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Jang M, Yoon J, Yun Y, Kim J, Jang H, Benmarhnia T, Han C. Changes in Healthcare Utilization After the 2022 Seoul Metropolitan Flood: Applying a Generalized Synthetic Control Approach. GEOHEALTH 2024; 8:e2024GH001084. [PMID: 39347018 PMCID: PMC11437896 DOI: 10.1029/2024gh001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/23/2024] [Accepted: 09/17/2024] [Indexed: 10/01/2024]
Abstract
Floods can have adverse health effects and impose a burden on healthcare systems. However, the potential consequences of floods on specific medical causes in densely populated metropolitan cities has not been characterized yet. Therefore, we evaluate the changes in healthcare utilization patterns after the 2022 Seoul flood using nationwide health insurance data. Based on the flood inundation map, districts within the flooded municipalities of Seoul were classified as severe-(n = 12), mild-(n = 22), or non-(n = 38) flood-affected districts. Capitalizing on the timing of the flood as a natural experiment, a generalized synthetic control method was applied to estimate changes in the number of disease-specific hospital visits in flood-affected districts during 2 weeks after the flood. We found excess hospital visits for external injuries (20.2 visits, 95% CI: -6.0, 45.2) and fewer visits for pregnancy and puerperium (-3.0 visits, 95% CI: -5.1, -0.5) in residents of flooded districts. When comparing severe- and non-flood districts, the increase in hospital visits for external injuries (56.2 visits, 95% CI: 17.2, 93.2) and a decrease in hospital visits related to pregnancy and puerperium (-5.3 visits, 95% CI: -8.4, -1.6) were prominent in residents living in severe-flood affected districts. Disease specific analysis showed an increase in hospital visits for injuries to the elbow and forearm, ankle and foot injuries, and chronic lower respiratory diseases in severe-flood-affected districts. However, these impacts were not observed when comparing the mild- and non-flood-affected districts. Our study suggests an immediate and substantial change in medical demand following flood exposure, highlighting the importance of public health responses after flood events.
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Affiliation(s)
- Marnpyung Jang
- Chungnam National University College of Medicine Daejeon Korea
| | - Jaeyoung Yoon
- Chungnam National University College of Medicine Daejeon Korea
| | | | - Jaiyong Kim
- Department of Big Data Research and Development National Health Insurance Service Wonju Korea
| | - Hoyeon Jang
- Department of Big Data Research and Development National Health Insurance Service Wonju Korea
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography UC San Diego La Jolla CA USA
- Inserm EHESP Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085 Université de Rennes Rennes France
| | - Changwoo Han
- Scripps Institution of Oceanography UC San Diego La Jolla CA USA
- Department of Preventive Medicine Chungnam National University College of Medicine Daejeon Korea
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Klamen A, Bryce R, Martin S, Benchell Eisman E. Chronic Cellulitis in the Unhoused: Case Study and Treatment Considerations. J Prim Care Community Health 2024; 15:21501319241249437. [PMID: 39058513 PMCID: PMC11282539 DOI: 10.1177/21501319241249437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
This report seeks to discuss sequelae of chronic cellulitis that is commonly treated in the ambulatory setting, as exacerbated by the conditions of living outside. Further we hope to identify etiologic factors that contribute to complication development. Additionally, this article will touch on unique treatment plan considerations for unhoused patients with the intention to educate providers and reduce mortality and morbidity relating to pedal skin and soft tissue infections in this population. This piece examines the case of a 52-year-old man with a history of chronic diseases, substance use disorder, and recurrent cellulitis. We highlight systemic issues in healthcare delivery for unhoused patients, including inadequate discharge planning, limited access to medication, and challenges in shelter placement. The discussion section emphasizes the importance of accurate diagnosis and tailored treatment plans for cellulitis in houseless individuals, the importance of a multidisciplinary approach incorporating social work services, and addressing chronic illnesses, substance use disorder, and housing issues. The report advocates for heightened awareness of bilateral cellulitis in unhoused populations, emphasizing the need for comprehensive, individualized treatment plans.
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Affiliation(s)
- Amelia Klamen
- Wayne State University School of Medicine, Detroit, MI, USA
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Chimed-Ochir O, Yumiya Y, Taji A, Kishita E, Kondo H, Wakai A, Akahoshi K, Chishima K, Toyokuni Y, Koido Y, Kubo T. Emergency Medical Teams' Responses during the West Japan Heavy Rain 2018: J-SPEED Data Analysis. Prehosp Disaster Med 2022; 37:1-7. [PMID: 35225205 PMCID: PMC8958047 DOI: 10.1017/s1049023x22000231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Rainfall-induced floods and landslides accounted for 20.7% of all disaster events in Japan from 1985 through 2018 and caused a variety of health problems, both directly and indirectly, including injuries, infectious diseases, exacerbation of pre-existing medical conditions, and psychological issues. More evidence of health problems caused by floods or heavy rain is needed to improve preparedness and preventive measures; however, collecting health data surrounding disaster events is a major challenge due to environmental hazards, logistical constraints, political and economic issues, difficulties in communication among stakeholders, and cultural barriers. In response to the West Japan Heavy Rain in July 2018, Emergency Medical Teams (EMTs) used Japan - Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED) as a daily reporting template, collecting data on the number and type of patients they treated and sending it to an EMT coordination cell (EMTCC) during the response. STUDY OBJECTIVE The aim of the study was to conduct a descriptive epidemiology study using J-SPEED data to better understand the health problems during floods and heavy rain disasters. METHODS The number and types of health problems treated by EMTs in accordance with the J-SPEED (Ver 1.0) form were reported daily by 85 EMTs to an EMTCC, where data were compiled during the West Japan Heavy Rain from July 8 through September 11, 2018. Reported items in the J-SPEED form were analyzed by age, gender, area (prefecture), and time period. RESULTS The analysis of J-SPEED data from the West Japan Heavy Rain 2018 revealed the characteristics of a total of 3,617 consultations with the highest number of consultations (2,579; 71.3%) occurring between Day 5 and Day 12 of the 65-day EMT response. During the response period, skin disease was the most frequently reported health event (17.3%), followed by wounds (14.3%), disaster stress-related symptoms (10.0%), conjunctivitis (6.3%), and acute respiratory infections (ARI; 5.4%). CONCLUSION During the response period, skin disease was the most frequently reported health event, followed by wounds, stress, conjunctivitis, and ARIs. The health impacts of a natural disaster are determined by a variety of factors, and the current study's findings are highly context dependent; however, it is expected that as more data are gathered, the consistency of finding will increase.
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Affiliation(s)
- Odgerel Chimed-Ochir
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yui Yumiya
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akihiro Taji
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Eisaku Kishita
- Hiroshima Prefectural Health and Welfare Bureau, Hiroshima, Japan
| | - Hisayoshi Kondo
- National Hospital Organization Headquarters DMAT Secretariat MHLW Japan, Tokyo, Japan
| | - Akinori Wakai
- National Hospital Organization Headquarters DMAT Secretariat MHLW Japan, Osaka City, Japan
| | - Kouki Akahoshi
- National Hospital Organization Headquarters DMAT Secretariat MHLW Japan, Tokyo, Japan
| | - Kayoko Chishima
- National Hospital Organization Headquarters DMAT Secretariat MHLW Japan, Tokyo, Japan
| | - Yoshiki Toyokuni
- National Hospital Organization Headquarters DMAT Secretariat MHLW Japan, Tokyo, Japan
| | - Yuichi Koido
- National Hospital Organization Headquarters DMAT Secretariat MHLW Japan, Tokyo, Japan
| | - Tatsuhiko Kubo
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Jenkin A, Mantha P, Palamuthusingam P. Do we need to change empiric antibiotic use following natural disasters? A reflection on the Townsville flood. ANZ J Surg 2021; 92:195-199. [PMID: 34723431 DOI: 10.1111/ans.17327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/02/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Skin and soft tissue infections have the potential to affect every patient admitted to a surgical service. Changes to the microbiota colonizing wounds during natural disasters, such as the Townsville floods of 2019, could impact empiric antibiotic choice and need for return to theatre. METHODS This retrospective observational cohort study reviews culture data and demographics for patients undergoing surgical debridement of infected wounds over a six-month period starting in November 2018 to May 2019 at the Townsville Hospital. RESULTS Of the 408 patients requiring operative intervention, only 61 patients met the inclusion criteria. The groups were comparative in terms of age and gender, but a greater proportion of patients (40.5% versus 29.1%, P = 0.368) in the post-flood group were diabetic. Common skin commensals, such as Staphylococcus aureus, were the most common pathogen in both groups, however the post-flood group had a higher proportion of atypical organisms (14 versus 8 patients), and an increased need for repeated debridement for infection control (24 versus 14 patients). CONCLUSION Wound swabs and tissue culture are imperative during surgical debridement and may guide the use of more broad-spectrum coverage following a significant flooding event.
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Affiliation(s)
- Ashley Jenkin
- General Surgery, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Pranay Mantha
- General Surgery, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
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Lin CH. Disaster Medicine in Taiwan. J Acute Med 2019; 9:83-109. [PMID: 32995238 PMCID: PMC7440387 DOI: 10.6705/j.jacme.201909_9(3).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study aimed to examine scientific publications that were related to disaster medicine and were authored by emergency medicine physicians in Taiwan. This descriptive study utilized the electronic databases of PubMed, Scopus, and Web of Science. Academic works that were published between January 1, 1999, and December 31, 2018, were collected for review and analysis. Of the 53 articles included in the final analysis,40 (75.5%) were original research, 3 (5.7%) were reviews, 1 (1.9%) was a brief report, and 9 (17.0%) were perspectives. The top 5 themes were disaster response systems (17, 32.1%), endemic diseases (11, 20.8%), emergency department (ED) overcrowding (10, 18.9%), earthquakes (10, 18.9%), and ED administration (9, 17.0%). Sixteen (30.2%) articles involved international collaborations. The median, interquartile range and range of the numbers of citations of the articles were 3, 1-11, and 0-65, respectively. Twenty-four (45.3%) articles were related to specific incidents: the Chi-Chi earthquake in 1999 (n = 5), the Singapore airline crash in 2000 (n = 1), Typhoon Nari in 2001 (n = 1), the outbreak of severe acute respiratory syndrome in 2003 (n = 7), Typhoon Morakot in 2009 (n = 1), the color party explosion in Formosa Fun Coast Park in 2015 (n = 4), and the Tainan earthquake in 2016 (n = 5). Regarding the study methods, 19 (35.8%) articles were quantitative studies; 10 (18.9%) were qualitative or semiqualitative studies; 8 (15.1%) used questionnaire surveys; 3 (5.7%) were literature reviews; 3 (5.7%) used computer simulations; and 10 (18.9%) were descriptive/narrative or other types of studies. Though the number of academic publications related to disaster medicine from the EDs in Taiwan is relatively limited, the quality and diversity of research seem promising. The research environment and education programs on disaster medicine in Taiwan deserve thoughtful consideration.
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Affiliation(s)
- Chih-Hao Lin
- National Cheng Kung University Department of Emergency Medicine National Cheng Kung University Hospital College of Medicine Tainan Taiwan
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Abstract
Hydrologic disasters, including hurricanes, tsunamis, and severe flooding, have been associated with infectious diseases, particularly among vulnerable and displaced populations in resource-poor settings. Skin and soft tissue infections, gastrointestinal infections, respiratory infections, zoonotic infections, and vector-borne diseases each present unique threats to human health in this setting. Increased emergency physician awareness of these infectious diseases and their diagnosis and management helps optimize medical care for survivors after a hydrologic disaster and safeguard the health of disaster responders.
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Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA; Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA.
| | - Nicole Messenger
- Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
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Paterson DL, Wright H, Harris PNA. Health Risks of Flood Disasters. Clin Infect Dis 2018; 67:1450-1454. [DOI: 10.1093/cid/ciy227] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/20/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- David L Paterson
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Hugh Wright
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Patrick N A Harris
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
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No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters. Prehosp Disaster Med 2017; 32:568-579. [PMID: 28606191 DOI: 10.1017/s1049023x17006574] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction How the burden of disease varies during different phases after floods and after storms is essential in order to guide a medical response, but it has not been well-described. The objective of this review was to elucidate the health problems following flood and storm disasters. METHODS A literature search of the databases Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); Cinahl (EBSCO Information Services; Ipswich, Massachusetts USA); Global Health (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science Core Collection (Thomson Reuters; New York, New York USA); Embase (Elsevier; Amsterdam, Netherlands); and PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA) was conducted in June 2015 for English-language research articles on morbidity or mortality and flood or storm disasters. Articles on mental health, interventions, and rescue or health care workers were excluded. Data were extracted from articles that met the eligibility criteria and analyzed by narrative synthesis. RESULTS The review included 113 studies. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections all increased after storms. Gastrointestinal infections were more frequent after floods. Leptospirosis and diabetes-related complications increased after both. The majority of changes occurred within four weeks of floods or storms. CONCLUSION Health changes differently after floods and after storms. There is a lack of data on the health effects of floods alone, long-term changes in health, and the strength of the association between disasters and health problems. This review highlights areas of consideration for medical response and the need for high-quality, systematic research in this area. Saulnier DD , Brolin Ribacke K , von Schreeb J . No calm after the storm: a systematic review of human health following flood and storm disasters. Prehosp Disaster Med. 2017;32(5):568-579.
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Lin PC, Lin HJ, Guo HR, Chen KT. Correction: Epidemiological Characteristics of Lower Extremity Cellulitis after a Typhoon Flood. PLoS One 2017; 12:e0171401. [PMID: 28135307 PMCID: PMC5279785 DOI: 10.1371/journal.pone.0171401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0065655.].
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Huang LY, Wang YC, Wu CC, Chen YC, Huang YL. Risk of Flood-Related Diseases of Eyes, Skin and Gastrointestinal Tract in Taiwan: A Retrospective Cohort Study. PLoS One 2016; 11:e0155166. [PMID: 27171415 PMCID: PMC4865035 DOI: 10.1371/journal.pone.0155166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 04/25/2016] [Indexed: 11/20/2022] Open
Abstract
Floods are known to cause serious environmental damage and health impacts. Studies on flood-related diseases have been primarily on individual events, and limited evidence could be drawn on potential health impacts from floods using large population data. This study used reimbursement records of one million people of the Taiwan National Health Insurance program to compare incident diseases of the eyes, skin and gastrointestinal (GI) tract associated with floods. Incidence rates for the selected diseases were calculated according to outpatient/emergency visit data. The incidence rates were evaluated by flood status: in 10 days before floods, during floods and within 10 days after the floods receded. Outpatient/emergency visit rates for the eye, skin and GI tract diseases were highest after floods and lowest during floods. Results from multivariate Poisson regression analyses showed that, when compared with the incidence in 10 days before floods, the incidence rate ratios (IRR) of diseases within 10 days after floods were 1.15 (95% confidence interval (CI) = 1.10–1.20) for eyes, 1.08 (95% C.I. = 1.05–1.10) for skin, and 1.11 (95% CI = 1.08–1.14) for GI tract, after controlling for covariates. All risks increased with ambient temperature. V-shaped trends were found between age and eye diseases, and between age and GI tract diseases. In contrast, the risk of skin diseases increased with age. In conclusion, more diseases of eyes, skin and GI tract could be diagnosed after the flood.
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Affiliation(s)
- Ling-Ya Huang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Chun Wang
- Department of Bioenvironmental Engineering, Chung Yuan Christian University College of Engineering, Chung Li, Taiwan
| | - Chin-Ching Wu
- Department of Public Health, China Medical University College of Public Health, Taichung, Taiwan
| | - Yi-Chun Chen
- Department of Health Management, I-Shou University, Kaohsiung, Taiwan
- Bachelor’s Degree Program for Indigenous Peoples in Long-term Care, I-Shou University, Kaohsiung, Taiwan
- * E-mail: ; (YLH)
| | - Yu-Li Huang
- Department of Safety, Health and Environmental Engineering, National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan
- * E-mail: ; (YLH)
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Lin CY, Chen TC, Dai CY, Yu ML, Lu PL, Yen JH, Chen YH. Serological investigation to identify risk factors for post-flood infectious diseases: a longitudinal survey among people displaced by Typhoon Morakot in Taiwan. BMJ Open 2015; 5:e007008. [PMID: 25976763 PMCID: PMC4442151 DOI: 10.1136/bmjopen-2014-007008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES After Typhoon Morakot struck Taiwan in 2009, thousands of Taiwanese citizens were displaced to shelters for several weeks. Others were placed in urban communities where they had family members. This study aimed to investigate serological status in both groups and identify risk factors associated with seroconversion of infectious diseases. DESIGN A longitudinal survey. SETTING All experimental and clinical investigations were performed in a tertiary teaching hospital. PARTICIPANTS A total of 288 displaced persons (96 males and 192 females) were recruited and complete follow-up data through two rounds of sampling were collected. The average age was 58.42 years (range 31-87 years). INTERVENTIONS First, serum specimens were collected between December 2009 and January 2010, 4-5 months after the typhoon. The second round of specimen collection was carried out after 6 months. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measured was serological status of vaccine-preventable droplet-borne infectious diseases (ie, measles, mumps, rubella) and water-borne diseases (ie, amoebiasis and leptospirosis). The secondary outcome was identification of risk factors for seroconversion using univariate and multivariate analyses. RESULTS Complete data were available for all 288 displaced persons (114 from the shelter group; 174 from the community group). Seroconversion of Entamoeba histolytica was observed in 128 (44.4%) participants, with a significantly higher rate in the shelter group than in the community group (56.1% vs 36.8%; p=0.001). There were 10 cases of rubella seroconversion. After adjusting for medical history, hypertension and hyperlipidaemia, shelter stay was associated with higher risk for seroconversion (OR=2.055, 95% CI 1.251 to 3.374; p=0.004). Amoebiasis was more evident in the shelter group, although the manifestations were mild. CONCLUSIONS Our results suggested that (1) a clean water supply is essential postdisaster, especially in crowded shelters, and (2) vaccination programmes should be extended to populations at higher risk for post-disaster displacement or to those with weakened immune status.
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Affiliation(s)
- Chun-Yu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tun-Chieh Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jeng-Hsien Yen
- Graduate Institute of Medicine, Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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