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Hsiu-An Lee
Department of Computer Science and Information Engineering, Tamkang University, New Taipei 251, Taiwan

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Journal article
Published: 05 May 2021 in International Journal of Environmental Research and Public Health
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Recently, the role of lifestyle factors in testicular function has developed into a growing area of interest. Based on cross-sectional data on 3283 Taiwanese men, we investigated whether interactive effects of unhealthy lifestyle behaviors were associated with testicular function. The men were recruited from a private screening institute between 2009 and 2015. Lifestyle behaviors (smoking, alcohol drinking, physical activity (PA), sleeping habits, and diet) were obtained by a validated self-reported questionnaire. The men provided a semen sample and had blood drawn for sex hormone measurement. Men who smoked and drank had higher testosterone (T) levels (β = 0.81, p < 0.001) than those who neither smoked nor drank. Men who smoked and had high Western dietary pattern scores had higher T levels—by 0.38 ng/mL (p = 0.03). Those who drank and did not get enough sleep or had high Western dietary pattern scores had elevated T levels—by 0.60 ng/mL (p = 0.005) or 0.45 ng/mL (p = 0.02), respectively. Light PA and insomnia were associated with decreased T levels—by 0.64 ng/mL (p < 0.001). Those who smoked and drank or had light PA or had high Western dietary pattern scores had lower normal sperm morphologies (NSMs)—by 2.08%, 1.77%, and 2.29%, respectively. Moreover, drinkers who had high Western dietary pattern scores had higher sperm concentrations—by 4.63 M/mL (p = 0.04). Awareness and recognition of the long-term impact of lifestyle behaviors and better lifestyle choices may help to optimize the chance of conception amongst couples.

ACS Style

Adi Kurniawan; Chien-Yeh Hsu; Jane Chao; Li-Yin Lin; Rathi Paramastri; Hsiu-An Lee; Nan-Chen Hsieh; Shu-Fang Wu. Interactive Effects of Unhealthy Lifestyle Behaviors on Testicular Function among Healthy Adult Men: A Cross-Sectional Study in Taiwan. International Journal of Environmental Research and Public Health 2021, 18, 4925 .

AMA Style

Adi Kurniawan, Chien-Yeh Hsu, Jane Chao, Li-Yin Lin, Rathi Paramastri, Hsiu-An Lee, Nan-Chen Hsieh, Shu-Fang Wu. Interactive Effects of Unhealthy Lifestyle Behaviors on Testicular Function among Healthy Adult Men: A Cross-Sectional Study in Taiwan. International Journal of Environmental Research and Public Health. 2021; 18 (9):4925.

Chicago/Turabian Style

Adi Kurniawan; Chien-Yeh Hsu; Jane Chao; Li-Yin Lin; Rathi Paramastri; Hsiu-An Lee; Nan-Chen Hsieh; Shu-Fang Wu. 2021. "Interactive Effects of Unhealthy Lifestyle Behaviors on Testicular Function among Healthy Adult Men: A Cross-Sectional Study in Taiwan." International Journal of Environmental Research and Public Health 18, no. 9: 4925.

Journal article
Published: 26 March 2021 in International Journal of Environmental Research and Public Health
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Inadequate dietary intake, poor nutritional status, heavy smoking, and alcohol consumption are associated with the risk of anemia. The objective of this study was to investigate the associations between dietary patterns, lifestyle, nutritional status, and anemia-related biomarkers among adults using a multivariable regression model. Taiwanese adults aged 20–45 years (n = 118,924, 43,055 men and 75,869 women) were obtained from the Mei Jau Health Management Institution database, between 2001 and 2015, for data analysis. The anemia–inflammation-related dietary pattern was derived by reduced rank regression analysis. Dietary patterns with high intakes of eggs, meat, organ meats, rice or flour products, fried foods, sugary beverages, and processed foods significantly increased the risk of anemia, and was associated with decreased hemoglobin, hematocrit, and red blood cells, but increased white blood cells and C-reactive protein levels. Moreover, current alcohol drinkers, as well as people who were underweight, overweight, obese, and central obese, were more likely to increase their risk of anemia by 46%, 20%, 23%, 34%, and 28%, respectively. Interestingly, participants who are current or past smokers were inversely associated with risk of anemia. In conclusion, adherence to the anemia–inflammation dietary pattern was associated with an increased risk of anemia in Taiwanese adults. Furthermore, abnormal weight status and alcohol drinking were correlated with an increased risk of anemia.

ACS Style

Rathi Paramastri; Chien-Yeh Hsu; Hsiu-An Lee; Li-Yin Lin; Adi Kurniawan; Jane Chao. Association between Dietary Pattern, Lifestyle, Anthropometric Status, and Anemia-Related Biomarkers among Adults: A Population-Based Study from 2001 to 2015. International Journal of Environmental Research and Public Health 2021, 18, 3438 .

AMA Style

Rathi Paramastri, Chien-Yeh Hsu, Hsiu-An Lee, Li-Yin Lin, Adi Kurniawan, Jane Chao. Association between Dietary Pattern, Lifestyle, Anthropometric Status, and Anemia-Related Biomarkers among Adults: A Population-Based Study from 2001 to 2015. International Journal of Environmental Research and Public Health. 2021; 18 (7):3438.

Chicago/Turabian Style

Rathi Paramastri; Chien-Yeh Hsu; Hsiu-An Lee; Li-Yin Lin; Adi Kurniawan; Jane Chao. 2021. "Association between Dietary Pattern, Lifestyle, Anthropometric Status, and Anemia-Related Biomarkers among Adults: A Population-Based Study from 2001 to 2015." International Journal of Environmental Research and Public Health 18, no. 7: 3438.

Journal article
Published: 18 March 2021 in Nutrients
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We investigated the association between dietary patterns and serum hepatic enzyme levels in adults with dyslipidemia and impaired fasting glucose in Taiwan. A total of 15,005 subjects (5452 men and 9553 women) aged 35–69 years were selected. Two major dietary patterns were identified by principal component analysis: Western dietary pattern and Mediterranean dietary pattern. Subjects in the highest quartile (Q4) of the Western dietary pattern showed an increased risk of elevated serum alanine aminotransferase (ALT) levels (OR: 1.24, 95% CI: 1.06–1.45, p-trend = 0.01). Fur-thermore, in the highest quartile of the Western dietary pattern, subjects with high waist circum-ference were observed to have a greater risk for developing abnormal serum ALT levels compared to those in the lowest quartile (Q1) (OR: 1.43, 95% CI: 1.04–1.97, p-trend = 0.01). In the highest quartile of the Western dietary pattern, only women were at an increased risk for having abnormal serum ALT levels (OR: 1.28, 95% CI: 1.04–1.59, p-trend = 0.03). By contrast, in the highest quartile of the Mediterranean dietary pattern, only men were at a reduced risk for having abnormal serum gamma-glutamyl transferase (GGT) levels (OR: 0.72, 95% CI: 0.53–0.97, p-trend = 0.048). We report a positive association between the Western dietary pattern and abnormal serum ALT levels.

ACS Style

Li-Yin Lin; Chien-Yeh Hsu; Hung-Yi Chiou; Hsiu-An Lee; Li-Ming Hsu; Po-Ya Chang; Adi Kurniawan; Jane Chao. Association between Dietary Patterns and Serum Hepatic Enzyme Levels in Adults with Dyslipidemia and Impaired Fasting Plasma Glucose. Nutrients 2021, 13, 987 .

AMA Style

Li-Yin Lin, Chien-Yeh Hsu, Hung-Yi Chiou, Hsiu-An Lee, Li-Ming Hsu, Po-Ya Chang, Adi Kurniawan, Jane Chao. Association between Dietary Patterns and Serum Hepatic Enzyme Levels in Adults with Dyslipidemia and Impaired Fasting Plasma Glucose. Nutrients. 2021; 13 (3):987.

Chicago/Turabian Style

Li-Yin Lin; Chien-Yeh Hsu; Hung-Yi Chiou; Hsiu-An Lee; Li-Ming Hsu; Po-Ya Chang; Adi Kurniawan; Jane Chao. 2021. "Association between Dietary Patterns and Serum Hepatic Enzyme Levels in Adults with Dyslipidemia and Impaired Fasting Plasma Glucose." Nutrients 13, no. 3: 987.

Journal article
Published: 23 February 2021 in Cancers
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Cancer is the leading cause of death in Taiwan. According to the Cancer Registration Report of Taiwan’s Ministry of Health and Welfare, a total of 13,488 people suffered from lung cancer in 2016, making it the second-most common cancer and the leading cancer in men. Compared with other types of cancer, the incidence of lung cancer is high. In this study, the National Health Insurance Research Database (NHIRDB) was used to determine the diseases and symptoms associated with lung cancer, and a 10-year probability deep neural network prediction model for lung cancer was developed. The proposed model could allow patients with a high risk of lung cancer to receive an earlier diagnosis and support the physicians’ clinical decision-making. The study was designed as a cohort study. The subjects were patients who were diagnosed with lung cancer between 2000 and 2009, and the patients’ disease histories were back-tracked for a period, extending to ten years before the diagnosis of lung cancer. As a result, a total of 13 diseases were selected as the predicting factors. A nine layers deep neural network model was created to predict the probability of lung cancer, depending on the different pre-diagnosed diseases, and to benefit the earlier detection of lung cancer in potential patients. The model is trained 1000 times, the batch size is set to 100, the SGD(Stochastic gradient descent) optimizer is used, the learning rate is set to 0.1, and the momentum is set to 0.1. The proposed model showed an accuracy of 85.4%, a sensitivity of 72.4% and a specificity of 85%, as well as an 87.4% area under ROC (AUROC) (95%, 0.8604–0.8885) model precision. Based on data analysis and deep learning, our prediction model discovered some features that had not been previously identified by clinical knowledge. This study tracks a decade of clinical diagnostic records to identify possible symptoms and comorbidities of lung cancer, allows early prediction of the disease, and assists more patients with early diagnosis.

ACS Style

Hsiu-An Lee; Louis Chao; Chien-Yeh Hsu. A 10-Year Probability Deep Neural Network Prediction Model for Lung Cancer. Cancers 2021, 13, 928 .

AMA Style

Hsiu-An Lee, Louis Chao, Chien-Yeh Hsu. A 10-Year Probability Deep Neural Network Prediction Model for Lung Cancer. Cancers. 2021; 13 (4):928.

Chicago/Turabian Style

Hsiu-An Lee; Louis Chao; Chien-Yeh Hsu. 2021. "A 10-Year Probability Deep Neural Network Prediction Model for Lung Cancer." Cancers 13, no. 4: 928.

Journal article
Published: 21 January 2021 in Nutrients
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We evaluated the interactive effects of nutrition education (NE) and lifestyle factors on kidney function parameters and cardiovascular risk factors among chronic kidney disease (CKD) patients. This cross-sectional cohort study recruited 2176 CKD stages 3–5 patients aged > 20 years from Integrated Chronic Kidney Disease Care Network, Shuang Ho Hospital, Taiwan between December 2008 and April 2019. The multivariable regression analysis was performed to investigate the interactive effects of NE with lifestyle factors on kidney function parameters and cardiovascular risk factors. Relative excess risk due to interaction (RERI) and attributable proportion (AP) were applied to assess additive interaction. Patients who were smoking or physically inactive but received NE had better estimated glomerular filtration rate (eGFR) (β: 3.83, 95% CI: 1.17–6.49 or β: 3.67, 95% CI: 2.04–5.29) compared to those without NE. Patients with smoking and NE significantly reduced risks for having high glycated hemoglobin A1c (HbA1c) by 47%, high low-density lipoprotein cholesterol (LDL-C) by 38%, and high corrected calcium (C-Ca) by 50% compared to those without NE. Moreover, NE and smoking or inactive physical activity exhibited an excess risk of high C-Ca (RERI: 0.47, 95% CI: 0.09–0.85 for smoking or RERI: 0.46, 95% CI: 0.01–0.90 and AP: 0.51, 95% CI: 0.03–0.99 for physical activity). Our study suggests that CKD patients who were enrolled in the NE program had better kidney function. Thus, NE could be associated with slowing kidney function decline and improving cardiovascular risk factors.

ACS Style

Adi-Lukas Kurniawan; Ya-Lan Yang; Mei-Yun Chin; Chien-Yeh Hsu; Rathi Paramastri; Hsiu-An Lee; Po-Yuan Ni; Jane Chao. Association of Nutrition Education and Its Interaction with Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors among Chronic Kidney Disease Patients in Taiwan. Nutrients 2021, 13, 298 .

AMA Style

Adi-Lukas Kurniawan, Ya-Lan Yang, Mei-Yun Chin, Chien-Yeh Hsu, Rathi Paramastri, Hsiu-An Lee, Po-Yuan Ni, Jane Chao. Association of Nutrition Education and Its Interaction with Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors among Chronic Kidney Disease Patients in Taiwan. Nutrients. 2021; 13 (2):298.

Chicago/Turabian Style

Adi-Lukas Kurniawan; Ya-Lan Yang; Mei-Yun Chin; Chien-Yeh Hsu; Rathi Paramastri; Hsiu-An Lee; Po-Yuan Ni; Jane Chao. 2021. "Association of Nutrition Education and Its Interaction with Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors among Chronic Kidney Disease Patients in Taiwan." Nutrients 13, no. 2: 298.

Journal article
Published: 18 January 2021 in Nutrients
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Diets could play an important role in testicular function, but studies on how adherence to the dietary patterns influences human testicular function in Asian countries are scarce. Herein, we examined the association between testosterone-related dietary patterns and testicular function among adult men in Taiwan. This cross-sectional study recruited 3283 men who attended a private medical screening program from 2009 to 2015. Testosterone-related dietary pattern was generated by the reduced rank regression (RRR) method. The association between adherence to quartile of dietary pattern scores with sex hormones (testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2)) and sperm quality (sperm concentration (SC), total sperm motility (TSM), progressive motility (PRM), and normal sperm morphology (NSM)) were examined by multivariable linear regression. Hemoglobin (β = 0.57, p < 0.001), hematocrit (β = 0.17, p = 0.002), triglyceride (β = −0.84, p < 0.001), HDL-cholesterol (β = 3.58, p < 0.001), total cholesterol to HDL-cholesterol ratio (β = −0.78, p < 0.001), and uric acid (β = −10.77, p < 0.001) were highly correlated with testosterone levels. Therefore, these biomarkers were used to construct a testosterone-related dietary pattern. Highest adherence (Q4) to dietary pattern scores were negatively associated with lower testosterone in the pooled analysis (β = −0.89, p = 0.037) and normal-weight men (β = −1.48, p = 0.019). Likewise, men in the Q4 of the dietary pattern had lower SC (β = −5.55, p = 0.001) and NSM (β = −2.22, p = 0.007) regardless of their nutritional status. Our study suggesting that testosterone-related dietary pattern (rich in preserved vegetables or processed meat or fish, deep-fried foods, innards organs, rice or flour products cooked in oil, and dipping sauce, but low in milk, dairy products, legumes, or beans, and dark or leafy vegetables) was associated with a poor testicular function.

ACS Style

Adi-Lukas Kurniawan; Chien-Yeh Hsu; Jane Chao; Rathi Paramastri; Hsiu-An Lee; Pao-Chin Lai; Nan-Chen Hsieh; Shu-Fang Wu. Association of Testosterone-Related Dietary Pattern with Testicular Function among Adult Men: A Cross-Sectional Health Screening Study in Taiwan. Nutrients 2021, 13, 259 .

AMA Style

Adi-Lukas Kurniawan, Chien-Yeh Hsu, Jane Chao, Rathi Paramastri, Hsiu-An Lee, Pao-Chin Lai, Nan-Chen Hsieh, Shu-Fang Wu. Association of Testosterone-Related Dietary Pattern with Testicular Function among Adult Men: A Cross-Sectional Health Screening Study in Taiwan. Nutrients. 2021; 13 (1):259.

Chicago/Turabian Style

Adi-Lukas Kurniawan; Chien-Yeh Hsu; Jane Chao; Rathi Paramastri; Hsiu-An Lee; Pao-Chin Lai; Nan-Chen Hsieh; Shu-Fang Wu. 2021. "Association of Testosterone-Related Dietary Pattern with Testicular Function among Adult Men: A Cross-Sectional Health Screening Study in Taiwan." Nutrients 13, no. 1: 259.

Journal article
Published: 28 December 2020 in Sustainability
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Personal health records (PHRs) have lots of benefits for things such as health surveillance, epidemiological surveillance, self-control, links to various services, public health and health management, and international surveillance. The implementation of an international standard for interoperability is essential to accessing personal health records. In Taiwan, the nationwide exchange platform for electronic medical records (EMRs) has been in use for many years. The Health Level Seven International (HL7) Clinical Document Architecture (CDA) was used as the standard of the EMRs. However, the complication of implementing CDA became a barrier for many hospitals to realize the standard EMRs. In this study, we implemented a Fast Healthcare Interoperability Resources (FHIR)-based PHR transformation process including a user interface module to review the contents of PHRs. We used “My Health Bank, MHB”, a PHR data book developed and issued to all people by the Taiwan National Health Insurance, as the PHRs contents in this study. Network Time Protocol (NTP)/Simple Network Time Protocol (SNTP) was used in the security and user authentication mechanism when processing and applying personal health information. Transport Layer Security (TLS) 1.2 (such as HyperText Transfer Protocol Secure (HTTPS) was used for protection in data communication. User authentication is important in the platform. OAuth (OAuth 2.0) was used as a user authentication mechanism to confirm legitimate user access to ensure data security. The contents of MHB were analyzed and mapped to the FHIR, and then converted to FHIR format according to the mapping logic template. The function of format conversion was carried out by using ASP.NET. XPath and JSPath technologies filtered out specific information tags. The converted data structure was verified through an HL7 Application Programming Interface (HAPI) server, and a new JSON file was finally created. This platform can not only capture any PHR based on the FHIR format but also publish FHIR-based MHB records to any other platform to bridge the interoperability gap between different PHR systems. Therefore, our implementation/application with the automatic transformation from MHB to FHIR format provides an innovative method for people to access their own PHRs (MHB). No one has published a similar application like us using a nationwide PHR standard, MHB, in Taiwan. The application we developed will be very useful for a single person to use or for other system developers to implement their own standard PHR software.

ACS Style

Yen-Liang Lee; Hsiu-An Lee; Chien-Yeh Hsu; Hsin-Hua Kung; Hung-Wen Chiu. Implement an International Interoperable PHR by FHIR—A Taiwan Innovative Application. Sustainability 2020, 13, 198 .

AMA Style

Yen-Liang Lee, Hsiu-An Lee, Chien-Yeh Hsu, Hsin-Hua Kung, Hung-Wen Chiu. Implement an International Interoperable PHR by FHIR—A Taiwan Innovative Application. Sustainability. 2020; 13 (1):198.

Chicago/Turabian Style

Yen-Liang Lee; Hsiu-An Lee; Chien-Yeh Hsu; Hsin-Hua Kung; Hung-Wen Chiu. 2020. "Implement an International Interoperable PHR by FHIR—A Taiwan Innovative Application." Sustainability 13, no. 1: 198.

Journal article
Published: 24 December 2020 in Nutrients
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This study explored the association between dietary patterns and kidney function parameters in adults with metabolic syndrome in Taiwan. This cross-sectional study was undertaken in 56,476 adults from the health screening centers in Taiwan from 2001 to 2010. Dietary intake and dietary patterns were assessed using a food frequency questionnaire and principal component analysis, respectively. Blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR), and uric acid were measured as clinical parameters of kidney function. Multivariate linear regression was conducted to explore the relationship between dietary patterns and kidney function parameters. After adjusting for confounders, the highest tertiles of the processed food–sweets dietary pattern and the meat–seafood–eggs dietary pattern were associated with increased BUN, creatinine, and uric acid but decreased eGFR (all adjusted p < 0.05). Meanwhile, the highest tertiles of the veggie–fruit–grains dietary pattern and the milk–dairy dietary pattern were associated with decreased BUN, creatinine, and uric acid but increased eGFR (all adjusted p < 0.05). A processed food–sweets dietary pattern or a meat–seafood–eggs dietary pattern is associated with worse kidney function parameters in adults with metabolic syndrome. In contrast, a veggie–fruit–grains dietary pattern or a milk–dairy dietary pattern is associated with better kidney function parameters.

ACS Style

Ahmad Syauqy; Chien-Yeh Hsu; Hsiu-An Lee; Hsiao-Hsien Rau; Jane C.-J. Chao. Association between Dietary Patterns and Kidney Function Parameters in Adults with Metabolic Syndrome: A Cross-Sectional Study. Nutrients 2020, 13, 40 .

AMA Style

Ahmad Syauqy, Chien-Yeh Hsu, Hsiu-An Lee, Hsiao-Hsien Rau, Jane C.-J. Chao. Association between Dietary Patterns and Kidney Function Parameters in Adults with Metabolic Syndrome: A Cross-Sectional Study. Nutrients. 2020; 13 (1):40.

Chicago/Turabian Style

Ahmad Syauqy; Chien-Yeh Hsu; Hsiu-An Lee; Hsiao-Hsien Rau; Jane C.-J. Chao. 2020. "Association between Dietary Patterns and Kidney Function Parameters in Adults with Metabolic Syndrome: A Cross-Sectional Study." Nutrients 13, no. 1: 40.

Journal article
Published: 22 December 2020 in JMIR Medical Informatics
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Background COVID-19 has affected more than 180 countries and is the first known pandemic to be caused by a new virus. COVID-19’s emergence and rapid spread is a global public health and economic crisis. However, investigations into the disease, patient-tracking mechanisms, and case report transmissions are both labor-intensive and slow. Objective The pandemic has overwhelmed health care systems, forcing hospitals and medical facilities to find effective ways to share data. This study aims to design a global infectious disease surveillance and case tracking system that can facilitate the detection and control of COVID-19. Methods The International Patient Summary (IPS; an electronic health record that contains essential health care information about a patient) was used. The IPS was designed to support the used case scenario for unplanned cross-border care. The design, scope, utility, and potential for reuse of the IPS for unplanned cross-border care make it suitable for situations like COVID-19. The Fast Healthcare Interoperability Resources confirmed that IPS data, which includes symptoms, therapies, medications, and laboratory data, can be efficiently transferred and exchanged on the system for easy access by physicians. To protect privacy, patient data are deidentified. All systems are protected by blockchain architecture, including data encryption, validation, and exchange of records. Results To achieve worldwide COVID-19 surveillance, a global infectious disease information exchange must be enacted. The COVID-19 surveillance system was designed based on blockchain architecture. The IPS was used to exchange case study information among physicians. After being verified, physicians can upload IPS files and receive IPS data from other global cases. The system includes a daily IPS uploading and enhancement plan, which covers real-time uploading through the interoperation of the clinic system, with the module based on the Open Application Programming Interface architecture. Through the treatment of different cases, drug treatments, and the exchange of treatment results, the disease spread can be controlled, and treatment methods can be funded. In the Infectious Disease Case Tracking module, we can track the moving paths of infectious disease cases. The location information recorded in the blockchain is used to check the locations of different cases. The Case Tracking module was established for the Centers for Disease Control and Prevention to track cases and prevent disease spread. Conclusions We created the IPS of infectious diseases for physicians treating patients with COVID-19. Our system can help health authorities respond quickly to the transmission and spread of unknown diseases, and provides a system for information retrieval on disease transmission. In addition, this system can help researchers form trials and analyze data from different countries. A common forum to facilitate the mutual sharing of experiences, best practices, therapies, useful medications, and clinical intervention outcomes from research in various countries could help control an unknown virus. This system could be an effective tool for global collaboration in evidence-based efforts to fight COVID-19.

ACS Style

Hsiu-An Lee; Hsin-Hua Kung; Yuarn-Jang Lee; Jane C-J Chao; Jai Ganesh Udayasankaran; Hueng-Chuen Fan; Kwok-Keung Ng; Yu-Kang Chang; Boonchai Kijsanayotin; Alvin B Marcelo; Chien-Yeh Hsu. Global Infectious Disease Surveillance and Case Tracking System for COVID-19: Development Study. JMIR Medical Informatics 2020, 8, e20567 .

AMA Style

Hsiu-An Lee, Hsin-Hua Kung, Yuarn-Jang Lee, Jane C-J Chao, Jai Ganesh Udayasankaran, Hueng-Chuen Fan, Kwok-Keung Ng, Yu-Kang Chang, Boonchai Kijsanayotin, Alvin B Marcelo, Chien-Yeh Hsu. Global Infectious Disease Surveillance and Case Tracking System for COVID-19: Development Study. JMIR Medical Informatics. 2020; 8 (12):e20567.

Chicago/Turabian Style

Hsiu-An Lee; Hsin-Hua Kung; Yuarn-Jang Lee; Jane C-J Chao; Jai Ganesh Udayasankaran; Hueng-Chuen Fan; Kwok-Keung Ng; Yu-Kang Chang; Boonchai Kijsanayotin; Alvin B Marcelo; Chien-Yeh Hsu. 2020. "Global Infectious Disease Surveillance and Case Tracking System for COVID-19: Development Study." JMIR Medical Informatics 8, no. 12: e20567.

Journal article
Published: 14 October 2020 in BMC Medical Research Methodology
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Background Dietary patterns were associated with the risk of chronic disease development and outcome-related diseases. In this study, we aimed to compare the correlation between dietary patterns and metabolic syndrome (MetS) using two methods for identifying dietary patterns. Methods The participants (n = 25,569) aged ≥40 years with impaired kidney function were retrieved from Mei Jau (MJ) Health Screening database from 2008 to 2010. Dietary patterns were identified by principal component analysis (PCA) and reduced rank regression (RRR) from twenty-two food groups using PROC FACTOR and PROC PLS functions. Results We identified two similar dietary pattern characteristics (high intakes of deep fried foods, preserved or processed foods, dipping sauce, meat, sugary drinks, organ meats, jam/honey, fried rice/flour products, instant noodles and eggs) derived by PCA and RRR. Logistic regression analysis revealed that RRR-derived dietary pattern scores were positively associated with an odds ratio (OR = 1.70, 95% CI: 1.56, 1.86) of having MetS than PCA-derived dietary pattern scores (OR = 1.38, 95% CI: 1.27, 1.51). The correlations between RRR-derived dietary pattern scores and elevated systolic and diastolic blood pressure (OR = 1.30 for both) or low high density lipoprotein cholesterol in women (OR = 1.32) were statistically significant but not significant in PCA-derived dietary pattern scores. Conclusions Our findings suggest that RRR gives better results when studying behavior related dietary patterns in association with MetS. RRR may be more preferable to provide dietary information for developing dietary guidelines among people with MetS. Further studies with prospective measurements are needed to verify whether RRR is a useful analytic tool for the association between dietary patterns and other chronic diseases.

ACS Style

Adi Lukas Kurniawan; Chien-Yeh Hsu; Hsiu-An Lee; Hsiao-Hsien Rau; Rathi Paramastri; Ahmad Syauqy; Jane C.-J. Chao. Comparing two methods for deriving dietary patterns associated with risk of metabolic syndrome among middle-aged and elderly Taiwanese adults with impaired kidney function. BMC Medical Research Methodology 2020, 20, 1 -12.

AMA Style

Adi Lukas Kurniawan, Chien-Yeh Hsu, Hsiu-An Lee, Hsiao-Hsien Rau, Rathi Paramastri, Ahmad Syauqy, Jane C.-J. Chao. Comparing two methods for deriving dietary patterns associated with risk of metabolic syndrome among middle-aged and elderly Taiwanese adults with impaired kidney function. BMC Medical Research Methodology. 2020; 20 (1):1-12.

Chicago/Turabian Style

Adi Lukas Kurniawan; Chien-Yeh Hsu; Hsiu-An Lee; Hsiao-Hsien Rau; Rathi Paramastri; Ahmad Syauqy; Jane C.-J. Chao. 2020. "Comparing two methods for deriving dietary patterns associated with risk of metabolic syndrome among middle-aged and elderly Taiwanese adults with impaired kidney function." BMC Medical Research Methodology 20, no. 1: 1-12.

Journal article
Published: 09 June 2020 in Journal of Medical Internet Research
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Background Personal health record (PHR) security, correctness, and protection are essential for health and medical services. Blockchain architecture can provide efficient data retrieval and security requirements. Exchangeable PHRs and the self-management of patient health can offer many benefits to traditional medical services by allowing people to manage their own health records for disease prevention, prediction, and control while reducing resource burdens on the health care infrastructure and improving population health and quality of life. Objective This study aimed to build a blockchain-based architecture for an international health record exchange platform to ensure health record confidentiality, integrity, and availability for health management and used Health Level 7 Fast Healthcare Interoperability Resource international standards as the data format that could allow international, cross-institutional, and patient/doctor exchanges of PHRs. Methods The PHR architecture in this study comprised 2 main components. The first component was the PHR management platform, on which users could upload PHRs, view their record content, authorize PHR exchanges with doctors or other medical health care providers, and check their block information. When a PHR was uploaded, the hash value of the PHR would be calculated by the SHA-256 algorithm and the PHR would be encrypted by the Rivest-Shamir-Adleman encryption mechanism before being transferred to a secure database. The second component was the blockchain exchange architecture, which was based on Ethereum to create a private chain. Proof of authority, which delivers transactions through a consensus mechanism based on identity, was used for consensus. The hash value was calculated based on the previous hash value, block content, and timestamp by a hash function. Results The PHR blockchain architecture constructed in this study is an effective method for the management and utilization of PHRs. The platform has been deployed in Southeast Asian countries via the Asia eHealth Information Network (AeHIN) and has become the first PHR management platform for cross-region medical data exchange. Conclusions Some systems have shown that blockchain technology has great potential for electronic health record applications. This study combined different types of data storage modes to effectively solve the problems of PHR data security, storage, and transmission and proposed a hybrid blockchain and data security approach to enable effective international PHR exchange. By partnering with the AeHIN and making use of the network’s regional reach and expert pool, the platform could be deployed and promoted successfully. In the future, the PHR platform could be utilized for the purpose of precision and individual medicine in a cross-country manner because of the platform’s provision of a secure and efficient PHR sharing and management architecture, making it a reasonable base for future data collection sources and the data analytics needed for precision medicine.

ACS Style

Hsiu-An Lee; Hsin-Hua Kung; Jai Ganesh Udayasankaran; Boonchai Kijsanayotin; Alvin B Marcelo; Louis R Chao; Chien-Yeh Hsu. An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study. Journal of Medical Internet Research 2020, 22, e16748 .

AMA Style

Hsiu-An Lee, Hsin-Hua Kung, Jai Ganesh Udayasankaran, Boonchai Kijsanayotin, Alvin B Marcelo, Louis R Chao, Chien-Yeh Hsu. An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study. Journal of Medical Internet Research. 2020; 22 (6):e16748.

Chicago/Turabian Style

Hsiu-An Lee; Hsin-Hua Kung; Jai Ganesh Udayasankaran; Boonchai Kijsanayotin; Alvin B Marcelo; Louis R Chao; Chien-Yeh Hsu. 2020. "An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study." Journal of Medical Internet Research 22, no. 6: e16748.

Preprint content
Published: 26 May 2020
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BACKGROUND COVID-19 has affected more than 180 countries and is the first known pandemic to be caused by a new virus. COVID-19’s emergence and rapid spread is a global public health and economic crisis. However, investigations into the disease, patient-tracking mechanisms, and case report transmissions are both labor-intensive and slow. OBJECTIVE The pandemic has overwhelmed health care systems, forcing hospitals and medical facilities to find effective ways to share data. This study aims to design a global infectious disease surveillance and case tracking system that can facilitate the detection and control of COVID-19. METHODS The International Patient Summary (IPS; an electronic health record that contains essential health care information about a patient) was used. The IPS was designed to support the used case scenario for unplanned cross-border care. The design, scope, utility, and potential for reuse of the IPS for unplanned cross-border care make it suitable for situations like COVID-19. The Fast Healthcare Interoperability Resources confirmed that IPS data, which includes symptoms, therapies, medications, and laboratory data, can be efficiently transferred and exchanged on the system for easy access by physicians. To protect privacy, patient data are deidentified. All systems are protected by blockchain architecture, including data encryption, validation, and exchange of records. RESULTS To achieve worldwide COVID-19 surveillance, a global infectious disease information exchange must be enacted. The COVID-19 surveillance system was designed based on blockchain architecture. The IPS was used to exchange case study information among physicians. After being verified, physicians can upload IPS files and receive IPS data from other global cases. The system includes a daily IPS uploading and enhancement plan, which covers real-time uploading through the interoperation of the clinic system, with the module based on the Open Application Programming Interface architecture. Through the treatment of different cases, drug treatments, and the exchange of treatment results, the disease spread can be controlled, and treatment methods can be funded. In the Infectious Disease Case Tracking module, we can track the moving paths of infectious disease cases. The location information recorded in the blockchain is used to check the locations of different cases. The Case Tracking module was established for the Centers for Disease Control and Prevention to track cases and prevent disease spread. CONCLUSIONS We created the IPS of infectious diseases for physicians treating patients with COVID-19. Our system can help health authorities respond quickly to the transmission and spread of unknown diseases, and provides a system for information retrieval on disease transmission. In addition, this system can help researchers form trials and analyze data from different countries. A common forum to facilitate the mutual sharing of experiences, best practices, therapies, useful medications, and clinical intervention outcomes from research in various countries could help control an unknown virus. This system could be an effective tool for global collaboration in evidence-based efforts to fight COVID-19.

ACS Style

Hsiu-An Lee; Hsin-Hua Kung; Yuarn-Jang Lee; Jane C-J Chao; Jai Ganesh Udayasankaran; Hueng-Chuen Fan; Kwok-Keung Ng; Yu-Kang Chang; Boonchai Kijsanayotin; Alvin B Marcelo; Chien-Yeh Hsu. Global Infectious Disease Surveillance and Case Tracking System for COVID-19: Development Study (Preprint). 2020, 1 .

AMA Style

Hsiu-An Lee, Hsin-Hua Kung, Yuarn-Jang Lee, Jane C-J Chao, Jai Ganesh Udayasankaran, Hueng-Chuen Fan, Kwok-Keung Ng, Yu-Kang Chang, Boonchai Kijsanayotin, Alvin B Marcelo, Chien-Yeh Hsu. Global Infectious Disease Surveillance and Case Tracking System for COVID-19: Development Study (Preprint). . 2020; ():1.

Chicago/Turabian Style

Hsiu-An Lee; Hsin-Hua Kung; Yuarn-Jang Lee; Jane C-J Chao; Jai Ganesh Udayasankaran; Hueng-Chuen Fan; Kwok-Keung Ng; Yu-Kang Chang; Boonchai Kijsanayotin; Alvin B Marcelo; Chien-Yeh Hsu. 2020. "Global Infectious Disease Surveillance and Case Tracking System for COVID-19: Development Study (Preprint)." , no. : 1.

Preprint
Published: 21 October 2019
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BACKGROUND Personal health record (PHR) security, correctness, and protection are essential for health and medical services. Blockchain architecture can provide efficient data retrieval and security requirements. Exchangeable PHRs and the self-management of patient health can offer many benefits to traditional medical services by allowing people to manage their own health records for disease prevention, prediction, and control while reducing resource burdens on the health care infrastructure and improving population health and quality of life. OBJECTIVE This study aimed to build a blockchain-based architecture for an international health record exchange platform to ensure health record confidentiality, integrity, and availability for health management and used Health Level 7 Fast Healthcare Interoperability Resource international standards as the data format that could allow international, cross-institutional, and patient/doctor exchanges of PHRs. METHODS The PHR architecture in this study comprised 2 main components. The first component was the PHR management platform, on which users could upload PHRs, view their record content, authorize PHR exchanges with doctors or other medical health care providers, and check their block information. When a PHR was uploaded, the hash value of the PHR would be calculated by the SHA-256 algorithm and the PHR would be encrypted by the Rivest-Shamir-Adleman encryption mechanism before being transferred to a secure database. The second component was the blockchain exchange architecture, which was based on Ethereum to create a private chain. Proof of authority, which delivers transactions through a consensus mechanism based on identity, was used for consensus. The hash value was calculated based on the previous hash value, block content, and timestamp by a hash function. RESULTS The PHR blockchain architecture constructed in this study is an effective method for the management and utilization of PHRs. The platform has been deployed in Southeast Asian countries via the Asia eHealth Information Network (AeHIN) and has become the first PHR management platform for cross-region medical data exchange. CONCLUSIONS Some systems have shown that blockchain technology has great potential for electronic health record applications. This study combined different types of data storage modes to effectively solve the problems of PHR data security, storage, and transmission and proposed a hybrid blockchain and data security approach to enable effective international PHR exchange. By partnering with the AeHIN and making use of the network’s regional reach and expert pool, the platform could be deployed and promoted successfully. In the future, the PHR platform could be utilized for the purpose of precision and individual medicine in a cross-country manner because of the platform’s provision of a secure and efficient PHR sharing and management architecture, making it a reasonable base for future data collection sources and the data analytics needed for precision medicine.

ACS Style

Hsiu-An Lee; Hsin-Hua Kung; Jai Ganesh Udayasankaran; Boonchai Kijsanayotin; Alvin B. Marcelo; Louis R. Chao; Chien-Yeh Hsu. An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study (Preprint). 2019, 1 .

AMA Style

Hsiu-An Lee, Hsin-Hua Kung, Jai Ganesh Udayasankaran, Boonchai Kijsanayotin, Alvin B. Marcelo, Louis R. Chao, Chien-Yeh Hsu. An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study (Preprint). . 2019; ():1.

Chicago/Turabian Style

Hsiu-An Lee; Hsin-Hua Kung; Jai Ganesh Udayasankaran; Boonchai Kijsanayotin; Alvin B. Marcelo; Louis R. Chao; Chien-Yeh Hsu. 2019. "An Architecture and Management Platform for Blockchain-Based Personal Health Record Exchange: Development and Usability Study (Preprint)." , no. : 1.

Journal article
Published: 14 April 2019 in Nutrients
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Dietary patterns have been proposed to be related to dyslipidemia and hyperglycemia. This study investigated the correlation of dietary patterns with components of dyslipidemia and fasting plasma glucose (FPG) among young and middle-aged adults (aged between 20 and 50 years) with dyslipidemia and abnormal FPG in Taiwan. This cross-sectional study used the database compiled in Taiwan between 2001 to 2010. A total of 13,609 subjects aged between 20 and 50 years were selected. Dyslipidemia was defined primarily according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with minor modification. Elevated FPG level was defined according to the American Diabetes Association. The factor analysis was conducted to identify three dietary patterns. Higher scores of the meat-convenience dietary pattern (high intake of deep-fried and processed food, sauces, sugar-added beverages, meat and organ meats, instant noodles, rice or flour cooked in oil, and eggs) had no association with components of dyslipidemia and abnormal FPG. Higher scores of the vegetables-fruits-seafood dietary pattern (high intake of vegetables, vegetables with oil or dressing, fruits, seafood, legumes, soy products, and rice or flour products) was inversely associated with hypercholesterolemia and positively associated with hyperglycemia. Higher scores of the dairy-complex carbohydrate dietary pattern (high intake of dairy products, milk, root crops, jam or honey, and whole grains) was inversely correlated with hypertriglycemia and low high-density lipoprotein cholesterol level. Our results support that the dietary pattern may have a role in the prevention and management of dyslipidemia and abnormal fasting plasma glucose.

ACS Style

Li-Yin Lin; Chien-Yeh Hsu; Hsiu-An Lee; Wan-Hsiang Wang; Adi Lukas Kurniawan; Jane C.-J. Chao. Dietary Patterns in Relation to Components of Dyslipidemia and Fasting Plasma Glucose in Adults with Dyslipidemia and Elevated Fasting Plasma Glucose in Taiwan. Nutrients 2019, 11, 845 .

AMA Style

Li-Yin Lin, Chien-Yeh Hsu, Hsiu-An Lee, Wan-Hsiang Wang, Adi Lukas Kurniawan, Jane C.-J. Chao. Dietary Patterns in Relation to Components of Dyslipidemia and Fasting Plasma Glucose in Adults with Dyslipidemia and Elevated Fasting Plasma Glucose in Taiwan. Nutrients. 2019; 11 (4):845.

Chicago/Turabian Style

Li-Yin Lin; Chien-Yeh Hsu; Hsiu-An Lee; Wan-Hsiang Wang; Adi Lukas Kurniawan; Jane C.-J. Chao. 2019. "Dietary Patterns in Relation to Components of Dyslipidemia and Fasting Plasma Glucose in Adults with Dyslipidemia and Elevated Fasting Plasma Glucose in Taiwan." Nutrients 11, no. 4: 845.