Improving diabetic retinopathy screening at the point of care: integrating telemedicine to overcome current challenges.

OBJECTIVE: To investigate the utility of point of care screening of diabetic retinopathy (DR) and the impact of a telemedicine program to overcome current challenges. METHODS: This was a retrospective study on people with type 2 diabetes mellitus (T2DM) who were screened for DR using the single-field non-mydriatic fundus photography at the point of care during routine follow-up visits at endocrinology clinic. Retinal images were uploaded and sent to a retina specialist for review. Reports indicating retinopathy status and the need for direct retinal examination were transmitted back to the endocrinology clinic. All patients were informed about DR status and, if needed, referred to the retina specialist for direct retinal examination. RESULTS: Of the 1159 individuals screened for DR, 417 persons (35.98%) were screen-positive and referred to the retina specialist for direct retinal examination. A total of 121 individuals (29.01%) underwent direct retinal examination by the specialist. Diabetes macular edema (DME) was detected in 12.1%. In addition, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) were detected in 53.4% and 2.6% of the patients, respectively. CONCLUSION: Integrating DR screening program at the point of care at the secondary care services improves the rate of DR screening as well as detection of sight threatening retinopathy and provides the opportunity for timely intervention in order to prevent advanced retinopathy in people with T2DM.

Trends and Barriers in Diabetic Retinopathy Screening: Korea National Health and Nutritional Examination Survey 2016-2021.

BACKGROUND: The prevalence of diabetes is increasing globally, highlighting the importance of preventive healthcare. This study aimed to identify the diabetic retinopathy (DR) screening rates and risk factors linked to DR screening nonadherence in the Korean population through a nationally representative sample survey. METHODS: Among the Korea National Health and Nutrition Examination Survey database from 2016 to 2021, participants aged ≥ 40 years with diabetes were included. The weighted estimate for nonadherence to DR screening within a year was calculated. Risk factor analyses were conducted using univariate and multivariate logistic regression. RESULTS: Among the 3,717 participants, 1,109 (29.5%) underwent DR screening within the past year, and this national estimate exhibited no statistically significant difference from 2016 to 2021 (P = 0.809). Nonadherence to annual DR screening was associated with residing in rural areas, age ≥ 80 years, low educational level, self-reported good health, absence of ocular disease, current smoking, lack of exercise and dietary diabetes treatment, and no activity limitation (all P < 0.05). CONCLUSION: The recent DR screening rate in Korea was relatively low. Factors associated with apathy and complacency towards personal health were associated with the nonadherence to DR screening. Educational interventions have the potential to enhance the annual screening rate for diabetic patients.

Effects of communicating lifetime risks and screening rates of colorectal cancer and breast cancer.

Colorectal cancer and breast cancer are among the most common types of cancer in the United States, and cancer screening is an effective way to detect and treat these cancers early. Health news stories, medical websites, and media campaigns regularly highlight the national lifetime risks of specific cancers and their screening rates, but recent research suggests that people tend to overestimate the prevalence of health problems but underestimate the prevalence of disease prevention behaviors in the absence of numerical information. This study featured two online experiments, one focused on breast cancer (N = 632) and one focused on colorectal cancer (N = 671), to examine the effects of communicating national cancer lifetime risks and screening rates among samples of screening-eligible adults in the United States. Findings confirmed prior work in showing that people overestimated colorectal/breast cancer lifetime risks but underestimated colorectal/breast cancer screening rates. Communicating the national lifetime risk of dying from colorectal/breast cancer lowered people's national risk estimates, which in turn was associated with lower perceived cancer risks for themselves. In contrast, communicating the national colorectal/breast cancer screening rate increased people's estimates of the prevalence of cancer screening, which in turn was associated with higher perceived self-efficacy to engage in cancer screening and greater screening intentions. We conclude that efforts to promote cancer screening may benefit from messages that include data on national cancer screening rates but may not benefit from including national rates of lifetime cancer risks.

[Improving the Pap Smear Screening Rate for Cervical Cancer in a Health Management Center: A Quality Improvement Program].

BACKGROUND & PROBLEMS: Early detection tests are highly effective in helping adult women prevent the onset of cervical cancer. However, the cervical Pap smear screening rate in a health management center was only 54.3% in 2020. PURPOSE: This project was developed to improve the Pap smear screening rate for cervical cancer in a health management center. RESOLUTION: The strategies developed included revising the health examination lists, developing an online appointment booking system, designing a patient decision aid, creating a standardized simulation moulage for education, and rechecking patient's National Health Insurance cards. RESULTS: After implementation of these strategies, the Pap smear screening rate for cervical cancer rose from 54.3% to 81.2%. The screening rate at the health management center in 2022 reached 96.6%. CONCLUSIONS: Shared decision-making can elucidate the comprehensive options available to clients and support them in considering their options and achieving informed choices regarding Pap smear preferences.

Self-sampling HPV test in women not undergoing Pap smear for more than 5 years and factors associated with under-screening in Taiwan.

BACKGROUND/PURPOSE: Under-utilization of Papanicolaou (Pap) smear causes a gap in the prevention of cervical neoplasms. A prospective population-based study was conducted investigating whether a self-sampling human papillomavirus (HPV) test was feasible for under-users of Pap smear and factors associated with under-screening in Taiwan. METHODS: Women not having Pap smear screening for > 5 years were invited to participate in this study. Invitation letters and educational brochures were mailed to 4% of randomly selected eligible women from Taoyuan City, Taiwan, and responders received an HPV self-sampling kit. Those with HPV-positive results were recalled for a Pap smear and colposcopy. RESULTS: Between March 2010 and June 2012, 10,693 women were invited, 354 responded (3.3%), and 282 (2.6%) gave valid informed consent, answered the questionnaire, and submitted HPV samples. The median age of enrolled women was 48.1 years. Forty-seven women (16.7%) had a positive HPV test, and 14 women accepted further survey to find two CIN2+. Another two cases of CIN2+ were identified from a national registry database. The cost of direct mailing self-samplers was less than that done on request (from NT$434,866 to NT$164,229, response rate of 5% to 15%, respectively, versus NT$683,957 for detecting 1 CIN2+). Reasons for not attending screening included lack of time, embarrassment, assumed low risk, fear of positive results, and perceived potential pain. Among the responders, 90.8% found the method acceptable. CONCLUSION: Our study indicated that different approaches (e.g., direct mailing self-samplers to under-users and/or various educational interventions) must be explored to improve coverage in populations with culture characteristics similar to Taiwan.

Prevalence and Risk Factors of Chronic Kidney Disease in Patients With Type 2 Diabetes in China: Cross-Sectional Study.

BACKGROUND: Chronic kidney disease (CKD) is a significant long-term complication of diabetes and is a primary contributor to end-stage kidney disease. OBJECTIVE: This study aimed to report comprehensive nationwide data on the prevalence, screening, and awareness rates of CKD in Chinese patients with type 2 diabetes, along with associated risk factors. METHODS: Baseline data analysis of the ongoing prospective, observational IMPROVE study was conducted. The study cohort comprised patients who had been diagnosed with type 2 diabetes more than 12 months prior, received at least 1 hypoglycemic medication, and were aged ≥18 years. The participants completed questionnaires and underwent laboratory assessments, including blood and urine samples. The data encompassed patient demographics, medical history, concurrent medications, and comorbidities. Comprehensive evaluations involved physical examinations, urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), fasting blood glucose, 2-hour postprandial blood glucose, fasting blood lipid profile, and urinalysis. Descriptive statistics were applied for data interpretation, and logistic regression analyses were used to identify the CKD-associated risk factors in patients with type 2 diabetes. RESULTS: A national study from December 2021 to September 2022 enlisted 9672 participants with type 2 diabetes from 45 hospitals that had endocrinology departments. The enrollees were from diverse regions in China, as follows: central (n=1221), east (n=3269), south (n=1474), north (n=2219), and west (n=1489). The prevalence, screening, and awareness rates of CKD among patients with type 2 diabetes were 31% (2997/9672), 27% (810/2997), and 54.8% (5295/9672), respectively. Multivariate binary regression analysis revealed that the CKD risk factors were screening, awareness, smoking, age, diabetes duration, concurrent antihypertensive and microcirculation medications, diabetic complications (foot, retinopathy, and neuropathy), hypertension, elevated low-density lipoprotein (LDL) cholesterol, and suboptimal glycemic control. Subgroup analysis highlighted an increased CKD prevalence among older individuals, those with prolonged diabetes durations, and residents of fourth-tier cities. Residents of urban areas that had robust educational and economic development exhibited relatively high awareness and screening rates. Notably, 24.2% (1717/7107) of patients with an eGFR ≥90 mL/min/1.73 m2 had proteinuria, whereas 3.4% (234/6909) who had a UACR <30 mg/g presented with an eGFR <60 mL/min/1.73 m2. Compared with patients who were cognizant of CKD, those who were unaware of CKD had increased rates of HbA1c ≥7%, total cholesterol >5.18 µmol/L, LDL cholesterol >3.37 µmol/L, BMI ≥30 kg/m2, and hypertension. CONCLUSIONS: In a Chinese population of adults with type 2 diabetes, the CKD prevalence was notable, at 31%, coupled with low screening and awareness rates. Multiple risk factors for CKD have been identified. TRIAL REGISTRATION: ClinicalTrials.gov NCT05047471; https://clinicaltrials.gov/study/NCT05047471.

Offering on-site mammography in workplaces improved screening rates: Cluster randomized controlled trial.

OBJECTIVES: Despite evidence of breast cancer screening efficacy, the screening rate has remained less than 50% in Japan. This study aimed to evaluate the effect of an environmental approach offering on-site mammography in workplaces. METHODS: Supermarket stores were randomly assigned into two groups, the intervention group (leaflet and mammography) and the control group (leaflet). From May to July 2018, participants in the intervention group were given a leaflet informing them of the subsidies for breast cancer screening and offered the opportunity to have mammography in their workplaces. Participants in the control group were given the same leaflet, but had to arrange their own screening outside the workplace. The primary outcome was the breast cancer screening rate in 2018. The odds ratio (OR) and 95% confidence interval (CI) for having screening in the intervention group compared with the control group were estimated using multilevel logistic regression. RESULTS: We analyzed data from 1624 participants (mean age 53 years) from 25 supermarket stores (intervention: 8 stores, control: 17 stores). Among participants who had not attended screening in the previous year, the screening rate was 7% in the control group and 53% in the intervention group, with an adjusted OR (95% CI) of 14.22 (8.97-22.54). The effect was greater in those who had never attended screening before. CONCLUSION: In a worksite-based cluster randomized controlled trial in Japanese supermarket stores, an environmental approach offering mammography in workplaces substantially increased the breast cancer screening rate within 1 year (UMIN000030465).

Screening of ADHD symptoms in primary school students and investigation of parental awareness of ADHD and its influencing factors: A cross-sectional study.

Objective: The present study aimed to compare the differences in positive screening rates of attention deficit hyperactivity disorder (ADHD) symptoms between parents and teachers in the same sample of primary school students. Concurrently, parental awareness and information sources of ADHD were investigated, and possible relevant factors affecting parental awareness and their influence on positive screening rate of ADHD were analyzed. Methods: A cross-sectional study was conducted in Changchun, China, between September 2020 and January 2021. Parents of 1,118 primary school students and 24 head teachers were recruited in the survey. Data were collected through a structured self-administered questionnaire. It consisted of socio-demographic characteristics, ADHD symptom screening questionnaire, parental awareness, and information sources of ADHD. Results: Among the 1,118 primary school students, 30 (2.7%) and 60 (5.4%) students were positive for Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) screening in the parent version and teacher version, respectively. Parents had lower positive screening rates for ADHD symptoms than teachers. Relationship with children (mother, OR = 1.552, 95% CI = 1.104-2.180), bachelor degree or above of parents (OR = 1.526, 95% CI = 1.054-2.210), children's sex (girl, OR = 1.442, 95% CI = 1.093-1.904), and age (OR = 1.344, 95% CI = 1.030-1.754), children's grade (grade 2, OR = 0.522, 95% CI = 0.310-0.878; grade 3, OR = 0.388, 95% CI = 0.185-0.782), information sources of ADHD (medical staff, OR = 1.494, 95% CI = 1.108-2.015; family/relative/friend, OR = 1.547, 95% CI = 1.148-2.083; TV/Internet, OR = 3.200, 95% CI = 2.270-4.510) were the factors related to the parental awareness of ADHD. Conclusion: Parents and teachers of primary school students recognize ADHD symptoms differently. The positive screening rate of ADHD among teachers was significantly higher than that of parents. Relationship with children, educational level of parents, children's sex, age, and grade, and information sources of ADHD are the relevant factors affecting parental awareness of ADHD. More efforts should be made to disseminate ADHD knowledge through mass media, and medical staff. Fathers, parents with low educational level, and parents of grade 2 and 3 pupils should be encouraged to acquire more knowledge on ADHD to improve the early recognition rate of ADHD symptoms. Clinical trial registration: [http://www.chictr.org.cn/showproj.aspx?proj=54 072], identifier [ChiCTR2000033388].

A Multi-level Analysis of Factors Affecting Participation in Health Screenings in Korea: A Focus on Household and Regional Factors.

OBJECTIVES: This study divided the factors that affect participation in health screenings into individual, household, and regional levels and conducted a multi-level analysis to identify the factors related to participation in health screenings. METHODS: Participants from the 2017 Community Health Survey were classified into 2 groups (under 40 and 40 or older). A multi-level logistic regression analysis was conducted to identify the factors that affected participation in health screenings. RESULTS: The screening rate of the participants was 69.7%, and it was higher among participants aged 40 and older (80.3%) than it was among participants younger than 40 (49.8%). At the individual level, the factors that influenced participation in health screenings included age, economic activity, smoking status, physician-diagnosed hypertension, and a moderate or high physical activity level. At the household level, the odds ratio of participation in health screenings was high for participants who lived in single-person households, lived with a spouse, earned a high monthly household income, and were not beneficiaries of national basic livelihood security. At the regional level, the odds ratio at the 95% confidence interval level of participation in health screenings was high for participants who had trust in the local community and lived in an area with a proportionally high social welfare budget. CONCLUSIONS: This study analyzed nationalwide data and confirmed that individual, household, and regional characteristics affected participation in health screenings. Therefore, policies that prioritize the improvement of regional level factors and especially household level factors are likely to be the most effective for improving the screening rate.

Disparity of Cervical Cancer Risk in Young Japanese Women: Bipolarized Status of HPV Vaccination and Cancer Screening.

Women born between 1994 and 1999 achieved high vaccination rates for human papillomavirus (HPV); they are now reaching the age of cervical cancer screening programs in Japan. In this study, we aimed to investigate the health awareness of HPV-vaccinated and unvaccinated women and to create tailored leaflets recommending cervical cancer screening for each. Surveys on the cancer screening rates for HPV-vaccinated and unvaccinated women aged 20 and 21 have demonstrated that the rate was significantly higher (p < 0.01) in vaccinated (6.2%) than in unvaccinated women (3.1%). Next, interviews and Internet questionnaires clarified that there was a trend that vaccinated women have a better health consciousness than the unvaccinated ones, and that in unvaccinated women, their willingness to receive cervical cancer screening was significantly enhanced by the fear of developing cancer. Finally, in a prospective study, the increase in the screening rate for both vaccinated and unvaccinated groups after they read tailored leaflets, from 6.4% to 7.4% and from 3.9% to 5.1%, respectively, was not statistically significant compared to the groups provided with a standard reminder letter. Cervical cancer control measures might be enhanced by recommending cervical cancer screening in ways better tailored to HPV vaccination status.

Newborn hearing loss in the south of China: a cross-sectional study.

OBJECTIVE: Newborn hearing screening can identify congenital deafness and hearing loss. The current status of newborn hearing screening in the south of China is unclear. We aimed to assess the hearing loss of newborns in Dongguan, China. METHODS: A total of 62,545 newborns were enrolled in this retrospective, cross-sectional study between September 2015 and August 2020. The screening procedure was carried out using a two-step hearing screening. The trends were examined by the Cochran-Armitage trend test. RESULTS: From 2015 to 2020, the total initial newborn hearing screening rate was 98.16%, and it significantly increased over time (Z = 2.488). The initial screening pass rate of newborns was 90.08%, and no significant difference was observed in the initial screening pass rate between different years (Z = 0.845). After two-step hearing screening, the overall hearing screening pass rate of newborns was 94.65%. The overall hearing screening pass rate in normal newborns was higher than that in high-risk newborns (95.70% vs. 93.59%). CONCLUSION: The initial newborn hearing screening rate increased yearly in the study period, but there was still an approximately 10% referral rate. The initial screening pass rate in China needs to be further improved.

Lung Cancer Screening Registry Reveals Low-dose CT Screening Remains Heavily Underutilized.

BACKGROUND: Since 2013, the United States Preventive Services Task Force has recommended annual screening for lung cancer in high-risk patients with low-dose computed tomography (LDCT). Current literature has provided estimates of the lung cancer screening rate and only prior to appropriate insurance coverage for LDCTs. The aim of this study was to use newly established registry data to assess the lung cancer screening rate across the United States. MATERIALS AND METHODS: Using data from the Lung Cancer Screening Registry provided by the American College of Radiology in 2016, we collected the total number of LDCT screens performed from all 1962 accredited radiographic screening sites. The 2015 National Health Interview Survey was used to estimate screening eligible smokers per United States Preventive Services Task Force criteria. These data were compared to calculate screening rate. RESULTS: In 2016, 2.0% of 7.6 million eligible smokers were screened. Rates varied by region from 1.1% in the West to 3.9% in the Northeast. The South consisted of 40.4% of eligible smokers and the most accredited screening sites (37%); however, their screening rate was among the lowest (1.7%) in the nation. Smoking cessation counseling was offered to 84% of screened current smokers prior to receiving LDCTs. CONCLUSIONS: Lung cancer screening remains heavily underutilized despite guideline recommendation since 2013, insurance coverage, and its potential to prevent thousands of lung cancer deaths annually.

Cervical cancer screening rate differs by HPV vaccination status: An interim analysis.

BACKGROUND: The incidence of cervical cancer has been increasing, especially in younger generation, in Japan. The females born between 1994 and 1999, who achieved rates of HPV vaccination approaching 70%, have become the target of cervical cancer screening programs. Here, we have analyzed the cervical cancer screening rates among the vaccinated and unvaccinated women. METHODS: The survey data for cervical cancer screening at age 20 in FY 2015 was derived from two cities, Toyonaka and Iwaki. RESULTS: Among 2,727 females, in Toyonaka and Iwaki, who were born in FY 1995 and targeted in FY 2015 at age 20 for cervical cancer screening, their HPV vaccination rate was 64.2% (1,753/2,727). The screening rate was 6.4% (112/1,753) in the vaccinated and 3.9% (38/974) in the unvaccinated. This difference was statistically significant (p < 0.01). CONCLUSIONS: We have demonstrated that HPV-vaccinated females tended to be effectively protected from future cervical cancer than the unvaccinated.

Quality monitoring and evaluation of neonatal diseasescreening in Zhejiang Province / 预防医学

Abstract@#Neonatal disease screening is a major tool for prevention of birth defects, and monitoring and evaluation of neonatal disease screening facilitates the improvements in screening quality and efficiency. A strict quality control of screening, diagnosis, treatment and follow-up of neonatal diseases is performed in Zhejiang Provincial Center for Quality Control of Neonatal Disease Screening. In this study, the data pertaining to screening of neonatal inherited metabolic diseases, hearing loss and congenital heart diseases were collected in Zhejiang Province from 2018 to 2020, and the screening rate, recall rate of suspected screening-positive neonates, and detection rate of diseases were calculated to assess the quality of neonatal disease screening. The screening rate and recall rate of neonatal inherited metabolic diseases, hearing loss and congenital heart diseases were high in Zhejiang Province, and the detection of screened diseases was stable, indicating a high overall quality of neonatal disease screening. Increasing the impact of neonatal disease screening and consolidating the screening achievements should be given a high priority during the future quality control of neonatal disease screening in Zhejiang Province.

Quality evaluation of tandem mass spectrometry screening for neonatalinherited metabolic diseases in Zhejiang Province from 2009 to 2021 / 预防医学

Objective@#To evaluate the quality of tandem mass spectrometry (MSMS) screening for neonatal inherited metabolic diseases in Zhejiang Province from 2009 to 2021.@*Methods@#The data pertaining to MSMS screening for neonatal inherited metabolic diseases in Zhejiang Province from 2009 to 2021 were collected from the database created by Zhejiang Provincial Center for Neonatal Disease Screening. The percentage of MSMS screening, percentage of recall of suspected screening-positive infants and incidence of neonatal inherited metabolic diseases were analyzed retrospectively to evaluate the quality of MSMS screening for inherited metabolic diseases.@*Results@#A total of 4 706 916 newborns were screened among 8 297 039 live births by MSMS in Zhejiang Province from 2009 to 2021, and the percentage of MSMS screening increased from 5.48% to 97.54%, with a mean percentage of 56.73%. Of 46 838 suspected screening-positive infants, 45 527 infants were recalled, and the percentage of recall increased from 94.57% to 98.62%, with a mean percentage of 97.20%. A total of 1 038 infants were definitively diagnosed with inherited metabolic diseases in Zhejiang Province from 2009 to 2021, with an overall incidence rate of 1/4 535, and the incidence rates of amino acid metabolic disorder, fatty acid oxidation metabolic disorder and organic acid metabolic disorder were 1/11 767, 1/13 763 and 1\15 902, respectively. Of the 11 cities in Zhejiang Province, the highest percentage of tandem mass spectrometry screening for inherited metabolic diseases was found in Hangzhou City (83.01%), and the highest percentage of recall of suspected screening-positive infants was se en in Zhoushan City (99.08%). @*Conclusions@#A high percentage of MSMS screening for neonatal inherited metabolic diseases was observed in Zhejiang Province from 2009 to 2021; however, there was a region-specific percentage of screening, and the recall of suspected screening-positive infants remains to be improved.

The Relationship between Cancer Screening Rates and Promotional Methods in Incheon Metropolitan City / 보건행정학회지

BACKGROUND: National cancer screening reduces mortality from stomach, colon, breast, and cervical cancer. However, cancer screening rates remain lower than 50% in Korea. This research was designed to make effective guidelines for cancer screening promotion to increase participation rate in cancer screening. METHODS: Data was collected from Incheon regional cancer center's telephone survey ‘Recognition of cancer prevention and control’ of 861 Incheon citizens over age 40. Logistic regression was used to analyse a relationships between cancer screening rates and promotional methods. PASW SPSS ver. 18.0 program (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. RESULTS: About 27.4% of respondents (236 of 861 respondents) have recognized the promotional program of Incheon regional cancer center for cancer screening participation. Cancer screening rate was associated with age group, educational level for stomach cancer, age group, bus advertisement (odds ratio, 1.19 to 2.75) for colon cancer, educational level, residential area for breast cancer, and age group for cervical cancer. CONCLUSION: There was relationship between stomach cancer screening rates and promotional methods. Therefore, cancer screening promotion guidelines to increase participation rate should be considered.

Screening results of neonatal diseases and exploration of management mode in Yichang in 2017-2019 / 公共卫生与预防医学

Objective To retrospectively analyze the results of neonatal diseases screening in Yichang from 2017 to 2019, understand the incidence and recall of the diseases, and explore the management mode of neonatal disease screening suitable for this region. Methods The subjects were newborns who were delivered in Yichang midwifery institutions from 2017 to 2019 and were screened for neonatal diseases. Heel blood of the newborns was collected for the screening of neonatal diseases, including congenital hypothyroidism (CH), phenylketonuria (PKU), G6PD deficiency, congenital adrenal hyperplasia (CAH) and thalassemia. Those newborns with positive initial screening were recalled for reexamination and confirmation. The recall rates of different diseases were compared by Chi-square test. Results There were 85 891 live births in Yichang area from 2017 to 2019, and 84 063 cases were screened for neonatal diseases, with a screening rate of 97.87%. A total of 6 043 cases were positive in the initial screening, of which 5,047 cases were recalled, with a recall rate of 83.52%. The recall rates of the traditional two diseases (CH and PKU) and the new three diseases (CAH, G6PD deficiency and thalassemia) were significantly different ( χ2= 197.93, P＜0.01). A total of 501 cases were diagnosed. The incidence rate of CH was 1/1,911, the incidence rate of PKU was 1/12 009, the incidence rate of CAH was 1/28 021, the incidence rate of G6PD deficiency was 1/1 121, and the incidence rate of thalassemia was 1/226. Conclusions The neonatal disease screening rate increased year by year in Yichang, but the recall rate of suspicious positive initial screenings decreased. It is necessary to explore a more suitable management mode for the five neonatal disease screenings in this region, improve the recall rate of children with positive screening, reduce the incidence of disabled children, and improve the quality of the birth population.

National Health Screening Program of Korea

National Health Screening Program of Korea for chronic diseases was started in 1980. During the last 20 years, the problems of the program has been discussed. The problems discusses were as follows: (1) The current guideline is based on weak rationale, without concrete evidence-based decisions (2), The goal of the screening program was not set based on evidence, and there has been no evaluation for the effectiveness of the program (3), the program consists of test items without the diseases (4), the program was run by separate municipalities, so it was not organized for the subjects, and finally (5), there has been no remarkable reduction in incidence or prevalence of the related diseases. To improve the program, there have been many efforts including new national screening program called 'National screening program for the transitional period' in 2007 and launching the National Health Screening Act in 2009. The brief history of the National Health Screening program of Korea was reviewed. The Goal of the National Screening program is to reduce the mortality and/or morbidity of the target disease. To achieve this goal, the basic aspects of the Program should be fulfilled. Proper Guidelines, high screening uptake rate, high quality, appropriate follow-up program were discussed. And national screening programs are not so commonly provided internationally. Only Japan provide national health screening program and Japanese program was renovated in 2008. The aim, contents and the procedure of the Japanese program was reviewed. Finally, the aspects that should be discussed for the improvement of the national health screening program was listed.

Cancer Screening Rate and Related Factors in Rural Area / 예방의학회지

OBJECTIVES: Cancer is the second most frequent cause of death in Korea. Cancer screening tests can save lives through early detection. Enhancing the cancer screening rate is an important strategy for reducing cancer mortality. The purpose of our study was to evaluate the screening rate and related factors in a rural area. The study investigated relationships between sociodemographic characteristics, several preventive behaviors, and the experience of several cancer screening behaviors. MATERIALS AND METHODS: The study population was recruited voluntarily from the three rural areas(Myen) in Chungju city. The participants completed structured questionnaire from July 21, 1998 to July 26, 1998. RESULTS: The proportions of the study population who had previously received stomach, liver, breast, or cervix cancer screening tests were 24.5%, 18.5%, 27.0%, 59.2% respectively. The 1-year screening rates of stomach, liver, breast, and cervix cancer were 7.4%, 6.8%, 8.6%, 15.6% respectively. In multivariate logistic analysis, some sociodemographic variables, preventive behaviors, or psychological variables were significantly associated with several cancer screening tests. Those who had previously received a stomach cancer screening test were significantly associated with the presence of chronic disease, physician? recommendation, use of alcohol family history of cancer, or previous liver cancer screening test. Those who had previously received a liver cancer screening test were associated with education level, physician? recommendation and previous stomach cancer screening test. Those who had received a cervix cancer screening test were significantly associated with education level, presence of a transportation vehicle, physician? recommendation use of alcohol and previous breast cancer screening test. And those who had received a previous breast cancer screening test were significantly associated with age, marital status, and earlier cervix cancer screening test. CONCLUSION: Based on the results of this study a strategy to promote cancer screening and health objectives at the district level can be made.

Factors Associated with the Use of Pap Test in a Rural Area / 예방의학회지

OBJECTIVES: To construct basic data to develop strategies for achieving higher Pap test coverage rate by evaluating factors associated with the use of Pap test through population-based survey. METHODS: 16.4%(671) of the 4,090 women, who were eligible population for this study, in 3 Myens of Chung-ju City participated in this study voluntarily from July 21 to 26, 1997. After basic physical examination by trained doctors, they were interviewed with structured questionnaire by well-educated interviewers. RESULTS: It shows that only 54.3% of study participants experienced Pap test. The strongest factor which is related with the use of Pap test was the history of having breast screening tests(aOR=8.71, 95% CI=4.25-17.84). Probability of ever having Pap test was also higher in married women(aOR of single=0.46, 95% CI=0.29-0.72), younger(Ptrend<0.05), more educated (Ptrend<0.001), non-smoker (aOR of smoker=0.26, 95% CI=0.12-0.55), women of ever having hepatitis test(aOR=2.60, 95% CI=1.73-3.88) in multiple linear logistic analysis. CONCLUSIONS: This study suggests that several factors significantly associated with the use of Pap test, and especially, high-risk population for cervical cancer such as women of older ages, less educated, living alone are less likely to have the Pap test. We should concentrate on encouraging high-risk women in the use of Pap test to improve Pap test coverage rate.