Chen-Yang Hsu

National Taiwan University

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Chien‐Jen Chen

National Taiwan University

Han‐Mo Chiu

National Taiwan University Hospital

Yi‐Kung Lee

Tzu Chi University

Amy Ming‐Fang Yen

Taipei Medical University

Yung‐Cheng Su

Tzu Chi University

Yi‐Chia Lee

National Taiwan University

Ming‐Shiang Wu

National Taiwan University Hospital

Yen‐Po Yeh

Changhua County Public Health Bureau

Wen‐Feng Hsu

National Taiwan University

Ming-Yuan Huang

Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University

Cooperative Institutions

National Taiwan University

National Yang Ming Chiao Tung University

National Taiwan University Hospital

Chang Gung University

Taipei Medical University

Ministry of Health and Welfare

National Cheng Kung University

Taipei City Hospital

Kaohsiung Chang Gung Memorial Hospital

Fu Jen Catholic University

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Easing social distancing index after COVID-19 pandemic

medRxiv (Cold Spring Harbor Laboratory) (2020)

Sam Li‐Sheng Chen Amy Ming‐Fang Yen Chao-Chih Lai Chen-Yang Hsu Chien‐Jen Chen

Abstract Context Easing social distancing (ESD) is a global public health issue in post-pandemic period of COVID-19 and requires a simple index for real time assessment. Objective We aimed to develop a simple index for ESD to quantify the impacts of social distancing for reducing confirmed infected cases, optimal triage and care of patients for recovery, and critical care capacity for reducing death from COVID-19. Design, Setting, and Participants Data on the retrospective cohort of 185 countries with reported numbers on confirmed cases, recovery, and death from COVID-19 were retrieved from publicity available repository. Up to May 31, a total of 5,844,136 confirmed cases, 2,639,961 recovered, and 327,487 deaths were reported globally. Main Outcome Measures The ESD index measured by cumulative number of COVID-19 cases and recovery and case-fatality rate. Results We developed a simple index for the guidance of easing social distancing (ESD). If the ESD index is less than 1, ESD would be considered. The global ESD index declined from 3.87 at peak in March to 1.35 by the end of May, consisting of 56.76% countries/regions (105/185) with the ESD lower than one. Conclusion and Relevance This simple ESD index provides a quantitative assessment on whether and when to ease social distancing from local to global community.

Social distance

Case fatality rate

Pandemic

Triage

10.1101/2020.06.11.20128165

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Association of Ambient Fine Particulate Matter (PM_2.5) with Elevated Fecal Hemoglobin Concentration and Colorectal Carcinogenesis: A Population-Based Retrospective Cohort Study

Cancer Control (2021)

Mei-Sheng Ku Chen-Yu Liu Chen-Yang Hsu Han‐Mo Chiu Chien‐Jen Chen

The roles of ambient fine particulate matter (PM 2.5 ) in the prevention of colorectal cancer (CRC) have been scarcely highlighted as there is short of empirical evidence regarding the influences of PM 2.5 on multistep carcinogenic processes of CRC. A retrospective cohort design with multistate outcomes was envisaged by linking monthly average PM 2.5 concentrations at 22 city/county level with large-scale cohorts of cancer-screened population to study the influences of PM 2.5 on short-term inflammatory process and multistep carcinogenic processes of CRC. Our study included a nationwide CRC screening cohort of 4,628,995 aged 50–69 years who attended first screen between 2004 and 2009 and continued periodical screens until 2016. We aimed to illustrate the carcinogenesis of PM 2.5 related to CRC by applying both hierarchical logistical and multistate Markov regression models to estimate the effects of air pollution on fecal immunochemical test (FIT) positive (a proxy of inflammatory marker) and pre-clinical and clinical states of CRC in the nationwide cohort. We found a significant association of high PM 2.5 exposure and FIT-positive by an increased risk of 11% [95% confidence interval (CI), 10–12]. PM 2.5 enhanced the risk of being preclinical state by 14% (95% CI, 10–18) and that of subsequent progression from pre-clinical to clinical state by 21% (95% CI, 14–28). Furthermore, the elevated risks for CRC carcinogenesis were significantly higher for people living in high PM 2.5 pollution areas in terms of yearly averages and the number days above 35 µg/m 3 than those living in low PM 2.5 pollution areas. We concluded that both short-term and long-term PM 2.5 exposure were associated with multistep progression of CRC, which were useful to design precision primary and secondary prevention strategies of CRC for people who are exposed to high PM 2.5 pollution.

10.1177/10732748211041232

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Increased risk of ischemic stroke in patients with mild traumatic brain injury: a nationwide cohort study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine (2014)

Yi‐Kung Lee Chen-Wen Lee Ming-Yuan Huang Chen-Yang Hsu Yung‐Cheng Su

It is known that the risk of stroke in patients with traumatic brain injury might be increased. However, the relationship between mild traumatic brain injury and ischemic stroke has never been established. We conducted a study of patients in Taiwan with mild traumatic brain injury to evaluate if they had a higher risk of stroke compared with the general population. We utilized a sampled National Health Insurance claims database containing one million beneficiaries. We followed all adult beneficiaries older than 18 years from January 1, 2007 to December 31, 2010 to determine if they were diagnosed with ischemic stroke. We further identified patients with mild traumatic brain injury and compared their risk of ischemic stroke with the general population. We identified 24,905 patients with mild traumatic brain injury and 719,811 patients without mild traumatic brain injury. After controlling for age, gender, urbanization level, socioeconomic status, diabetes, hypertension, coronary artery disease, hyperlipidemia, history of alcohol intoxication, malignancies, heart failure, atrial fibrillation, smoking, obesity, epilepsy, peripheral artery disease and Charlson Comorbidity Index score, the adjusted hazard ratio for ischemic stroke was 1.46 (95% confidence interval, 1.33—1.62). Mild traumatic brain injury is an independent significant risk factor for ischemic stroke.

Stroke

10.1186/s13049-014-0066-y

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A New Approach to Modelling Pre-symptomatic Incidence and Transmission Time of SARS-CoV-2 Variants

Research Square (Research Square) (2022)

Sam Li‐Sheng Chen Hsiao-Hsuan Jen Chen-Yang Hsu Amy Ming‐Fang Yen Chao-Chih Lai

Abstract We applied a four-state stochastic process to decipher the natural infectious process of SARS-CoV-2 superimposed with the disease axis of pre-symptomatic, asymptomatic, and symptomatic states. So doing provides new insights into how pre-symptomatic transmission and the proportion of asymptomatic cases have been affected by SARS-CoV-2 variants, NPIs, and vaccination. We fitted the proposed model to empirical data on imported COVID-19 cases from D614G to Omicron between March 2020 and Jan 2022 in Taiwan. The pre-symptomatic incidence rate was the highest for Omicron followed by Alpha, Delta, and D614G. The median pre-symptomatic transmission time (MPTT) (in days) increased from 3.45 (first period) ~ 4.02(second period) of D614G until 3.94 ~ 4.65 of VOC Alpha before vaccination but dropped to 3.93 ~ 3.49 of Delta and 2 days (only first period) of Omicron after vaccination. The MPTT of the second re-surge was longer than the first surge for each variant before vaccination but this phenomenon disappeared for Delta after vaccination. The proportion of asymptomatic cases increased from 29% of D-614G period to 59.2% of Omicron. Modelling pre-symptomatic incidence and transmission time evolving with SARS-CoV-2 variants throws light on the underlying natural infectious properties of variants and also reveals how their properties are affected by vaccination and NPIs.

10.21203/rs.3.rs-1561446/v1

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410 TEMPORAL CHANGE OF T1N1 STAGE III COLORECTAL CANCER IN THE CONTEXT OF FECAL IMMUNOCHEMICAL TEST-BASED COLORECTAL CANCER SCREENING PROGRAM IMPLEMENTATION AND ITS POTENTIAL IMPACT ON SCREENING EFFECTIVENESS

Gastroenterology (2024)

Han‐Mo Chiu Chiu‐Wen Su Wen‐Feng Hsu Chun‐Ju Chiang Sam L. Chen

Colorectal cancer screening

10.1016/s0016-5085(24)00718-2

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Additional file 1: of Quantile-based fecal hemoglobin concentration for assessing colorectal neoplasms with 1,263,717 Taiwanese screenees

Szu-Min Peng Han-Mo Chiu Hsiao-Hsuan Jen Chen-Yang Hsu Sam Chen

Supplementary materials containing the detailed methodology of Bayesian inverse method, one appendix figure, and five appendix tables were included in the supplementary file. (DOCX 358 kb)

Quantile

10.6084/m9.figshare.8073110.v1

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Increased risk of ischemic stroke in patients with burn injury: a nationwide cohort study in Taiwan

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine (2016)

Tzu‐Yao Hung Yi‐Kung Lee Ming-Yuan Huang Chen-Yang Hsu Yung‐Cheng Su

Conflicting results have been obtained by studies attempting to assess the risks of ischemic stroke in patients with burn injury, while the long-term risk of stroke in survivors of burn injury remains unexplored. We evaluated whether the risk of ischemic stroke in patients hospitalized with burn injury in Taiwan is higher when compared to the general population. The data from one million National Health Insurance (NHI) adult beneficiaries were evaluated from January 1, 2005 until December 31, 2012 to identify those who developed ischemic stroke. Each identified patient with burn injury was matched with one hundred unexposed patients based on a high-dimensional propensity score. Cox regression models were applied to compare the risks of the development of ischemic stroke in the matched cohorts. A total of 743,237 patients were enrolled. After matching, 1,763 burn injury patients and 176,300 unexposed patients were selected and compared. The adjusted hazard ratio of ischemic stroke was significantly increased in burn injury patients (1.84; 95 % CI, 1.43–2.36). A subgroup analysis based on patients who survived longer than 12 months in the matched cohort also revealed higher hazard ratio in the burn injury patients (1.54; 95 % CI, 1.11–2.13). The risk of ischemic stroke is significantly higher in patients hospitalized with burn injury than in the general population, and these risks may extend longer than expected.

Stroke

10.1186/s13049-016-0236-1

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Advancing screening tool for hospice needs and end-of-life decision-making process in the emergency department

BMC Palliative Care (2024)

Yujing Wang Chen-Yang Hsu Amy Ming‐Fang Yen Chien‐Jen Chen Chao-Chih Lai

Abstract Background Predicting mortality in the emergency department (ED) is imperative to guide palliative care and end-of-life decisions. However, the clinical usefulness of utilizing the existing screening tools still leaves something to be desired. Methods We advanced the screening tool with the A-qCPR (Age, qSOFA (quick sepsis-related organ failure assessment), cancer, Performance Status Scale, and DNR (Do-Not-Resuscitate) risk score model for predicting one-year mortality in the emergency department of Taipei City Hospital of Taiwan with the potential of hospice need and evaluated its performance compared with the existing screening model. We adopted a large retrospective cohort in conjunction with in-time (the trained and the holdout validation cohort) for the development of the A-qCPR model and out-of-time validation sample for external validation and model robustness to variation with the calendar year. Results A total of 10,474 patients were enrolled in the training cohort and 33,182 patients for external validation. Significant risk scores included age (0.05 per year), qSOFA ≥ 2 (4), Cancer (5), Eastern Cooperative Oncology Group (ECOG) Performance Status score ≥ 2 (2), and DNR status (2). One-year mortality rates were 13.6% for low (score ≦ 3 points), 29.9% for medium (3 < Score ≦ 9 points), and 47.1% for high categories (Score > 9 points). The AUROC curve for the in-time validation sample was 0.76 (0.74–0.78). However, the corresponding figure was slightly shrunk to 0.69 (0.69–0.70) based on out-of-time validation. The accuracy with our newly developed A-qCPR model was better than those existing tools including 0.57 (0.56–0.57) by using SQ (surprise question), 0.54 (0.54–0.54) by using qSOFA, and 0.59 (0.59–0.59) by using ECOG performance status score. Applying the A-qCPR model to emergency departments since 2017 has led to a year-on-year increase in the proportion of patients or their families signing DNR documents, which had not been affected by the COVID-19 pandemic. Conclusions The A-qCPR model is not only effective in predicting one-year mortality but also in identifying hospice needs. Advancing the screening tool that has been widely used for hospice in various scenarios is particularly helpful for facilitating the end-of-life decision-making process in the ED.

End-of-Life Care

Performance status

10.1186/s12904-024-01391-w

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Incidence, Prevalence, and Duration of Chronic Kidney Disease in Taiwan: Results from a Community-Based Screening Program of 106,094 Individuals

The Nephron journals/Nephron journals (2018)

Ming‐Hsien Tsai Chen-Yang Hsu Ming‐Yen Lin Ming‐Fang Yen Chien‐Jen Chen

Taiwan has the highest incidence of end-stage renal disease, which requires renal replacement therapy. Chronic kidney disease (CKD) contributes to this burden. However, the current data on the epidemiologic features of CKD in Taiwan are incomplete. Therefore, we aimed to investigate the prevalence and incidence of CKD in a population-based study and then estimate the average dwelling time (ADT) in the main clinical burden of CKD (stages 3-5).A prospective cohort study was designed with an integrated community-based multiple screening program of 106,094 individuals aged ≥20 years in Keelung, Taiwan, in 1999-2009. Prevalence was estimated as the percentage of CKD stages among individuals attending the first screening, and incidence was expressed as the ratio of total desired events in the following period to the total observational time. Finally, ADT was estimated from the ratio of prevalence to incidence.The participants' mean age was 47.7 ± 15.4 years. The estimated prevalence was 15.46% for total CKD and 9.06% for CKD stages 3-5. The incidence was 27.21/1,000 person-years (PY) for total CKD and 16.89/1,000-PY for CKD stages 3-5. Older patients, males, and those patients with comorbidities of diabetes mellitus (DM), hypertension, and metabolic syndrome (MetS) exhibited higher prevalence and incidence rates than their opposing counterparts. Moreover, the ADT of CKD stages 3-5 was 5.37 years (95% CI 5.17-5.57). Males and those with comorbidities of DM or MetS had shorter ADTs in CKD stages 3-5 than their opposing counterparts. Interestingly, the ADT of participants with hypertension was longer than those without.The prevalence and incidence of CKD in Taiwan are high. Moreover, ADT in CKD stages 3-5 varied according to sex, age, and comorbidity. Further exploration of the factors associated with the shifting of this duration will shed light on effective CKD management.

Renal replacement therapy

10.1159/000491708

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The Effect of Nationwide Colorectal Cancer Screening on Colorectal Cancer Incidence and Mortality: A 30-Year Chronological Study

Gastroenterology (2017)

Yi‐Chia Lee Chen-Yang Hsu Tsung‐Hsien Chiang Chu‐Kuang Chou Han‐Mo Chiu

Cancer Incidence

Colorectal cancer screening

10.1016/s0016-5085(17)30599-1

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