Hung Yi Chiou

• Taipei Medical University Hospital

Objective To investigate the levels of anxiety and depression (A&D) and the association with knowledge, attitudes, and practices among healthcare professionals (HCPs) in Taiwan, Indonesia, and Vietnam. Methods A multinational cross-sectional survey was performed to collect data from 3,556 HCPs through online platforms. The Likert scale questionnai...

This time-stratified case-crossover study evaluated the association between short-term exposure to ambient air pollution and psoriasis. A total of 107 462 psoriasis cases between 2002 and 2016 were retrieved from Taiwan’s National Health Insurance Research Database. Conditional logistic regression was used to estimate the association between air po...

Background The global aging population poses critical challenges for long-term care (LTC), including workforce shortages, escalating health care costs, and increasing demand for high-quality care. Integrating artificial intelligence (AI), the Internet of Things (IoT), and edge intelligence (EI) offers transformative potential to enhance care qualit...

Purpose Autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and cerebral palsy (CP) are neurodevelopmental disorders that impose lasting burdens on families. Birth order and sibling presence may influence neurodevelopmental risks, providing critical insights for early intervention and public health policies. Method This...

Background and Purpose Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking.Methods This study used data from patients aged ≥20 years who underw...

The COVID-19 pandemic may have impacted disabilities among people living with HIV; however, data on the association between COVID-19 pandemic-related healthcare disruptions and disabilities among people living with HIV is limited. We aimed to evaluate the association between COVID-19-affected HIV care behaviors and disability domains among people l...

The need for home healthcare (HHC) is increasing among people living with dementia (PLWD) to achieve their desire to age. This study aimed to investigate the determinants of hospitalization among PLWD receiving HHC. This retrospective cohort study used data from the National Health Insurance Research Database of Taiwan from 2007 to 2017. The primar...

Background and Purpose: As populations age, there is an increasing need to optimize endovascular treatment (EVT) for acute ischemic stroke. We harmonized prospective stroke registries from Korea and Taiwan to enable direct comparisons of patient characteristics and clinical outcomes, with a particular focus on the impact of advanced age. Methods: P...

Background and Objectives: Misconceptions of and cultural differences in aging influence older adults' medical decision-making self-efficacy and engagement in advance care planning (ACP). This study aims to investigate the association between current medical decision-making participation self-efficacy and ACP engagement among older individuals rece...

An association between pituitary gland disorders and breast cancer remains controversial. We examined the prevalence and risk of breast cancer over a 15-year follow-up period or until diagnosed as breast cancer among premenopausal women (12–49 years old) with pituitary gland disorders in Taiwan. This retrospective matched-cohort study included 52,2...

Purpose Adolescent and young adult (AYA) patients with breast cancer generally have poor prognoses and a higher risk of secondary cancers compared to those at the same cancer stage. Notably, AYA patients in Asia exhibit a higher incidence rate of breast cancer, with Luminal A as the predominant molecular subtype, which contrasts with the trends obs...

Background: The Supportive and Palliative Care Indicators Tool (SPICT) was developed for identifying, in a timely manner, patients who may benefit from supportive and palliative care for better treatment review, care-plan discussion, and end-of-life care. Although the SPICT has been validated in different languages and for patients living in differ...

Aims/Introduction This study aimed to identify low‐ and high‐risk diabetes groups within prediabetes populations using data from the Taiwan Biobank (TWB) and UK Biobank (UKB) through a clustering‐based Unsupervised Learning (UL) approach, to inform targeted type 2 diabetes (T2D) interventions. Materials and Methods Data from TWB and UKB, comprisin...

Objective: Kidney failure manifests in various forms, from sudden occurrences such as Acute Kidney Injury (AKI) to progressive like Chronic Kidney Disease (CKD). Given its intricate nature, marked by overlapping comorbidities and clinical similarities—including treatment modalities like dialysis—we sought to design and validate an end-to-end framew...

The Supportive and Palliative Indicators Tool (SPICT) was developed for timely identifying patients who may benefit from supportive and palliative care for a better treatment review, care plan discussion, and end-of-life care. Although the SPICT has been validated in different languages and patients living in different settings, it has not been val...

Background An ageing population has heightened the need for long-term care (LTC) access. It is not well understood how information sources, both formal and informal, impact the utilisation of LTC. This study aims to investigate the influence of formal and informal sources on the utilisation of LTC services by Taiwanese families employing migrant li...

Despite recent findings indicating a paradoxical association between high-density lipoprotein cholesterol (HDL-C) levels and cardiovascular disease (CVD) mortality, the impact of HDL-C on subsequent outcomes after ischemic stroke remains unclear. The study aims to investigate the relationships between HDL-C levels and post-stroke functional outcome...

Background Quantifying the informal caregiver burden is important for understanding the risk factors associated with caregiver overload and for evaluating the effectiveness of services provided in Long-term Care (LTC). Objective This study aimed to develop and validate a Caregiver Strain Index (CSI)-based score for quantifying the informal caregiv...

Type 2 Diabetes (T2D) is a complex, multifactorial disease with a significant global health burden. Genome-Wide Association Studies (GWAS) have identified numerous genetic variants associated with T2D, yet understanding their functional mechanisms remains challenging due to the polygenic nature of the disease and the prevalence of non-coding region...

Background Hyperglycemia affects the outcomes of endovascular therapy (EVT) for acute ischemic stroke (AIS). This study compares the predictive ability of diabetes status and glucose measures on EVT outcomes using nationwide registry data. Methods The study included 1,097 AIS patients who underwent EVT from the Taiwan Registry of Endovascular Thro...

Objective Early diagnosis and treatment of nasopharyngeal carcinoma (NPC) are vital for a better prognosis. Still, because of obscure anatomical sites and insidious symptoms, nearly 80% of patients with NPC are diagnosed at a late stage. This study aimed to validate a machine learning (ML) model utilizing symptom‐related diagnoses and procedures in...

Background Taiwan was a coronavirus disease 2019 (COVID-19) outlier, with an extraordinarily long transmission-free record: 253 days without locally transmitted infections while the rest of the world battled wave after wave of infection. The appearance of the alpha variant in May 2021, closely followed by the delta variant, disrupted this transmiss...

BACKGROUND Timely intravenous thrombolysis and endovascular thrombectomy are the standard reperfusion treatments for large vessel occlusion stroke. Currently, it is unknown whether a low-dose thrombolytic agent (0.6 mg/kg alteplase) can offer similar efficacy to the standard dose (0.9 mg/kg alteplase). METHODS We enrolled consecutive patients in t...

BACKGROUND The global aging population poses critical challenges for long-term care (LTC), including workforce shortages, escalating health care costs, and increasing demand for high-quality care. Integrating artificial intelligence (AI), the Internet of Things (IoT), and edge intelligence (EI) offers transformative potential to enhance care qualit...

Objective Clinical evidence has shown that carotid intima-media thickness (CIMT) is a robust biomarker for determining the thickness of atherosclerosis, which in turn increases the risk of cardiovascular disease (CVD). Additionally, diabetes mellitus (DM) is linked to the acceleration of atherosclerosis. Thus, as measured by carotid ultrasound (US)...

Introduction The COVID-19 pandemic occurred in several waves with different levels of seriousness. Healthcare personnel (HCP) constituted a high-risk population for COVID-19, necessitating monitoring of their knowledge, attitudes, and practices (KAP) status and level of psychological distress. This study investigated differences in the impacts of C...

Type 2 diabetes (T2D) and hypertension are common comorbidities and, along with hyperlipidemia, serve as risk factors for cardiovascular diseases. This study aimed to evaluate the predictive value of polygenic risk scores (PRSs) on cardiometabolic traits related to T2D, hypertension, and hyperlipidemia and the incidence of these three diseases in T...

With the increase in the aging population, informal caregivers have become an essential pillar for the long-term care of older individuals. However, providing care can have a negative impact and increase the burden on caregivers, which is a cause for concern. This study aimed to comprehensively depict the concept of “informal caregiver burden” thro...

Before vaccines were introduced, mobility restriction was one of the primary control measures in the early stage of the coronavirus disease 2019 (COVID-19) pandemic. Because different age groups face disproportionate health risks, differences in their mobility changes affect the effectiveness of pandemic control measures. This study aimed to invest...

Background: The COVID-19 pandemic has disrupted rehabilitation services, with potential implications for the well-being of rehabilitation specialists. This study investigates the impact of service volume reduction during the pandemic on the mental health, general health, and quality of life of these professionals. Methods: A national survey conduct...

Background Arsenic exposure can cause adverse health effects. The effects of long-term low-to-moderate exposure and methylations remain unclear. Objective This study aims to examine the association between low-to-moderate arsenic exposure and urothelial tract cancers while considering the effects of methylation capacity. Methods In this study, 5,...

Background: Long-term care (LTC) service demands among cancer patients are significantly understudied, leading to gaps in healthcare resource allocation and policymaking. Objective: This study aimed to predict LTC service demands for cancer patients and identify the crucial factors. Methods: 3333 cases of cancers were included. We further deve...

Background Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide. Objective The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at di...

Background Endovascular thrombectomy (EVT) is the standard therapy for patients with acute ischemic stroke secondary to large‐artery occlusion. In January 2019, the Taiwan Stroke Society established a nationwide TREAT‐AIS (Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke). Here, we provide the study design, current progress, a...

Introduction We investigated the prevalence of undiagnosed diabetes and impaired fasting glucose (IFG) in individuals without known diabetes in Taiwan and developed a risk prediction model for identifying undiagnosed diabetes and IFG. Research design and methods Using data from a large population-based Taiwan Biobank study linked with the National...

Background The influence of recent influenza infection on perioperative outcomes is not completely understood. Method Using Taiwan’s National Health Insurance Research Data from 2008 to 2013, we conducted a surgical cohort study, which included 20,544 matched patients with a recent history of influenza and 10,272 matched patients without. The main...

People with dementia (PwD) who receive home healthcare (HHC) may have distressing symptoms, complex care needs and high mortality rates. However, there are few studies investigating the determinants of mortality in HHC recipients. To identify end-of-life care needs and tailor individualized care goals, we aim to explore the mortality rate and its d...

International students face many impediments under the COVID-19 pandemic. The objectives of this study are to assess the association between the perceptions of international students and the lockdown policy for COVID-19. In 2021, three different levels of lockdown policy were enforced, including level I from January to April, level III from May to...

Background Among Taiwanese adolescents, how the clustering of unhealthy behaviors, including insufficient physical activity, screen-based sedentary behavior and frequent sugar-sweetened beverage consumption affecting depressive symptom remains unclear. This study aims to examine the cross-sectional association between clustering of unhealthy behavi...

We examined the potential mediating roles of anxiety and loneliness on the association of concurrent food insecurity (FI) and being bullied (BB) with suicidal behavior (SB) in Eswatini, a lower-middle-income country. We used data from the Global School-based Student Health Survey (GSHS; N = 3264), which employed a two-stage cluster sampling: first,...

Background The transformation from institutionalization to community-based mental healthcare may increase the difficulty of psychiatric workforce estimation and change the role of psychiatrists in hospitals and private clinics. Methods This study aimed to estimate the growth and forecast psychiatric services in hospitals and private clinics in Tai...

Smokers of any age can reap substantial health benefits from quitting or reducing their smoking. E-cigarettes have been promoted as a potentially promising product for tobacco harm reduction because e-cigarettes deliver nicotine vapor without many of the hazardous chemical combustion byproducts produced by combustible cigarette smoking. However, th...

This modeling study considers different screening strategies, contact tracing, and the severity of novel epidemic outbreaks for various population sizes, providing insight into multinational containment effectiveness of emerging infectious diseases, prior to vaccines development. During the period of the ancestral SARS-Cov-2 virus, contact tracing...

Chronic kidney disease (CKD) has been a global public health problem with many adverse outcomes, but data are lacking regarding the relationship between air pollutants and risk of renal progression in patients with CKD. This study was to investigate whether 1-year average exposure to ambient air pollutants -CO, NO, NO2, SO2, O3, PM2.5, and PM10-is...

This study shows differences in the demand for and supply of psychiatrists in hospitals and private clinics; it also highlights the transformation from hospital-based to community-based mental healthcare in Taiwan. Our findings show that, although Taiwan had a balanced supply and demand of psychiatrists before 2020, the supply in clinics is project...

Background Evidence of associations between psychological symptoms and tumor necrosis factor (TNF)-α level is scant, as is evidence on sex differences in associations for children and adolescents with obesity. This study examined sex differences in associations between psychological symptoms (self-concept, anxiety, depression, anger, and disruptive...

BACKGROUND Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide. OBJECTIVE The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at di...

Background: Psoriatic disease is a chronic inflammatory disease that is associated with morbidity and a poor quality of life. However, studies on the trends of psoriatic disease incidence are limited. We examined trends in psoriasis and psoriatic arthritis from 2002 to 2016 in Taiwan and distinguished the effects of age, period, and cohort on thos...

The COVID-19 pandemic struck the world unguarded, some places outperformed others in COVID-19 containment. This longitudinal study considered a comparative evaluation of COVID-19 containment across 50 distinctly governed regions between March 2020 and November 2021. Our analysis distinguishes between a pre-vaccine phase (March–November 2020) and a...

Introduction Resilience refers to the ability to adapt to difficult situation or adversity. Resilience is what gives people the psychological strength to cope with stress and hardship. Previous studies have investigated the relationship between resilience and bullying victimization and mental health problems. But whether the moderating effect of re...

Smokers of any age can reap substantial health benefits from quitting or reducing their smoking. E-cigarettes have been promoted as a potentially promising product for tobacco harm reduction because e-cigarettes deliver nicotine vapor without many of the hazardous chemical combustion byproducts produced by combustible cigarette smoking. However, th...

Background Among Taiwanese adolescent, how depressive symptoms, screen use affect on substance use remains unclear. This study aimed to examine (1) the cross-sectional association between depressive symptoms, screen use and substance use ; and (2) the modified effects of sex and school type on those mentioned associations. Methods We analyzed 18,50...

Background Arsenic exposure can cause adverse health effects. The effects of long-term low-to-moderate arsenic concentrations and methylations remain unclear. Objectives This study aims to examine the association between low-to-moderate arsenic exposure and urothelial tract cancers while considering the effects of methylation capacity. Methods In t...

Introduction Post-stroke cognitive impairment (PSCI) cannot be neglected because it drastically influences the daily life of patients and their families. However, there are no studies exploring the association between preclinical blood biomarkers of neurodegeneration including plasma amyloid-β (Aβ), tau, and brain-derived neurotrophic factor (BDNF)...

Background How chronic diseases and lifestyle affect suicidal ideation in the sub-Saharan region remains unclear. We investigated the association of chronic diseases and lifestyle with suicidal ideation in the past year and the potential modifying role of sociodemographic status on this association. The findings can guide suicide prevention interve...

Background: Unfavorable prognoses are often accompanied for hyperglycemic stroke patients. This study aimed to construct a hyperglycemia/diabetes-derived polygenic risk score (PRS) to improve the predictive performance for poor outcome risks after a stroke and to evaluate its potential clinical application. Methods: A hospital-based cohort study...

Emotional eating is one factor that increases the consumption of unhealthy food. This study aimed to investigate the association between emotional eating and frequencies of consuming fast food, high-fat snacks, processed meat products, dessert foods, and sugar-sweetened beverages (SSBs) in adolescents. The baseline survey data (2015) from the Taiwa...

The induction of heme oxygenase-1 (HO-1) has been shown to have therapeutic potential in experimental models of hepatitis and liver fibrosis, which are closely related to liver cancer. In humans, HO-1 induction is transcriptionally modulated by the length of a GT-repeat [(GT)n] in the promoter region. We aimed to investigate the effect of HO-1 (GT)...

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 Medi...

Arsenic is a well-established human carcinogen and is considered a health risk worldwide, especially where groundwater is consumed as drinking water. In 2018, bladder and kidney cancers were the 14th and 17th leading causes of global cancer mortality, respectively. Our aim was to investigate the association between arsenic exposure, DNA damage, and...

Aims/hypothesis Worldwide, the information regarding the associations between long-term exposure to ozone (O3) and sulfur dioxide (SO2) and the development of type 2 diabetes remains scarce, especially in Asia. This study aimed to investigate the long-term effects of exposure to ambient O3 and SO2 on the incidence of type 2 diabetes with considerat...

Optimal stroke prevention strategies for women should take into account specific sex-related stroke risk factors. Anemia is a common medical condition in females, particularly in women of reproductive age. This study investigated whether anemia is an independent risk factor for stroke in females in a population-based cohort study. We investigated n...

Background Chronic exposure to inorganic arsenic results in many cancers in susceptible persons. The metabolism of inorganic arsenic and genomic susceptibility are thought to be associated with cancer occurrence. Material and methods This study aims to examine the interaction of genomic susceptibility markers and urinary methylation capacity indic...

Background and aim: Previous studies indicated that the HDAC3 and HDAC9 genes play critical roles in atherosclerosis and ischemic stroke (IS). The purpose of this study was to investigate the association of combined single-nucleotide polymorphisms in the HDAC3 and HDAC9 genes with the susceptibility to IS. Methods: A case-control study was condu...

Objective: To develop an easily applicable screening score to guide NOTCH3 p.R544C genetic testing for patients who presented with acute ischemic cerebrovascular events in Taiwan. Methods: 1734 patients who presented with ischemic cerebrovascular events were enrolled from the Formosa Stroke Genetic Consortium stroke registry and were screened fo...

Unstructured: Digital technology has been widely used in health care system and disease management, as well as controlling the spread of coronavirus. As one of the most successful countries in fighting against COVID-19, Taiwan successfully use digital technology to strengthen the COVID-19 epidemic prevention. Since we have a well-established Natio...

Background: The current study compared the efficacy and safety of clopidogrel vs aspirin in the secondary prevention of ischemic stroke (IS). Methods: We included patients from the Taiwan National Health Insurance Research Database who were aged between 20 and 80 years, had their first ever IS, had no diagnosis of atrial fibrillation, and had no...

Background/purpose Metabolites in blood have been found associated with the occurrence of vascular diseases, but its role in the functional recovery of stroke is unclear. The aim of this study is to investigate whether the untargeted metabolomics at the acute stage of ischemic stroke is able to predict functional recovery. Methods One hundred and...

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Background Hyperglycemia in acute stroke leads to poor neurological outcomes. The role of microRNA (miRNA) in hyperglycemia‐associated genes can provide new avenues for stroke prognostic applications. We aimed to identify novel genes and their regulated miRNAs that are associated with hyperglycemia‐induced unfavorable stroke outcomes and further va...

Background In addition to the traditional risk predictors, whether anemia is an early biomarker of dementia, needs to be confirmed. Objective This population-based cohort study aimed to investigate the dementia risk in patients with newly diagnosed anemia using data from the Taiwan National Health Insurance Research Database. Methods All newly di...

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Background: Chronic kidney disease (CKD) places a heavy burden on the healthcare system worldwide. The risk factors may vary by body adiposity. We aimed to investigate the associations of socioeconomic, environmental, and behavioral factors with CKD in different groups of body mass indexes (BMI). Methods: A case-control study was conducted in 3280...

Background Findings concerning nitric oxide (NO) in children and adolescents with obesity are scant. Objective This study examined the links of NO with obesity and psychological traits (ie, self‐concept, anxiety, depression, anger and disruptive behaviour) in children and adolescents in Taiwan. Methods A total of 564 first, fourth and seventh gra...

Objective Urticaria is a mast cell-related disease caused severe itching and the lifetime prevalence of urticaria is about 20% in general population. Our purpose is to evaluate risk of urticaria in geriatric stroke patients received influenza vaccination (IV). Methods In a cohort of 192,728 patients with newly diagnosed stroke aged over 65 years o...

Ischemic stroke (IS) is multifactorial causation combining with traditional cardiovascular disease (CVD) and genetic risk factors. Combined effects of MMP-7, MMP-8 and MMP-26 on the risk of IS remain incompletely understood. We aimed to assess individual and joint effects for IS risk by weighted genetic risk score (wGRS) from these three genes and...

Stroke is the third cause of death and the leading cause of adult disability in Taiwan. More than half of acute ischemic stroke patients had hyperglycemia, which is one of the major reason for unfavorable outcomes. However, the physiopathology is remain unclear and better knowledge of underlying genetic mechanisms is needed to improve prognosis. Th...

Background: The association between physician gender and the outcomes of stroke patients is not yet fully understood. The aim of this study was to evaluate outcomes after stroke hospitalization between patients who received female physicians’ care (FPC) vs male physicians’ care (MPC). Methods: We used Taiwan’s National Health Insurance Research Dat...

Our study aimed to establish the role of hemojuvelin (HJV) in acute ischemic stroke (AIS). We performed immunohistochemistry for HJV expression in human brain tissues from 10 AIS and 2 non-stroke autopsy subjects. Plasma HJV was measured in 112 AIS patients within 48 h after stroke. The results showed significantly increased HJV expression in brain...

Objectives: Post-stroke cognitive impairment (PSCI) is a common disease that may occur within 3 months after a stroke or even later. However, the mechanism of PSCI development is unclear. The present study investigated whether the levels of plasma amyloid beta-42 (Aβ42) and tau are associated with the onset of PSCI. Methods: Fifty-five patients adm...

Introduction This study aims to analyse the non-tax-induced price increasing strategies adopted by tobacco industry in Taiwan, a high-income country with comprehensive tobacco control policies but low tobacco taxes and a declining cigarette market. Methods Using governmental tax, price and inflation data, we analysed cigarette sales volume, afford...

A growing literature indicates that electronic cigarette use increases the risk of subsequent initiation of conventional smoking among cigarette-naïve adolescents in several Western countries. This research assesses the same relationship in an Asian country, Taiwan. The Taiwan Adolescent to Adult Longitudinal Study is a school-based survey that was...

Background and aims: The effects of influenza vaccination (IV) on stroke outcomes are unclear. The purpose of this study is to evaluate the outcomes after stroke in elderly individuals who have received an IV. Methods: We used Taiwan's National Health Insurance Research Database 2000-2009 claims data to conduct a nested stroke cohort study inclu...