Hepatocellular carcinoma (HCC) in patients with Non-Alcoholic Fatty Liver Disease (NAFLD): screening, treatment and survival analysis in a Brazilian series

Abstract Objective: The aim of the present study was to evaluate the clinical features, Hepatocellular Carcinoma (HCC) screening, treatment modalities, and Overall Survival (OS) in a series of Non-Alcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma (NAFLD-HCC) Brazilian patients. Methods: This was a cross-sectional study at the Instituto do Cancer do Estado de São Paulo, at the Faculdade de Medicina da Universidade de São Paulo with the approval of the local research ethics committee. NAFLD patients with HCC diagnosed, from May 2010 to May 2019, were included. Results: A total of 131 patients were included. Risk factors for NAFLD were present in 94.7% of the patients. Only 29% of patients were in the HCC screening program before diagnosis. HCC treatment was performed in 84.7% of patients. Cumulative survival at the end of the first year was 72%, second-year 52%, and fifth-year 32%. HCC screening before diagnosis was not significantly associated with higher cumulative survival. The independent factors associated with shorter general survival were BCLC C-D, p < 0.001, and the size of the largest nodule > 42 mm, p = 0.039. Conclusions: Although the efficacy of screening in our population regarding overall survival was hampered due to the sample size (29% had screening), BCLC stages C‒D and the size of the largest nodule larger than 42 mm were identified as independent factors of worse prognosis.

Implementation of newborn hearing screening in Rizal, Philippines, and Northern California: Lessons learned

Objective@#The universal newborn hearing screening program has been implemented in the Philippines for the past ten years. However, screening rates in the country are still low. The current study aimed to describe the universal newborn hearing screening program (UNHSP) delivery system in Rizal, Philippines, and Northern California. @*Methods@#The study utilized a case study research design using data triangulation of FGD, KII, and document review to characterize and compare the implementation of the Universal Newborn Hearing Screening Program in Rizal Province and Northern California. @*Results@#Several differences were found in the protocols for newborn hearing screening in Rizal, Philippines, and Northern California, including centralization of the program, availability of surveillance data, screening protocols, and tracking system. @*Conclusion@#There is an immense need to disseminate universal newborn hearing screening among healthcare practitioners and create a system to monitor and evaluate real-time data.

Knowledge, Attitude and Practice towards cervical cancer screening among healthcare providers in Luang Prabang and Salavan Provinces, Lao PDR / Lao Medical Journal

@#Objective: we aimed to assess the knowledge, attitude and practice (KAP) of healthcare providers (HCP) towards cervical cancer (CC) screening and to identify possible factors associated with its low utilization among women presenting at gynaeco-obstetrics units in the Lao PDR. Methods: A cross-sectional study was conducted between March - June 2018 on a sample of 85 (HCP) at gynaecology units in two provincial and eleven district hospitals in Luang Prabang (LPB) and Salavan (SLV) Provinces. Results: Of the 85 HCP, 63.4% were from SLV and 36.6% from LPB. 81% were females and mean ager was 32 years. Only 7% of them had good knowledge, 18.8% had good CC screening attitudes and only 1.2% had good CC screening practices. 36.2% of female HCP had been screened for CC and 48.3% had not been screened because they thought only those who had symptoms and risk factors should go for. The most common reasons for not conducting routine CC screening of patients were: lack of medical equipment (53.7%), and incompetent techniques (43.3%). HCP graduates and post graduates had a higher knowledge score (aOR = 4.09, 95% CI: 1.43-11.66, P = 0.008), and attitude score (aOR = 5.54, 95% CI: 1.55-19.75, p=0.008). Those, who had been working for more than 10 years, were more likely to have higher attitude scores (aOR = 6.07, 95% CI: 1.36-27.15, p =0.018). Conclusions: CC screening knowledge among HCP is generally fair. However, CC screening attitudes are still poor. Re-orientation courses on CC screening for HCP are urgently needed in order to move forward to the next steps in CC screening programs.

Retinopathy of prematurity: Maharashtra state model

This report describes the goal, activities, and outcomes of the Queen Elizabeth Diamond Jubilee Trust funded retinopathy of prematurity (ROP) program in the state of Maharashtra in collaboration with the Public Health Foundation of India, Hyderabad. The project was initiated in July 2016 with the goal of establishing a sustainable ROP program in the special newborn care units (SNCUs) in public health facilities of five districts. Between 2016 and 2018, ophthalmology and neonatology teams from five district hospitals (DHs) were trained by nongovernment partner hospitals in the state. Infrastructure was developed by procuring equipment for ROP screening/treatment, and awareness generation activities were conducted with a range of stakeholders. Eight ophthalmologists were trained to perform ROP screening (from five DHs and one medical college), and five neonatology teams (pediatricians and nurses) from the project hospitals were trained in best neonatal practices to prevent ROP. The Pune district's hospital was developed as an ROP treatment center. Toward the end of the project period, six new facilities had an established ROP program. The state health department is in the process of scaling up the ROP program to a larger geographic region to ensure universal ROP screening coverage in the state of Maharashtra.

Comparison of risk-assessment tools for cardio-cerebrovascular diseases (CVD) in male shipyard workers: a cross-sectional study

BACKGROUND: Periodic revision of assessment tools is essential to ensure risk assessment reliability and validity. Despite the recent revision of the Korea Occupational Safety and Health Agency (KOSHA) 2018, there is no evidence showing that the revision is superior to other cardio-cerebrovascular diseases (CVDs) risk-assessment tools for workplace health management. We conducted a comparative analysis using the Framingham risk score (FRS) as a gold standard to identify the most relevant CVDs risk-assessment tool for workplace health management. METHODS: We included 4,460 shipyard workers who had undergone a workers' health examination during January–December 2016. Risk levels for CVDs were calculated based on the FRS, KOSHA 2013, KOSHA 2017, KOSHA 2018 (2 methods), National Health Screening Program health risk appraisal (NHS HRA) 2017, and NHS HRA 2018. Study participants were categorized into low-risk, moderate-risk, or high-risk groups. Sensitivity, specificity, correlation, and agreement of each risk-assessment tool were calculated compared with the FRS as a gold standard. For statistical analyses, Spearman's rank correlation coefficient and the linearly weighted kappa coefficient were calculated. RESULTS: Sensitivity of the risk assessments was highest in the KOSHA 2018 (health risk appraisal [HRA]). The FRS showed correlation coefficients of 0.354 with the KOSHA 2013, 0.396 with the KOSHA 2017, 0.386 with the KOSHA 2018, 0.505 with the KOSHA 2018 (HRA), 0.288 with the NHS HRA 2017, and 0.622 with the NHS HRA 2018. Kappa values, calculated to examine the agreement in relation to the KOSHA 2013, KOSHA 2017, KOSHA 2018, KOSHA 2018 (HRA), NHS HRA 2017, and NHS HRA 2018 with the FRS, were 0.268, 0.322, 0.352, 0.136, 0.221, and 0.559, respectively. CONCLUSIONS: The NHS HRA 2018 risk calculation method is a useful risk-assessment tool for CVDs, but only when appropriate classification criteria are applied. In order to enhance the risk-group identification capability of the KOSHA guideline, we propose to apply the classification criteria set in this study based on the risk group definition of the 2018 Korean Society of Hypertension guidelines for the management of hypertension instead of the current classification criteria of the KOSHA 2018.

Newborn screening program and blood amino acid profiling in early neonates with citrin deficiency / 中华儿科杂志

Objective@#To investigate the profiles of blood amino acid and acylcarnitine in early neonates with neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) and the sensitivity of newborn screening, and to explore potential biochemical metabolic markers for newborn screening program.@*Methods@#Amino acid and acylcarnitine profiles in dried blood spots of newborn screening program were analyzed by tandem mass spectrometry (MS/MS). A total of 158 651 neonates born in Guangzhou from January 1, 2015 to June 30, 2019 were enrolled in this newborn screening program, and additionally 55 patients with NICCD confirmed by SLC25A13 gene analysis in Guangzhou Women and Children Medical Center were included in this study. NICCD screen-positive was defined as the cutoff value of citrulline (Cit) ≥ 30 μmol/L. The values of blood sampling time of the true positive group and those of the false negative group were compared by t-test. The levels of amino acid and acylcarnitine among different groups, including true positive group (Cit≥30 μmol/L), false negative group (Cit 21-<30 μmol/L and Cit<21 μmol/L) and the normal control group, were analyzed by F test, respectively.@*Results@#Among 158 651 neonates, 39 neonates were positive for NICCD screening. Three of them were confirmed NICCD and 4 cases were found to be false negatives. The positive predictive value was 7.7% and the sensitivity was about 43.0%. Among 55 patients with NICCD, 18 cases (18/55, 32.7%) were true positives and 37 cases (37/55, 67.3%) were false negatives based on the cutoff value of citrulline in the dried blood spots for newborn screening. The blood sampling time was significantly different between true positive group and false negative group ((4.28±1.6) vs. (2.98±0.74) d, t=4.06, P<0.01). The increased levels of tyrosine((176.0±98.4) μmol/L), methionine ((37.0±26.9) μmol/L) and phenylalanine ((133.0±80.9)μmol/L) in Cit≥30 μmol/L group (n=18) were significantly different as compared with those in the other three groups, respectively (F=117.0, 58.5, 135.0, P<0.01). The levels of arginine ( (10.0±9.2) , (11.0±9.3) , (9.0±17.8) μmol/L), valine ( (119.0±29.8) , (107.6±14.1) , (102±68) μmol/L) and leucine ( (167.0±37.1) , (161.0±37.7) , (163.5±180.6) μmol/L) were not statistically significant among groups of Cit≥30 μmol/L(n=18), Cit21-<30 μmol/L(n=7) and Cit<21μmol/L(n=30,P>0.05), but they were significantly higher than those of the normal control group ((4±3), (78±21), (114.0±31.5) μmol/L, n=1 000), respectively(F=30.1, 23.0, 29.8, P<0.01). Alanine (Ala) ( (150±50) , (156.0±30.2), (168±105), (152±52) μmol/L) levels showed no significant difference (F=0.86, P>0.05) but the ratios of Ala/Cit (1.52±1.44, 6.82±1.56, 12.06±7.71, 19.42±6.27) decreased significantly among the four groups (F=69.0, P<0.05). The acylcarnitine levels showed no statistically significant results among the different groups (P>0.05). With Cit≥30 μmol/L and Ala/Cit<7.5 as cutoff values, the number of screen-positive cases reduced from 39 to 22 cases with no additional false negative case. With Cit≥21 μmol/L and Ala/Cit<7.5 as cutoff values the number of screen-positive cases increased to 117 cases with 1 additional true positive.@*Conclusions@#The profiles of blood amino acid in early neonates with NICCD present the increased levels of multiple amino acids including citrulline, tyrosine, methionine and phenylalanine, and decreased ratio of Ala/Cit. Taking citrulline and ratio of Ala/Cit as screening markers can improve the positive predictive value appropriately. The limited sensitivity of NICCD newborn screening may be related to early blood sampling time.

Community outreach: An indicator for assessment of prevalence of amblyopia

Purpose: To study the prevalence, determine the magnitude, and cause of amblyopia among the children aged 6 months to 16 years in Kamrup district, Assam, India. Methods: Among a total of 39,651 children between 6 months and 16 years of age, door-to-door screening was conducted by trained workers. For children above 5 years of age who failed to read the 6/9 line, camps were conducted in the nearby schools. Children below 5 years of age were directly referred to the tertiary eye care institute. After visual acuity assessment at the institute, cycloplegic refraction and complete ophthalmic examination were done to rule out other causes of diminution of vision. Axial length measurement and corneal topography were performed in children with high refractive errors. Results: Of the total 39,651 children screened, 469 were diagnosed to have amblyopia at the camp and 223 were diagnosed at the institute. The prevalence of amblyopia was 1.75%. Amblyopia was more common among the males (52.50%) as compared to females. Maximum number of patients were found in the age group of 11–16 (63.58%). Refractive amblyopia was found to be the most common cause of amblyopia (45.29%). In children below 5 years, deprivation amblyopia and strabismic amblyopia were more common. Conclusion: Awareness of amblyopia among the parents is essential for early detection and treatment of the disease, which will, in turn, reduce the burden of childhood visual impairment.

Knowledge and Attitude of Parents of Preschool Children about Early Childhood Caries and Dental Caries Prevention / 대한소아치과학회지

To investigate knowledge and attitude of parents about early childhood caries and dental caries prevention, a questionnaire survey was conducted on 247 parents of children who had oral screening experience among 3 to 5 years old children in 3 kindergartens in Jeonju city.A total of 220 completed questionnaires were selected for final analysis. The overall perception of the parents about oral health of the children was 82.3 points (10.7 / 13) in terms of 100 points. There were statistically significant correlations between maternal age (p = 0.027), maternal education level (p = 0.002), household monthly income (p = 0.000) and maternal oral health knowledge level. The main source of oral health information was ‘dentist and dental hygienist’(83.6%) followed by ‘Web search’(22.3%).Compared with the previous studies, the level of knowledge of parents about oral health of the children was improved. However, in order to raise awareness of the parents about the poorly assessed items in this study, it is necessary to increase the participation rate by advertising the national dental screening program for infants and children and make efforts to improve the quality of oral health education in screening.

Regional Variation in National Gastric Cancer Screening Rate in Korea / 보건행정학회지

BACKGROUND: This study purposed to analyze regional factors related to gastric cancer screening rate provided by national cancer screening program in Korea. METHODS: The unit of analysis was administrative districts of si∙gun∙gu level. Dependent variable was regional gastric cancer screening rate provided by national cancer screening program, and regional variables were selected to represent the regional characteristics such as demographic, health behavior and status, socioeconomic, and health resource. Tobit regression was applied for the analysis. RESULTS: Analysis results showed that gastric cancer screening rate was varied depending on regions from 47.8% to 69.1%. Tobit regression showed that gastric cancer screening rate had negative relationships with smoking rate, financial independence rate, and National Health Insurance premium per capita. And regional gastric cancer screening rate had positive relationships with sex ratio and number of gastric cancer screening center. CONCLUSION: Regional characteristics should be considered in establishing regional policies for increasing the gastric cancer screening rate.

Level of radiation dose in university hospital non-insured private health screening programs in Korea

OBJECTIVES: The aim of this study is to evaluate radiation exposure resulting from the comprehensive health examinations of selected university hospital programs and to present basic data for research and management strategies on the health effects of medical radiation exposure. METHODS: Radiation-based diagnostic studies of the comprehensive health examination programs of ten university hospitals in Seoul, Korea, as introduced in their websites, were analyzed. The medical radiation studies of the programs were reviewed by radiologists. Only the effective doses of the basic studies were included in the analysis. The optional studies of the programs were excluded. RESULTS: Among the 190 comprehensive health examination programs, 132 programs (69.5%) included computed tomography studies, with an average of 1.4 scans. The average effective dose of radiation by program was 3.62 mSv for an intensive program for specific diseases; 11.12 mSv for an intensive program for cancer; 18.14 mSv for a premium program; and 24.08 mSv for an overnight program. A higher cost of a programs was linked to a higher effective dose (r=0.812). The effective doses of the examination programs for the same purposes differed by as much as 2.1 times by hospital. Inclusion of positron emission tomography–computed tomography was the most critical factor in determining the level of effective dose. CONCLUSIONS: It was found that radiation exposure dose from comprehensive health exam programs targeted for an asymptomatic, healthy public reached between 3.6 and 24 times the annual dose limit for the general public. Relevant management policies at the national level should be provided to minimize medical radiation exposure.

Effects of Disease Detection on Changes in Smoking Behavior

PURPOSE: This study was conducted to investigate the effect that detection of chronic disease via health screening programs has on health behaviors, particularly smoking. MATERIALS AND METHODS: We analyzed national health insurance data from 2007 and 2009. Subjects who were 40 years of age in 2007 and eligible for the life cycle-based national health screening program were included. The total study population comprised 153518 individuals who participated in the screening program in 2007 and follow-up screening in 2009. Multiple logistic regression analyses were conducted by sex, with adjustment for health insurance type, socioeconomic status, body mass index, diabetes, hypertension, hyperlipidemia, and family history of cardiovascular and/or neurovascular disease. RESULTS: Among men with smoking behavior changes, those newly diagnosed with hyperlipidemia were more likely to show a positive health behavior change, such as smoking cessation, and were less likely to have a negative behavior change (e.g., smoking initiation). Additionally, men newly diagnosed with diabetes showed lower rates of negative health behavior changes compared to those without disease. Body mass index (BMI)> or =25, compared to BMI<23, showed higher rates of positive health behavior changes and lower rates of negative health behavior changes. Newly diagnosed chronic disease did not influence smoking behavior in women. CONCLUSION: Smoking behavior changes were only detected in men who participated in health screening programs. In particular, those newly diagnosed with hyperlipidemia were more likely to stop smoking and less likely to start smoking.

Comparison of application of 3 nutrition screening methods in elderly in-patients / 中国实用护理杂志

Objective To identify the applicability of Traditional nutritional evaluation method,short-form mini-nutritional assessment (MNA-SF) and nutrition risk screening 2002 (NRS 2002) on screening malnutrition in elderly in-patients.Methods 100 elderly in-patients with malnutrition were screened by the above screening instruments.The evaluation effects of the 3 methods were compared by sensitivity,specificity and ROC curve.Results The detection rates of elderly in-patients with malnutrition by BMI,MNA-SF and NRS 2002 was 7％,58％ and 39％ respectively.Taking the human body measurement instrument as standard,the sensitivities of BMI,MNA-SF and NRS 2002 was 0.475,0.918 and 0.410respectively,the specificities was 0.615,0.103 and 0.641 respectively.3 tools series test sensitivity and specificities was 0.557 and 0.913 respectively,parallel test sensitivity and specificities was 0.929 and 0.435 respectively.Conclusions There is significant difference among the sensitivities of the 3 methods,NRS 2002 has the highest accuracy and is applicable to the screening of nutrition risks in elderly patients.Combined 3 kinds of tool can better improve the effect.

Effect of Instituting a Hospital Pre-discharge Bilirubin Screening on Subsequent Significant Hyperbilirubinemia in Term and Near Term Newborn.

Background: Neonatal Jaundice is a common disorder worldwide. Early identification and proper management is needed to prevent the serious neurological complications associated with it. Objective: The aim of this study is to assess the predictive ability of a pre-discharge serum bilirubin measurement to screen for subsequent significant hyperbilirubinemia in the term and near-term newborn. Materials and Methods: This is a historic cohort study conducted at Makassed General Hospital during two periods of time: January 2011 till December 2011, versus January 2013 till December 2013. A bilirubin screening program, instituted in February 2012, called for a total serum bilirubin to be performed on every neonate before discharge regardless of whether clinical jaundice was observed. For non-jaundiced neonates, the nursery staff was encouraged to obtain the screening total serum bilirubin at the sametime they obtained the hospital-mandated newborn screen for inborn errors of metabolism. Bilirubin values were plotted on an hour-specific nomogram. This study compared mean total serum bilirubin and hospital readmission data for two different periods before and after implementing the program. Results: The study involved 1200 neonates: 601 in period one and 599 in period two. After initiating the program, the mean peak of total serum bilirubin fell from 14.76 mg/dl to 11.03 mg/dl. Also the rate of hospital readmission with a primary diagnosis of jaundice fell from 10% in period one to 1.8% in period two. Conclusion: A pre-discharge total serum bilirubin applied as a policy in hospitals would facilitate targeted intervention and follow-up for indirect hyperbilirubinemiaina safe, cost-effective manner.

Puntos de corte de 17-hidroxiprogesterona en la detección de Hiperplasia Suprarrenal Congénita / Cut offs levels of 17-hydroxyprogesterone in screening of Congenital Adrenal Hyperplasia / Pontos de corte da 17-hidroxiprogesterona na detecção de Hiperplasia Adrenal Congênita

El presente estudio investiga la utilidad de determinar puntos de corte ajustados según la edad gestacional y el peso al nacer de neonatos (2-100 días) en la cuantificación de 17-hidroxiprogesterona en muestras de sangre seca en papel de filtro. Se analizaron los resultados de 6.266 determinaciones realizadas en el marco del Programa Nacional de Fortalecimiento de la Detección Precoz de Enfermedades Congénitas. Los datos se dividieron en cuatro grupos; Grupo 1: recién nacido pretérmino con bajo peso; Grupo 2: recién nacido pretérmino con peso normal; Grupo 3: recién nacido a término con bajo peso y Grupo 4: recién nacido a término con peso normal. Se establecieron puntos de corte diferentes a partir del cálculo del percentilo 99 de la distribución de frecuencias. Basado en este análisis se realizó la comparación de la tasa de resultados falsos positivos que se obtuvieron según el punto de corte establecido por el fabricante y los obtenidos en el estudio. Los nuevos puntos de corte obtenidos fueron: 217,72 nmol/L, 102,14 nmol/L, 61,62 nmol/L y 82,38 nmol/L para los grupos 1, 2, 3 y 4 respectivamente. Se evidenció una tasa total de falsos positivos del 1% con los nuevos puntos de corte, significativamente menor a la tasa del 6,2% obtenida al utilizar el punto de corte del fabricante. Esto puso en evidencia que el uso de puntos de corte adecuadamente establecidos para la población en estudio reduce significativamente las complicaciones derivadas de las repeticiones de análisis y eventualmente la tasa de recitaciones, lo cual es una importante contribución a la Salud Pública.

The present work studies the usefulness of determining adjusted cut-offs for the quantification of 17-hydroxyprogesterone in dried blood samples on filter paper, taking into account the gestational age and weight of the neonates. The results of 6266 determinations made within the framework of the National Program of Strengthening Early Detection of Congenital Disease were analysed. Data were divided into groups, Group 1: early established from the calculation of the 99 percentiles of the frequency distribution. New cutoff points were: 217.72 nmol/L, 102.14 nmol/L, 61.62 nmol/L and 82.38 nmol/L for groups 1, 2, 3 and 4 respectively. It showed a total rate of 1% false positives with the new cut-off points, which was significantly lower than the rate of 6.2% obtained using the manufacturer's cutoff. This revealed that the use of properly established cut-offs for the study of population reduces significantly the complications derived fromn analysis repetitions and eventually the recitation rate, which is an important contribution to Public Health.

O presente estudo investiga a utilidade de determinar pontos de corte estabelecidos conforme a idade gestacional e o peso ao nascer de neonatos (2-100 dias) na quantificação da 17-hidroxiprogesterona em amostras de sangue seco em papel filtro. Foram analisados os resultados de 6.266 determinações feitas no âmbito do Programa Nacional de Fortalecimento da Detecção Precoce de Doenças Congênitas. Os dados foram divididos em quatro grupos; Grupo 1: recém-nascido pré-termo com baixo peso, Grupo 2: recém-nascido pré-termo com peso normal, Grupo 3: recém-nascido a termo com baixo peso e Grupo 4: recém-nascido a termo com peso normal e foram estabelecidos pontos de corte diferentes a partir do cálculo do percentil 99 da distribuição de frequências. Com base nesta análise foi realizada a comparação da taxa de resultados falsos positivos obtidos conforme o ponto de corte estabelecido pelo fabricante e os obtidos no estudo. Os novos pontos de corte obtidos foram: 217,72 nmol/L, 102,14 nmol/L, 61,62 nmol/L e 82,38 nmol/L para os grupos 1, 2, 3 e 4, respectivamente. Tornou-se evidente uma taxa total de 1% de falsos positivos, com os novos pontos de corte significativamente menor do que a taxa de 6,2% obtida utilizando o ponto de corte do fabricante. Isto revelou que o uso de pontos de corte de forma adequada estabelecidos para a população em estudo reduz significativamente as complicações decorrentes das repetições de análises e eventualmente a taxa de repetição de novos encontros, o que é uma importante contribuição para a saúde pública.

The Appropriateness of the Items of Korean Ages and Stages Questionnaires (K-ASQ) Developmental Screening Test in Korean Infants and Children

PURPOSE: Since National Health Screening Program for Infants and Children in Korea started from November, 2007, the need to design a new tool that can timely identify infants and chlildren with possible delayed development has been emphasized. The developmental screening devices currently used in Korea are mostly adapted from foreign tests and could be considered inappropriate for children growing in a different cultural background. Therefore, we assessed the appropriateness of Korean-Ages and Stages Questionnaires (K-ASQ) items in Korean infants and children, as a preliminary study to develop a new developmental screening test tool. METHODS: Data on K-ASQ tests that were performed in multicenters as a National Health Screening Program in Korea were analyzed to measure (1) the item difficulty and norm relevance (2) the goodness of fit for factor structure (3) the sensitivity of item for developmental evaluation. A total of 1,696 subjects, 877 boys (51.7%) and 819 girls (48.3%) were studied and with about 50 boys and 50 girls for each age of months, the sample was relatively evenly distributed. RESULTS: Analysis of K-ASQ data showed that (1) The subjects scored higher when compared to the K-ASQ's original criteria. (2) The suitability of confirmative factor structure was insufficient, especially problem solving [x2=41.063, P<0.01, CFI (Comparative Fit Index)=0.929, TLI (Turker-Lewis index)=0.834, RMSEA (Root Mean Square Error Approximation)=0.152] and personal-social domains (x2=55.208, P<0.01, CFI=0.817, TLI=0.573, RMSEA=0.182). (3) Some questions did not show significant difference in the sensitivity of item for developmental evaluation among monthly age groups. CONCLUSION: According to the analysis of previous K-ASQ data, the appropriateness of the questionnaires is good in general, but some questions of problem-solving and personal social domains are not appropriate. We suggested the development of a new developmental screening test tool, which is suitable for Korean infants and children.

HPV vaginal self-sampling among women non-adherent to Papanicolaou screening in Chile / Autotoma vaginal para detección de virus del papiloma humano en mujeres no adherentes a tamizaje con Papanicolaou en Chile

OBJECTIVE: To evaluate acceptance, preference and compliance with referral of vaginal self-sampling for the detection of Human papillomavirus (HPV) among women non-adherent to Papanicolaou (Pap) screening in Santiago, Chile. MATERIALS AND METHODS: Using multistage sampling we identified women aged 30-64 years who reported not receiving a Pap test in the previous three years and offered them Pap testing at the health center or vaginal self-sampling for HPV testing at home. Self-collected samples were analyzed with hybrid capture. All HPV+ women were referred for colposcopy, biopsy and treatment when needed. RESULTS: 1 254 eligible women were contacted; 86.5% performed self-sampling and 8.1% refused; 124 women were HPV+ (11.4%: 95%CI 9.6-13.5) of whom 85.5% attended colposcopy; 12 had CIN2+ (1.1%: 95 %CI 0.5-1.7). CONCLUSION: HPV vaginal self-sampling can be easily implemented in Chile and could improve coverage, successfully reaching women who drop out of the screening program.

OBJETIVO: Evaluar la aceptación, preferencia y adherencia a seguimiento de la autotoma vaginal para detección del virus del papiloma humano (VPH) en mujeres inasistentes a Papanicolaou (Pap) en Santiago, Chile. MATERIAL Y MÉTODOS: Mediante un muestreo polietápico se identificaron mujeres entre 30 y 64 años inasistentes a Pap por < 3 años, invitándolas a realizarse un Pap en su centro de salud o una autotoma vaginal a domicilio. Las muestras fueron analizadas con captura de híbridos. Las mujeres VPH+ fueron referidas a colposcopía, biopsia y tratamiento en caso necesario. RESULTADOS: 1 254 mujeres elegibles fueron contactadas; 86.5% aceptó la autotoma vaginal y 8.1% la rechazó; 124 mujeres resultaron VPH+ (11.4%: IC95% 9.6-13.5) de las que 85.5% asistió a colposcopía; 12 tenían CIN2+ (1.1%: IC95% 0.5-1.7). CONCLUSIÓN: La autotoma vaginal para detección de VPH es implementable en Chile y su utilización podría mejorar la cobertura del programa rescatando a mujeres inasistentes.

Breast Cancer Risk Factors in a Defined Population: Weighted Logistic Regression Approach for Rare Events / 한국유방암학회지

PURPOSE: This study aimed to determine out risk factors for female breast cancer in a low socioeconomic population in Iran. METHODS: Between 2007 and 2009, a total of 25,592 women who were ensured by the Imam Khomeini Relief Foundation participated in this screening program. The characteristics of patients diagnosed with breast cancer (n=111) were compared with those of control cases (n=25,481). In this study, we used relogit analysis (rare event logistic regression) with a weighting method using program Zelig. RESULTS: Of 25,592 women, 3.9/1,000 had breast cancer, from which 38 were diagnosed during screening and 73 had already been diagnosed. The mean and standard deviation of age in breast cancer patients and in healthy controls were 49.18+/-8.86 years and 46.65+/-9.40 years, respectively. The findings based on the multivariate model revealed that the past history of ovarian cancer, hormone therapy, and first relatives with breast cancer were associated with increased risk for breast cancer. However, the use of oral contraceptive pills was found to be associated with reduced risk for breast cancer. CONCLUSION: Due to the rarity of the event in the population, relogit with a weighting method was used to investigate the major risk factors for breast cancer. These factors include oral contraceptive pill use, a history of ovarian cancer of the person under study, first relatives with breast cancer and hormone therapy.

Regional Factors Associated with Participation in the National Health Screening Program: A Multilevel Analysis Using National Data

High participation rates are important for maximizing the effects of a health screening program. Previous studies have suggested that individual or regional characteristics have effects on health behaviors. In this study, we investigated the determinants of participation in the National Screening Program for Transitional Ages by simultaneously analyzing individual and area-level factors by multilevel analysis. A total of 1,081,216 subjects, aged 40 and 66 yr and nested in 254 areas, were included. There was a significant variation in participation rates across the areas even after adjusting for individual and area-level variables. Among the individual-level variables, increasing age, sex, higher income, and mild disability grade were associated with a higher participation rate. In urban areas, the 40-yr-old group had higher participation rates than the 66-yr-old group. Deprived areas had significantly high participation rates for both age groups. The number of screening centers per 1,000 inhabitants had no significant effect on participation in the screening program. In conclusion, regional characteristics are associated with participation rates independent of personal features and regional factors have differential effects with respect to age. A multi-dimensional approach is recommended to promote participation in health screening programs.

Outcomes and Efficiency of National Gastric Cancer Screening Program in Korea

BACKGROUND/AIMS: The National Cancer Screening Program (NCSP) for Medicaid recipients has contributed to reduction of cancer-related mortality in Korea. Although biennial gastric cancer screening by endoscopy has been increasing in Korea as part of the NCSP, few studies have evaluated its efficiency. Therefore, we analyzed the outcomes and efficiency of the NCSP for gastric cancer using endoscopy in Korea. MATERIALS AND METHODS: We reviewed results from the NCSP for gastric cancer at Chung-Ang University Yong-San Hospital in Korea from March 2003 to March 2008. The study population comprised of Medicaid recipients more than 40 years old, who were taken from the National Health Insurance Corporation. RESULTS: A total of 7,278 asymptomatic subjects underwent endoscopy for gastric cancer screening. The mean age of the screened subjects was 51.3 years for men and 48.9 years for women. The male to female ratio of the screened subjects was 1.2:1. Gastric cancer was diagnosed in 32 (0.44%) of 7,278 subjects (22 men and 10 women). Their mean age was 54.4 years. Of these, 21 subjects (0.29%) were diagnosed as early gastric cancer (EGC) and 11 subjects (0.15%) were diagnosed as advanced gastric cancer. The proportion of EGCs among total gastric cancers was 65.6%. CONCLUSIONS: Despite accomplishments of the NCSP for gastric cancer in Korea, its effectiveness remains an issue. Efficiency and cost-effectiveness analysis will be needed for successful progression.

Control de la calidad en los programas de pesquisa de cáncer cérvicouterino / Quality control in screening programs for cervical cancer

La neoplasia maligna del cérvix es una de las pocas localizaciones de cáncer evitables, si se detecta antes de que progrese hacia la infiltración. La manera más eficiente de detección precoz es mediante un programa de pesquisa que facilite a la mujer, realizar una prueba citológica con calidad y regularidad y si esta resulta anormal, ofrecer las facilidades para acceder a una atención especializada y un tratamiento efectivo y su seguimiento evolutivo. El objetivo del presente artículo es exponer la utilidad de los métodos para el control de la calidad empleados en los programas de pesquisa de cáncer del cérvix para la detección de sus insuficiencias. Se muestran algunos factores y condiciones que deben tenerse en consideración en cada uno de los pasos a realizar, para que un programa de pesquisa de cáncer cérvicouterino resulte exitoso y cumpla con los objetivos propuestos para la disminución de la mortalidad por esta causa. Se menciona cómo calcular algunos índices útiles para asegurar la calidad en todo el proceso. Debe existir la medición de la calidad durante todo el proceso de pesquisa que permita la obtención de datos confiables y corregir las deficiencias detectadas

The malignancy of the cervix is †one of the few locations avoidable cancers, if detected before it progresses to the infiltration. The most efficient way of early detection is through a screening program to provide women undertaking a regular and quality Pap smear. If this test results abnormal, the program offers easier access to specialized care, effective treatment, and follow-up. The objective of this article is to present usefulness of methods for quality control used in screening programs for cervical cancer to detect their inadequacies. Here are some factors and conditions that must be considered in each of the steps to take, for a cervical cancer screening program to be successful and to meet the objectives proposed in reducing mortality due to this cause. This document contains some useful indexes calculated to ensure quality throughout the process. There should be the measurement of quality throughout the screening process that allows collecting of reliable data as well as correcting deficiencies