Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introdu...Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.展开更多
Purpose: Diabetes Mellitus (DM) is a prevalent metabolic disorder associated with significant complications, including visual impairment. This study aimed to assess the prevalence and severity of visual impairment and...Purpose: Diabetes Mellitus (DM) is a prevalent metabolic disorder associated with significant complications, including visual impairment. This study aimed to assess the prevalence and severity of visual impairment and its associated factors in diabetic patients in Libya. Methods: This cross-sectional study included 2365 DM patients (4730 eyes). Most participants were aged 30 - 49 (38.3%) and 50 - 69 (50.8%) with a nearly equal gender distribution (47.8% males, 52.2% females). Type 2 diabetes was predominant (92.6%), and 62.9% had HbA1c levels of 7.5% or higher. Results: Diabetic retinopathy (DR) was present in 2068 eyes (43.8%), with mild non-proliferative diabetic retinopathy (NPDR) affecting 1178 eyes (25%), moderate NPDR 476 eyes (10.1%), severe NPDR 228 eyes (4.8%), and proliferative diabetic retinopathy (PDR) 186 eyes (3.9%). Diabetic maculopathy was observed in 621 eyes (13.1%), with CSME in 287 eyes (6.07%) and non-CSME in 334 eyes (7.06%). Non-retinal conditions included cataracts in 1938 eyes (41%) and glaucoma in 252 eyes (5.3%). Visual impairment was observed in 1159 patients (49%), with 534 (23%) experiencing mild impairment, 382 (18%) moderate impairment, and 243 (12%) severe impairment;142 patients (6%) were classified as legally blind. DR showed a strong association with visual impairment severity (p Conclusions: These findings underscore the urgency for targeted public health interventions to mitigate visual impairment in Libyan individuals with DM.展开更多
Gastric cancer(GC)remains one of the most common cancers and leading causes of cancer deaths globally1with 60.0%of cases and 56.6%of deaths occurring in East Asia.South Korea and Japan have conducted nationwide GC scr...Gastric cancer(GC)remains one of the most common cancers and leading causes of cancer deaths globally1with 60.0%of cases and 56.6%of deaths occurring in East Asia.South Korea and Japan have conducted nationwide GC screening programs for decades but with essential differences in strategies,organization,and coverage2.展开更多
This study compared HPV testing and liquid-based cytology （LCT） as performance indicators for cervical cancer screening in a hospital-based study. A total of 61,193 outpatients were screened initially by LCT. Sample...This study compared HPV testing and liquid-based cytology （LCT） as performance indicators for cervical cancer screening in a hospital-based study. A total of 61,193 outpatients were screened initially by LCT. Samples with screening results showing atypical squamous cells of undetermined significance （ASC-US） or worse were referred for colposcopy, and some samples were tested for high-risk HPV types with the Hybrid Capture II system （HC II）. Data on LCT （n=61,193） and HC II （n=1056） results were analysed. Overall test positivity for LCT was 2.53% using an ASC-US threshold, 3.11% using a low-grade squamous intraepithelial lesion （LSIL） threshold, and 0.67% using a high-grade squamous intraepithelial lesion （HSIL） threshold. A total of 1839 women （84% of the 3893 patients with abnormal cytology） underwent colposcopy-directed biopsy. HPV was positive in 80.3% of women with cervical intraepithelial neoplasia 1 （CIN1）, 88.3% of those with CIN2, 79.2% of women with CIN3 and 50% （2 of 4） of women with invasive cancer. There was a significant increase in the detection of CIN2 or worse with adjunct HPV testing of women with ASC-US and LSIL However, there were detection of CIN2＋ cases no differences in the with adjunct HPV testing of women with HSlI.. The results indicate that HPV testing for HSlL triage should not be recommended in cervical cancer screening.展开更多
AIM:To investigate the outcome and effectiveness of two screening programs,National Cancer Screening Program(NCSP)and opportunistic screening(OS),for the detection of gastric cancer. METHODS:A total of 45 654 subjects...AIM:To investigate the outcome and effectiveness of two screening programs,National Cancer Screening Program(NCSP)and opportunistic screening(OS),for the detection of gastric cancer. METHODS:A total of 45 654 subjects underwent upper endoscopy as part of the NCSP or OS at the Chung-Ang University Healthcare System in Korea between January 2007 and December 2010.The study population was comprised of subjects over the age of 40 years.More specifically,subjects who took part in the NCSP were Medicaid recipients and beneficiaries of the National Health Insurance Corporation.Still photo-graphs from the endoscopies diagnosed as gastric cancer were reviewed by two experienced endoscopists. RESULTS:The mean age of the screened subjects was 55 years for men and 54 years for women.A total of 126 cases(0.28%)of gastric cancer were detected from both screening programs;100 cases(0.3%)from NCSP and in 26 cases(0.2%)from OS.The proportion of early gastric cancer(EGC)detected in NCSP was higher than that in OS(74.0%vs 53.8%,P=0.046). Among the 34 416 screenees in NCSP,6585(19.1%) underwent upper endoscopy every other year as scheduled.Among the 11 238 screenees in OS,3050(27.1%) underwent upper endoscopy at least once every two years during the study period.The detection rate of gastric cancer was found to be significantly higher during irregular follow-up than during regular follow-up in both screening programs(0.3%vs 0.2%,P=0.036).A higher incidence of EGC than advanced gastric cancer was observed during regular follow-up compared with irregular follow-up. CONCLUSION:Compliance to the screening program is more important than the type of screening system used.展开更多
AIM:To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program.METHODS:Colorectal cancer(CRC) was the second leading cause of ...AIM:To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program.METHODS:Colorectal cancer(CRC) was the second leading cause of cancer mortality in men(n = 1063,49.77/100 000),as well as women(n = 803,34.89/100 000) in Croatia in 2009.The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare,and its implementation started in September,2007.The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing(FOBT) to the participants,followed by colonoscopy in all positive cases.The FOBT was performed by hypersensitive guaiac-based Hemognost card test(Biognost,Zagreb).The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period.Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis.About 4% FOBT positive cases are expected in normal risk populations.A descriptive analysis was performed.RESULTS:A total of 1 056 694 individuals(born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011.In total,210 239(19.9%) persons returned the envelope with a completed questionnaire,and 181 102 of them returned it with a correctly placed stool specimen on FOBT cards.Until now,12 477(6.9%),FOBT-positive patients have been found,which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union(EU) Guidelines].Colonoscopy was performed in 8541 cases(uptake 66%).Screening has identified CRC in 472 patients(5.5% of colonoscopied,3.8% of FOBT-positive,and 0.26% of all screened individuals).This is also in the expected range according to EU Guidelines.Polyps were found and removed in 3329(39% of colonoscopied) patients.The largest number of polyps were found in the left half of the colon:64%(19%,37% and 8% in the rectum,sigma,and descendens,respectively).The other 36% were detected in the proximal part(17% in the transverse colon and 19% in ceco-ascending colon).Small polyps in the rectum(5-10 mm in diameter),sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases,with a low degree of dysplasia,and 40% were classified as hyperplastic.Polyps of this size in the transverse or ceco-ascending colon in almost 20% had a histologically villous component,but still had a low degree of dysplasia.Polyps sized 10-20 mm in diameter were in 43% cases tubulovillous,and among them,32% had areas with a high degree of dysplasia,especially those polyps in the cecoascending or transverse part.The characteristics of the Croatian CRC Screening National Program in the first 3 years were as follows:relatively low percentage of returned FOBT,higher number of FOBT-positive persons but still in the range for population-based programs,and higher number of pathologic findings(polyps and cancers).CONCLUSION:These results suggest a need for intervention strategies that include organizational changes and educational activities to improve awareness of CRC screening usefulness and increase participation rates.展开更多
This article explains how two AI systems have been incorporated into the everyday operations of two Singapore public healthcare nation‐wide screening programs.The first example is embedded within the setting of a nat...This article explains how two AI systems have been incorporated into the everyday operations of two Singapore public healthcare nation‐wide screening programs.The first example is embedded within the setting of a national level population health screening program for diabetes related eye diseases,targeting the rapidly increasing number of adults in the country with diabetes.In the second example,the AI assisted screening is done shortly after a person is admitted to one of the public hospitals to identify which inpatients—especially which elderly patients with complex conditions—have a high risk of being readmitted as an inpatient multiple times in the months following discharge.Ways in which healthcare needs and the clinical operations context influenced the approach to designing or deploying the AI systems are highlighted,illustrating the multiplicity of factors that shape the requirements for successful large‐scale deployments of AI systems that are deeply embedded within clinical workflows.In the first example,the choice was made to use the system in a semi‐automated(vs.fully automated)mode as this was assessed to be more cost‐effective,though still offering substantial productivity improvement.In the second example,machine learning algorithm design and model execution trade-offs were made that prioritized key aspects of patient engagement and inclusion over higher levels of predictive accuracy.The article concludes with several lessons learned related to deploying AI systems within healthcare settings,and also lists several other AI efforts already in deployment and in the pipeline for Singapore's public healthcare system.展开更多
The paper realizes the importance of communicating with schools to conduct nutritional screening, assessment and intervention programs for obesity and related risk factors to tackle the problem at earlier stage. The s...The paper realizes the importance of communicating with schools to conduct nutritional screening, assessment and intervention programs for obesity and related risk factors to tackle the problem at earlier stage. The screening program was conducted by dietetics＇ students ＂under supervision＂ as part of their practice and community services to apply some assessment method for mritional status. Two intermediate schools for girls in Jeddah city were involved in the screening stage, followed by a full nutritional assessment and implementation of a designed intervention program at one of the schools. At screening stage, interview questionnaires for diet histories and anthropometric measurements used to screen overweight status and related food patterns. National and international references data used for assessment and comparison. Following screening approach, a designed comprehensive nutritional assessment and intervention program was piloted at one of the screened schools for overweight status. For screening stage： the overall prevalence of overweight girls is 61% （n = 81 out of 133） of the population, 73% （n = 91） of girls were centrally obese. Almost 3/4 of all students reported no participations in any type of physical activities/exercises. Dietary behaviors included non-consumption of breakfast （83%） and low intake of fruit and vegetables （38%）. For intervention stage, the present report concentrates on data concerning post intervention changes in Body Mass Index （BMI） and Waist Circumference （WC）. By the 30 days of intervention there were significant changes in values for BMI according to Saudi growth chart （p value = 0.009） with no changes among the control group. No statistically significant difference in the mean WC of the group. Study＇s results suggest that approaching young girls through schools to screen, assess and intervene overweight status and risk factors is vital. Although the non-random selection of only two schools for screening the prevalence of overweight status among school girls prevent the geralizability of the study findings to wider population, previous studies used random selection of schools and large sample sizes showed a high prevalence of overweight status among Saudi students Therefore, designing and piloting of an intervention program for implementation at a national level is useful to tackle theproblem.展开更多
Mammographic screening programs are essential in timely detection and effective treatment of breast cancer. Since 2006, Croatia implemented a national MSP which asks for a regular biannual mammography for all women 50...Mammographic screening programs are essential in timely detection and effective treatment of breast cancer. Since 2006, Croatia implemented a national MSP which asks for a regular biannual mammography for all women 50 - 69 years of age. First-visit screening attendance in the country is estimated at 58.3% with the trend of gradually decreasing re-attendance rates. Since patient satisfaction with the screening procedure may influence subsequent adherence, this study aimed to assess patient satisfaction in order to predict and improve patient re-attendance rate, a first-time effort of such kind in Croatia. 201 random patients undergoing mammography screening procedure at four facilities in Croatia were asked to complete an anonymous questionnaire which specifically evaluated the following aspects of patient experience: patient attitude, facility surroundings, staff attitude and pre-examination information transfer, associated physical pain, psychological discomfort, and finally overall patient impressions and satisfaction. The majority of our examinees expressed high satisfaction with MSP and an intention to re-screen;patient attitude, facility environment and staff attitude were deemed overly positive, whereas the majority of patients estimated the physical and psychological pain associated tolerable. These results suggest that patient satisfaction is not a critical factor influencing future adherence rate in MSP, and other components of the program should be evaluated and improved.展开更多
In this editorial,we comment on the article published by Agatsuma et al in a recent issue of the World J Gastroenterol(2024;30:1368-1376).We firmly concur with Agatsuma et al regarding the vital significance of colore...In this editorial,we comment on the article published by Agatsuma et al in a recent issue of the World J Gastroenterol(2024;30:1368-1376).We firmly concur with Agatsuma et al regarding the vital significance of colorectal cancer(CRC)screening as a public health strategy to diminish disease burden.Individuals exposed to risk factors for CRC,those with comorbid conditions,and those with limited health literacy should undergo screening.However,we believe that more regular screenings should be accompanied by a greater focus on primary prevention(PP)of CRC.CRC remains a significant global health challenge,and its incidence is strongly linked to age,lifestyle,and socioeconomic factors.It is particularly noteworthy that the majority of CRC patients are diagnosed outside of established screening pathways and frequently at an advanced stage of the disease,and the majority of patients possess inadequate or even nonexistent knowledge regarding CRC,which significantly impacts the prognosis and imposes a substantial economic burden.This study revealed that CRC identified during hospital visits for comorbid conditions was typically diagnosed at an earlier stage than detected via symptomatic pathways.Remarkably,early incidental detection of CRC aligns closely with the timing of discovery through routine cancer screenings.This suggests that by adopting more inclusive screening protocols that combine opportunistic testing with traditional screening methods,health care systems can create a more comprehensive safety net for individuals at risk of CRC.However,before maximizing the health benefits of screening programs,it is essential to make additional efforts prior to screening,such as raising awareness via public education,risk assessment,and personalized recommendations,enhancing the knowledge and skills of health care professionals,optimizing the accessibility and convenience of screening processes,ensuring the quality and safety of screening services,strengthening follow-up and support systems,and providing policy support and financial investment.The establishment of a comprehensive screening system often requires substantial investment in human,material,and financial resources,which can be challenging to achieve in regions with limited health care resources.Strengthening PP strategies can reduce the disease burden by targeting the cause,representing a more cost-effective and impactful approach.Establishing a comprehensive cancer PP service platform that integrates authoritative public education on malignant tumor PP,individualized malignant tumor risk assessment,and self-health management assistance accessible to the entire population will significantly enhance the overall effectiveness of CRC PP strategies.展开更多
The purpose of this research is to implement an IT-based education program in order to promote cervical cancer screenings for women aged 20 - 29 years, as well as to examine the results of said program. This is a long...The purpose of this research is to implement an IT-based education program in order to promote cervical cancer screenings for women aged 20 - 29 years, as well as to examine the results of said program. This is a longitudinal/comparative study of two groups, one for which the program was implemented (the intervention group), and the other for which it was not (the control group). The program consisted of attending a health lecture and encouragement to be screened one month, six months, and one year later sent through IT-based methods. The target was unmarried women aged 20 - 29 who had neither previously given birth nor had been screened for cervical cancer in a period one year prior. They were divided into two groups, the intervention group (n = 142) and control group (n = 145). The effectiveness of the program was assessed via an initial survey and further surveys six months and one year later. Results were based on the Japanese version of the Health Belief Model Scale for Cervical Cancer and the Pap Smear Test (HBMSCCPST), knowledge scores in the categories of Healthy Lifestyles, Cervical Cancer, Cervical Cancer Screening, and screening behavior. A two-way ANOVA of the HBMSCCPST subscales and knowledge scores in the initial, six-month, and one-year surveys was performed, showing interaction in Cervical Cancer (p = 0.00). Main effects were observed in Cervical Cancer Screening (p = 0.00) and Healthy Lifestyles (p = 0.00). Regarding the amount of change from the initial survey, knowledge scores in the Cervical Cancer (p = 0.027) and Cervical Cancer Screening (p = 0.016) categories were significantly higher in the intervention group than in the control group. There was no significant difference in cervical cancer screening rates (p = 0.26) between the two groups. However, a small-degree effect size was observed for Benefits, Seriousness, and Susceptibility subscales in both examinees and non-examinees. Although the educational program of this study was effective in improving the knowledge of women in their twenties, there was little improvement in HBMSCCPST and it did not lead to the promotion of cervical cancer screening. In order to raise interest in cervical cancer screening, it is necessary to consider useful content to guide women to consult with healthcare professionals, a long-term population approach, and organizational structure of consultation.展开更多
Introduction Progress toward the global elimination of cervical cancer as a public health concern remains slow and highly uneven across countries.High-income nations such as Australia and FinlandDboth of which have ac...Introduction Progress toward the global elimination of cervical cancer as a public health concern remains slow and highly uneven across countries.High-income nations such as Australia and FinlandDboth of which have achieved high human papillomavirus(HPV)vaccination coverage and implemented quality-assured cervical cancer screening programs-have successfully decreased the incidence rates to below 8 cases per 100,000 women~1.These countries are on track to reach the elimination threshold of fewer than 4 cases per 100,000 women within the next few years,as defined by the World Health Organization(WHO).展开更多
文摘Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.
文摘Purpose: Diabetes Mellitus (DM) is a prevalent metabolic disorder associated with significant complications, including visual impairment. This study aimed to assess the prevalence and severity of visual impairment and its associated factors in diabetic patients in Libya. Methods: This cross-sectional study included 2365 DM patients (4730 eyes). Most participants were aged 30 - 49 (38.3%) and 50 - 69 (50.8%) with a nearly equal gender distribution (47.8% males, 52.2% females). Type 2 diabetes was predominant (92.6%), and 62.9% had HbA1c levels of 7.5% or higher. Results: Diabetic retinopathy (DR) was present in 2068 eyes (43.8%), with mild non-proliferative diabetic retinopathy (NPDR) affecting 1178 eyes (25%), moderate NPDR 476 eyes (10.1%), severe NPDR 228 eyes (4.8%), and proliferative diabetic retinopathy (PDR) 186 eyes (3.9%). Diabetic maculopathy was observed in 621 eyes (13.1%), with CSME in 287 eyes (6.07%) and non-CSME in 334 eyes (7.06%). Non-retinal conditions included cataracts in 1938 eyes (41%) and glaucoma in 252 eyes (5.3%). Visual impairment was observed in 1159 patients (49%), with 534 (23%) experiencing mild impairment, 382 (18%) moderate impairment, and 243 (12%) severe impairment;142 patients (6%) were classified as legally blind. DR showed a strong association with visual impairment severity (p Conclusions: These findings underscore the urgency for targeted public health interventions to mitigate visual impairment in Libyan individuals with DM.
基金supported by grants from the Shanghai Key Disciplines of Public Health(2023-2025)for New Threeyear Action Plan(Grant Nos.GWVI-11.1-22 and GWVI-11.1-23)the Fudan School of Public Health-Jiading CDC key disciplines for the high-quality development of public health(Grant No.GWGZLXK-2023-02)the Fudan Undergraduate Research Opportunities Program(Grant No.FDUROP-24647)。
文摘Gastric cancer(GC)remains one of the most common cancers and leading causes of cancer deaths globally1with 60.0%of cases and 56.6%of deaths occurring in East Asia.South Korea and Japan have conducted nationwide GC screening programs for decades but with essential differences in strategies,organization,and coverage2.
基金funded by Beijing Municipal Science & Technology Commission(No.Y0905001000091)
文摘This study compared HPV testing and liquid-based cytology （LCT） as performance indicators for cervical cancer screening in a hospital-based study. A total of 61,193 outpatients were screened initially by LCT. Samples with screening results showing atypical squamous cells of undetermined significance （ASC-US） or worse were referred for colposcopy, and some samples were tested for high-risk HPV types with the Hybrid Capture II system （HC II）. Data on LCT （n=61,193） and HC II （n=1056） results were analysed. Overall test positivity for LCT was 2.53% using an ASC-US threshold, 3.11% using a low-grade squamous intraepithelial lesion （LSIL） threshold, and 0.67% using a high-grade squamous intraepithelial lesion （HSIL） threshold. A total of 1839 women （84% of the 3893 patients with abnormal cytology） underwent colposcopy-directed biopsy. HPV was positive in 80.3% of women with cervical intraepithelial neoplasia 1 （CIN1）, 88.3% of those with CIN2, 79.2% of women with CIN3 and 50% （2 of 4） of women with invasive cancer. There was a significant increase in the detection of CIN2 or worse with adjunct HPV testing of women with ASC-US and LSIL However, there were detection of CIN2＋ cases no differences in the with adjunct HPV testing of women with HSlI.. The results indicate that HPV testing for HSlL triage should not be recommended in cervical cancer screening.
基金Supported by The Chung-Ang University Research Grants in 2011
文摘AIM:To investigate the outcome and effectiveness of two screening programs,National Cancer Screening Program(NCSP)and opportunistic screening(OS),for the detection of gastric cancer. METHODS:A total of 45 654 subjects underwent upper endoscopy as part of the NCSP or OS at the Chung-Ang University Healthcare System in Korea between January 2007 and December 2010.The study population was comprised of subjects over the age of 40 years.More specifically,subjects who took part in the NCSP were Medicaid recipients and beneficiaries of the National Health Insurance Corporation.Still photo-graphs from the endoscopies diagnosed as gastric cancer were reviewed by two experienced endoscopists. RESULTS:The mean age of the screened subjects was 55 years for men and 54 years for women.A total of 126 cases(0.28%)of gastric cancer were detected from both screening programs;100 cases(0.3%)from NCSP and in 26 cases(0.2%)from OS.The proportion of early gastric cancer(EGC)detected in NCSP was higher than that in OS(74.0%vs 53.8%,P=0.046). Among the 34 416 screenees in NCSP,6585(19.1%) underwent upper endoscopy every other year as scheduled.Among the 11 238 screenees in OS,3050(27.1%) underwent upper endoscopy at least once every two years during the study period.The detection rate of gastric cancer was found to be significantly higher during irregular follow-up than during regular follow-up in both screening programs(0.3%vs 0.2%,P=0.036).A higher incidence of EGC than advanced gastric cancer was observed during regular follow-up compared with irregular follow-up. CONCLUSION:Compliance to the screening program is more important than the type of screening system used.
文摘AIM:To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program.METHODS:Colorectal cancer(CRC) was the second leading cause of cancer mortality in men(n = 1063,49.77/100 000),as well as women(n = 803,34.89/100 000) in Croatia in 2009.The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare,and its implementation started in September,2007.The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing(FOBT) to the participants,followed by colonoscopy in all positive cases.The FOBT was performed by hypersensitive guaiac-based Hemognost card test(Biognost,Zagreb).The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period.Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis.About 4% FOBT positive cases are expected in normal risk populations.A descriptive analysis was performed.RESULTS:A total of 1 056 694 individuals(born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011.In total,210 239(19.9%) persons returned the envelope with a completed questionnaire,and 181 102 of them returned it with a correctly placed stool specimen on FOBT cards.Until now,12 477(6.9%),FOBT-positive patients have been found,which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union(EU) Guidelines].Colonoscopy was performed in 8541 cases(uptake 66%).Screening has identified CRC in 472 patients(5.5% of colonoscopied,3.8% of FOBT-positive,and 0.26% of all screened individuals).This is also in the expected range according to EU Guidelines.Polyps were found and removed in 3329(39% of colonoscopied) patients.The largest number of polyps were found in the left half of the colon:64%(19%,37% and 8% in the rectum,sigma,and descendens,respectively).The other 36% were detected in the proximal part(17% in the transverse colon and 19% in ceco-ascending colon).Small polyps in the rectum(5-10 mm in diameter),sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases,with a low degree of dysplasia,and 40% were classified as hyperplastic.Polyps of this size in the transverse or ceco-ascending colon in almost 20% had a histologically villous component,but still had a low degree of dysplasia.Polyps sized 10-20 mm in diameter were in 43% cases tubulovillous,and among them,32% had areas with a high degree of dysplasia,especially those polyps in the cecoascending or transverse part.The characteristics of the Croatian CRC Screening National Program in the first 3 years were as follows:relatively low percentage of returned FOBT,higher number of FOBT-positive persons but still in the range for population-based programs,and higher number of pathologic findings(polyps and cancers).CONCLUSION:These results suggest a need for intervention strategies that include organizational changes and educational activities to improve awareness of CRC screening usefulness and increase participation rates.
文摘This article explains how two AI systems have been incorporated into the everyday operations of two Singapore public healthcare nation‐wide screening programs.The first example is embedded within the setting of a national level population health screening program for diabetes related eye diseases,targeting the rapidly increasing number of adults in the country with diabetes.In the second example,the AI assisted screening is done shortly after a person is admitted to one of the public hospitals to identify which inpatients—especially which elderly patients with complex conditions—have a high risk of being readmitted as an inpatient multiple times in the months following discharge.Ways in which healthcare needs and the clinical operations context influenced the approach to designing or deploying the AI systems are highlighted,illustrating the multiplicity of factors that shape the requirements for successful large‐scale deployments of AI systems that are deeply embedded within clinical workflows.In the first example,the choice was made to use the system in a semi‐automated(vs.fully automated)mode as this was assessed to be more cost‐effective,though still offering substantial productivity improvement.In the second example,machine learning algorithm design and model execution trade-offs were made that prioritized key aspects of patient engagement and inclusion over higher levels of predictive accuracy.The article concludes with several lessons learned related to deploying AI systems within healthcare settings,and also lists several other AI efforts already in deployment and in the pipeline for Singapore's public healthcare system.
文摘The paper realizes the importance of communicating with schools to conduct nutritional screening, assessment and intervention programs for obesity and related risk factors to tackle the problem at earlier stage. The screening program was conducted by dietetics＇ students ＂under supervision＂ as part of their practice and community services to apply some assessment method for mritional status. Two intermediate schools for girls in Jeddah city were involved in the screening stage, followed by a full nutritional assessment and implementation of a designed intervention program at one of the schools. At screening stage, interview questionnaires for diet histories and anthropometric measurements used to screen overweight status and related food patterns. National and international references data used for assessment and comparison. Following screening approach, a designed comprehensive nutritional assessment and intervention program was piloted at one of the screened schools for overweight status. For screening stage： the overall prevalence of overweight girls is 61% （n = 81 out of 133） of the population, 73% （n = 91） of girls were centrally obese. Almost 3/4 of all students reported no participations in any type of physical activities/exercises. Dietary behaviors included non-consumption of breakfast （83%） and low intake of fruit and vegetables （38%）. For intervention stage, the present report concentrates on data concerning post intervention changes in Body Mass Index （BMI） and Waist Circumference （WC）. By the 30 days of intervention there were significant changes in values for BMI according to Saudi growth chart （p value = 0.009） with no changes among the control group. No statistically significant difference in the mean WC of the group. Study＇s results suggest that approaching young girls through schools to screen, assess and intervene overweight status and risk factors is vital. Although the non-random selection of only two schools for screening the prevalence of overweight status among school girls prevent the geralizability of the study findings to wider population, previous studies used random selection of schools and large sample sizes showed a high prevalence of overweight status among Saudi students Therefore, designing and piloting of an intervention program for implementation at a national level is useful to tackle theproblem.
文摘Mammographic screening programs are essential in timely detection and effective treatment of breast cancer. Since 2006, Croatia implemented a national MSP which asks for a regular biannual mammography for all women 50 - 69 years of age. First-visit screening attendance in the country is estimated at 58.3% with the trend of gradually decreasing re-attendance rates. Since patient satisfaction with the screening procedure may influence subsequent adherence, this study aimed to assess patient satisfaction in order to predict and improve patient re-attendance rate, a first-time effort of such kind in Croatia. 201 random patients undergoing mammography screening procedure at four facilities in Croatia were asked to complete an anonymous questionnaire which specifically evaluated the following aspects of patient experience: patient attitude, facility surroundings, staff attitude and pre-examination information transfer, associated physical pain, psychological discomfort, and finally overall patient impressions and satisfaction. The majority of our examinees expressed high satisfaction with MSP and an intention to re-screen;patient attitude, facility environment and staff attitude were deemed overly positive, whereas the majority of patients estimated the physical and psychological pain associated tolerable. These results suggest that patient satisfaction is not a critical factor influencing future adherence rate in MSP, and other components of the program should be evaluated and improved.
文摘In this editorial,we comment on the article published by Agatsuma et al in a recent issue of the World J Gastroenterol(2024;30:1368-1376).We firmly concur with Agatsuma et al regarding the vital significance of colorectal cancer(CRC)screening as a public health strategy to diminish disease burden.Individuals exposed to risk factors for CRC,those with comorbid conditions,and those with limited health literacy should undergo screening.However,we believe that more regular screenings should be accompanied by a greater focus on primary prevention(PP)of CRC.CRC remains a significant global health challenge,and its incidence is strongly linked to age,lifestyle,and socioeconomic factors.It is particularly noteworthy that the majority of CRC patients are diagnosed outside of established screening pathways and frequently at an advanced stage of the disease,and the majority of patients possess inadequate or even nonexistent knowledge regarding CRC,which significantly impacts the prognosis and imposes a substantial economic burden.This study revealed that CRC identified during hospital visits for comorbid conditions was typically diagnosed at an earlier stage than detected via symptomatic pathways.Remarkably,early incidental detection of CRC aligns closely with the timing of discovery through routine cancer screenings.This suggests that by adopting more inclusive screening protocols that combine opportunistic testing with traditional screening methods,health care systems can create a more comprehensive safety net for individuals at risk of CRC.However,before maximizing the health benefits of screening programs,it is essential to make additional efforts prior to screening,such as raising awareness via public education,risk assessment,and personalized recommendations,enhancing the knowledge and skills of health care professionals,optimizing the accessibility and convenience of screening processes,ensuring the quality and safety of screening services,strengthening follow-up and support systems,and providing policy support and financial investment.The establishment of a comprehensive screening system often requires substantial investment in human,material,and financial resources,which can be challenging to achieve in regions with limited health care resources.Strengthening PP strategies can reduce the disease burden by targeting the cause,representing a more cost-effective and impactful approach.Establishing a comprehensive cancer PP service platform that integrates authoritative public education on malignant tumor PP,individualized malignant tumor risk assessment,and self-health management assistance accessible to the entire population will significantly enhance the overall effectiveness of CRC PP strategies.
文摘The purpose of this research is to implement an IT-based education program in order to promote cervical cancer screenings for women aged 20 - 29 years, as well as to examine the results of said program. This is a longitudinal/comparative study of two groups, one for which the program was implemented (the intervention group), and the other for which it was not (the control group). The program consisted of attending a health lecture and encouragement to be screened one month, six months, and one year later sent through IT-based methods. The target was unmarried women aged 20 - 29 who had neither previously given birth nor had been screened for cervical cancer in a period one year prior. They were divided into two groups, the intervention group (n = 142) and control group (n = 145). The effectiveness of the program was assessed via an initial survey and further surveys six months and one year later. Results were based on the Japanese version of the Health Belief Model Scale for Cervical Cancer and the Pap Smear Test (HBMSCCPST), knowledge scores in the categories of Healthy Lifestyles, Cervical Cancer, Cervical Cancer Screening, and screening behavior. A two-way ANOVA of the HBMSCCPST subscales and knowledge scores in the initial, six-month, and one-year surveys was performed, showing interaction in Cervical Cancer (p = 0.00). Main effects were observed in Cervical Cancer Screening (p = 0.00) and Healthy Lifestyles (p = 0.00). Regarding the amount of change from the initial survey, knowledge scores in the Cervical Cancer (p = 0.027) and Cervical Cancer Screening (p = 0.016) categories were significantly higher in the intervention group than in the control group. There was no significant difference in cervical cancer screening rates (p = 0.26) between the two groups. However, a small-degree effect size was observed for Benefits, Seriousness, and Susceptibility subscales in both examinees and non-examinees. Although the educational program of this study was effective in improving the knowledge of women in their twenties, there was little improvement in HBMSCCPST and it did not lead to the promotion of cervical cancer screening. In order to raise interest in cervical cancer screening, it is necessary to consider useful content to guide women to consult with healthcare professionals, a long-term population approach, and organizational structure of consultation.
文摘Introduction Progress toward the global elimination of cervical cancer as a public health concern remains slow and highly uneven across countries.High-income nations such as Australia and FinlandDboth of which have achieved high human papillomavirus(HPV)vaccination coverage and implemented quality-assured cervical cancer screening programs-have successfully decreased the incidence rates to below 8 cases per 100,000 women~1.These countries are on track to reach the elimination threshold of fewer than 4 cases per 100,000 women within the next few years,as defined by the World Health Organization(WHO).
