 2021

Cited by 16 | Viewed by 4293

Abstract

It is known that social support and empathy are beneficial for mental health. As a result of the widespread development of social media, online social support and empathy could also influence user behaviors during the development of online communities. However, few studies have [...] Read more.

It is known that social support and empathy are beneficial for mental health. As a result of the widespread development of social media, online social support and empathy could also influence user behaviors during the development of online communities. However, few studies have examined these effects from the perspective of online mental health communities. These communities appear to be a crucial source for mental health related support, but the spread of online empathy in these communities is not well-understood. This study focused on 22 mental health related subreddits, and matched and compared users (1) who received social support with those who did not receive social support, and users (2) who received more empathic social support with those who received less empathic social support. The results showed that social support and empathy are “contagious”. That is, users who received social support at their first post would be more likely to post again and provide support for others; in addition, users who received more empathic support would subsequently express a higher level of empathy to others in the future. Our findings indicate the potential chain reaction of social support and empathy in online mental health communities. Our study also provides insights into how online mental health communities might better assist people to deliver social support that can help others to deal with mental problems. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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8 pages, 316 KiB

Open AccessArticle

A Nationwide Population-Based Study on the Association between Land Transport Accident and Peripheral Vestibular Disorders

by Herng-Ching Lin, Sudha Xirasagar, Chia-Hui Wang, Yen-Fu Cheng, Tsai-Ching Liu and Tzong-Hann Yang

Int. J. Environ. Res. Public Health 2021, 18(12), 6570; https://doi.org/10.3390/ijerph18126570 - 18 Jun 2021

Cited by 2 | Viewed by 1898

Abstract

This case–control study aimed to investigate the association of peripheral vestibular disorders (PVD) with subsequent land transport accidents. Data for this study were obtained from Taiwan’s National Health Insurance (NHI) dataset. We retrieved 8704 subjects who were newly found to have land transport [...] Read more.

This case–control study aimed to investigate the association of peripheral vestibular disorders (PVD) with subsequent land transport accidents. Data for this study were obtained from Taiwan’s National Health Insurance (NHI) dataset. We retrieved 8704 subjects who were newly found to have land transport accidents as cases. Their diagnosis date was used as their index date. Controls were identified by propensity score matching (one per case, n = 8704 controls) from the NHI dataset with their index date being the date of their first health service claim in 2017. Multiple logistic regressions were performed to calculate the prior PVD odds ratio of cases vs. controls. We found that 2.36% of the sampled patients had been diagnosed with PVD before the index date, 3.37% among cases and 1.36% among controls. Chi-square test revealed that there was a significant association between land transport accident and PVD (p < 0.001). Furthermore, multiple logistic regression analysis suggested that cases were more likely to have had a prior PVD diagnosis when compared to controls (OR = 2.533; 95% CI = 2.041–3.143; p < 0.001). After adjusting for age, gender, hypertension, diabetes, coronary heart disease, and hyperlipidemia, cases had a greater tendency to have a prior diagnosis of PVD than controls (OR = 3.001, 95% CI = 2.410–3.741, p < 0.001). We conclude that patients with PVD are at twofold higher odds for land transport accidents. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

12 pages, 318 KiB

Open AccessArticle

Long-Term Medical Resource Consumption between Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

by Yang-Lan Lo, Zen Lang Bih, Ying-Hui Yu, Ming-Chang Li, Ho-Min Chen and Szu-Yuan Wu

Int. J. Environ. Res. Public Health 2021, 18(11), 5989; https://doi.org/10.3390/ijerph18115989 - 02 Jun 2021

Cited by 6 | Viewed by 2490

Abstract

Purpose: To estimate long-term medical resource consumption in patients with subarachnoid aneurysmal hemorrhage (SAH) receiving surgical clipping or endovascular coiling. Patients and methods: From Taiwan’s National Health Insurance Research Database, we enrolled patients with aneurysmal SAH who received clipping or coiling. After propensity [...] Read more.

Purpose: To estimate long-term medical resource consumption in patients with subarachnoid aneurysmal hemorrhage (SAH) receiving surgical clipping or endovascular coiling. Patients and methods: From Taiwan’s National Health Insurance Research Database, we enrolled patients with aneurysmal SAH who received clipping or coiling. After propensity score matching and adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the accumulative hospital stay (days), intensive care unit (ICU) stay, and total medical cost for aneurysmal SAH, as well as possible subsequent surgical complications and recurrence. Results: The matching process yielded a final cohort of 8102 patients (4051 and 4051 in endovascular coil embolization and surgical clipping, respectively) who were eligible for further analysis. The mean accumulative hospital stay significantly differed between coiling (31.2 days) and clipping (46.8 days; p < 0.0001). After the generalized linear model adjustment of gamma distribution with a log link, compared with the surgical clipping procedure, the adjusted odds ratios (aOR; 95% confidence interval [CI]) of the medical cost of accumulative hospital stay for the endovascular coil embolization procedure was 0.63 (0.60, 0.66; p < 0·0001). The mean accumulative ICU stay significantly differed between the coiling and clipping groups (9.4 vs. 14.9 days; p < 0.0001). The aORs (95% CI) of the medical cost of accumulative ICU stay in the endovascular coil embolization group was 0.61 (0.58, 0.64; p < 0.0001). The aOR (95% CI) of the total medical cost of index hospitalization in the endovascular coil embolization group was 0·85 (0.82, 0.87; p < 0.0001). Conclusions: Medical resource consumption in the coiling group was lower than that in the clipping group. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

14 pages, 2383 KiB

Open AccessArticle

A Real-Time Artificial Intelligence-Assisted System to Predict Weaning from Ventilator Immediately after Lung Resection Surgery

by Ying-Jen Chang, Kuo-Chuan Hung, Li-Kai Wang, Chia-Hung Yu, Chao-Kun Chen, Hung-Tze Tay, Jhi-Joung Wang and Chung-Feng Liu

Int. J. Environ. Res. Public Health 2021, 18(5), 2713; https://doi.org/10.3390/ijerph18052713 - 08 Mar 2021

Cited by 20 | Viewed by 3027

Abstract

Assessment of risk before lung resection surgery can provide anesthesiologists with information about whether a patient can be weaned from the ventilator immediately after surgery. However, it is difficult for anesthesiologists to perform a complete integrated risk assessment in a time-limited pre-anesthetic clinic. [...] Read more.

Assessment of risk before lung resection surgery can provide anesthesiologists with information about whether a patient can be weaned from the ventilator immediately after surgery. However, it is difficult for anesthesiologists to perform a complete integrated risk assessment in a time-limited pre-anesthetic clinic. We retrospectively collected the electronic medical records of 709 patients who underwent lung resection between 1 January 2017 and 31 July 2019. We used the obtained data to construct an artificial intelligence (AI) prediction model with seven supervised machine learning algorithms to predict whether patients could be weaned immediately after lung resection surgery. The AI model with Naïve Bayes Classifier algorithm had the best testing result and was therefore used to develop an application to evaluate risk based on patients’ previous medical data, to assist anesthesiologists, and to predict patient outcomes in pre-anesthetic clinics. The individualization and digitalization characteristics of this AI application could improve the effectiveness of risk explanations and physician–patient communication to achieve better patient comprehension. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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13 pages, 2592 KiB

Open AccessArticle

Clinical Knowledge Supported Acute Kidney Injury (AKI) Risk Assessment Model for Elderly Patients

by Kao-Yi Shen, Yen-Ching Chuang and Tao-Hsin Tung

Int. J. Environ. Res. Public Health 2021, 18(4), 1607; https://doi.org/10.3390/ijerph18041607 - 08 Feb 2021

Cited by 2 | Viewed by 2403

Abstract

From the clinical viewpoint, the statistical approach is still the cornerstone for exploring many diseases. This study was conducted to explore the risk factors related to acute kidney injury (AKI) for elderly patients using the multiple criteria decision-making (MCDM) approach. Ten nephrologists from [...] Read more.

From the clinical viewpoint, the statistical approach is still the cornerstone for exploring many diseases. This study was conducted to explore the risk factors related to acute kidney injury (AKI) for elderly patients using the multiple criteria decision-making (MCDM) approach. Ten nephrologists from a teaching hospital in Taipei took part in forming the AKI risk assessment model. The key findings are: (1) Comorbidity and Laboratory Values would influence Comprehensive Geriatric Assessment; (2) Frailty is the highest influential AKI risk factor for elderly patients; and (3) Elderly patients could enhance their daily activities and nutrition to improve frailty and lower AKI risk. Furthermore, we illustrate how to apply MCDM methods to retrieve clinical experience from seasoned doctors, which may serve as a knowledge-based system to support clinical prognoses. In conclusion, this study has shed light on integrating multiple research approaches to assist medical decision-making in clinical practice. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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7 pages, 823 KiB

Open AccessArticle

A Nationwide Population-Based Study on the Incidence of Parapharyngeal and Retropharyngeal Abscess—A 10-Year Study

by Tzong-Hann Yang, Sudha Xirasagar, Yen-Fu Cheng, Chuan-Song Wu, Yi-Wei Kao and Herng-Ching Lin

Int. J. Environ. Res. Public Health 2021, 18(3), 1049; https://doi.org/10.3390/ijerph18031049 - 25 Jan 2021

Cited by 11 | Viewed by 2753

Abstract

This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample [...] Read more.

This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of over two million enrollees of the National Health Insurance system that covers over 99% of Taiwan’s citizens. During 2007–2016, 5779 patients received a diagnosis of PRPA. We calculated the population-wide incidence rates of PRPA by sex and age group (20–44, 45–64, and >64) as well as in-hospital mortality. The annual incidence rate of PRPA was 2.64 per 100,000 people. The gender-specific incidence rates per 100,000 people were 3.34 for males and 1.94 for females with a male:female gender ratio of 1.72. A slight increase in incidence rates among both genders over the study period was noted. Age-specific rates were lowest in the 20–44 age group with a mean annual incidence of 2.00 per 100,000 people, and the highest rates were noted in the age groups of 45–64 and >64 years with mean annual incidences of 3.21 and 3.20, respectively. We found that PRPA is common in Taiwan, males and older individuals are more susceptible to it, and incidence has increased in recent years. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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12 pages, 903 KiB

Open AccessArticle

Impact of Matrix Metalloproteinase-11 Gene Polymorphisms on Biochemical Recurrence and Clinicopathological Characteristics of Prostate Cancer

by Chun-Yu Hsieh, Ying-Erh Chou, Chia-Yen Lin, Shian-Shiang Wang, Ming-Hsien Chien, Chih-Hsin Tang, Jian-Cheng Lin, Yu-Ching Wen and Shun-Fa Yang

Int. J. Environ. Res. Public Health 2020, 17(22), 8603; https://doi.org/10.3390/ijerph17228603 - 19 Nov 2020

Cited by 8 | Viewed by 2003

Abstract

Prostate cancer is among the most common malignant tumors worldwide. Matrix metalloproteinase (MMP)-11 is involved in extracellular matrix degradation and remodeling and plays an essential role in cancer development and metastasis. This study investigated the association of MMP-11 polymorphisms with the clinicopathological characteristics [...] Read more.

Prostate cancer is among the most common malignant tumors worldwide. Matrix metalloproteinase (MMP)-11 is involved in extracellular matrix degradation and remodeling and plays an essential role in cancer development and metastasis. This study investigated the association of MMP-11 polymorphisms with the clinicopathological characteristics and biochemical recurrence of prostate cancer. Five single-nucleotide polymorphisms (SNPs) of the MMP-11 were analyzed in 578 patients with prostate cancer through real-time polymerase chain reaction analysis. A prostate-specific antigen level of >10 ng/mL, Gleason grade groups 4 + 5, advanced tumor stage, lymph node metastasis, invasion, and high-risk D’Amico classification were significantly associated with biochemical recurrence in the patients (p < 0.001). MMP-11 rs131451 “TC + CC” polymorphic variants were associated with advanced clinical stage (T stage; p = 0.007) and high-risk D’Amico classification (p = 0.015) in patients with biochemical recurrence. These findings demonstrate that MMP-11 polymorphisms were not associated with prostate cancer susceptibility; however, the rs131451 polymorphic variant was associated with late-stage tumors and high-risk D’Amico classification in prostate cancer patients with biochemical recurrence. Thus, the MMP-11 SNP rs131451 may contribute to the tumor development in prostate cancer patients with biochemical recurrence. Full article

(This article belongs to the Special Issue 2nd Edition of Big Data, Decision Models, and Public Health)

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