上海市社区居民大肠癌筛查分析

目的了解上海社区市民大肠癌筛查情况。方法对1000名符合筛查条件的居民由社区卫生服务中心使用《上海市社区居民大肠癌筛查危险度评估表》开展大肠癌患病风险评估,并进行大便隐血试验（FOBT）,对问卷结果和FOBT结果进行分析。结果 1000名居民中,女性560人,占总数56%;男性440人,占总数44%;评价高危险度的人占总样本的11.6%,其中男性55人,女性61人;FOBT检查为阳性的总样本的占2.8%;在这些人中患慢性疾病以及有一级亲属遗传史的比例明显高于普通人,男女差异无统计学意义,但患病可能性却与年龄呈现高相关;慢性便秘史、黏液血便史以及直系家庭癌症史与FOBT检验结果差异有统计学意义,OR值分别为4.38（95%CI：1.71-11.21,P〈0.05）,8.86（95%CI：2.37-32.96,P〈0.05）和4.89（95%CI：1.60-14.91,P〈0.05）。结论即使在危险评估中显示阴性的人群,仍有FOBT检查为阳性的可能性,大肠癌筛查工作中不能掉以轻心,同时对于检查为阴性的人群同样需要进行相关的预防和健康教育干预。     

Inanspruchnahme von Krebsfrüherkennungsuntersuchungen

A growing number of people in Germany participate in the cancer screening services offered by statutory health insurance. Using data from the first wave of the German Health Interview and Examination Survey for Adults (DEGS1), current levels of participation in cancer screening services were determined. DEGS1 (2008–2011) permits representative cross-sectional analyses to be performed. In DEGS1, persons who were entitled to different cancer screening services were interviewed on their awareness, participation and regular utilisation of cancer screening for different types of cancer. Overall, 67.2% of women and 40.0% of men participate regularly. Participation rates fluctuate to a great extent for individual types of cancer screening. Women participate in cancer screening more frequently than men do. For women, a better socioeconomic status was associated with higher participation rates. Participation rates improve with increasing age, meaning that the difference in participation rates between women and men becomes smaller. The current analyses present information on specifically targeted population groups to promote informed decision-making about cancer screening, so that participation rates can be improved further. The analyses thus provide an important basis for health policy measures. An English full-text version of this article is available at SpringerLink as supplemental.     

Participation in breast cancer screening: randomised controlled trials of doctors' letters and of telephone reminders

Abstract: The study used a randomised controlled trial to find out whether supporting letters from general practitioners accompanying the invitations from a screening centre affected participation in a population-based breast cancer screening program for women aged 50 to 64. A further randomised controlled trial compared the effect of postal reminders with telephone reminders for women who did not respond to an initial invitation to participate in the program. There were 482 women in the first trial and 641 in the second. Excluding women who were ineligible or could not be contacted, participation in screening was 71 per cent in the group which received letters from their general practitioners compared with 62 per cent in the group which did not receive letters (P = 0.059). In the group that received letters, 56 per cent were screened without a reminder compared with 43 per cent of the group that did not receive letters (P = 0.01). Fewer women who received letters from their general practitioners declined the invitation to be screened (P = 0.048). In the second trial, there was no difference in participation between the group receiving telephone reminders and the group receiving postal reminders. As in breast cancer screening programs in other countries, general practitioner endorsement of invitations increased participation in breast cancer screening. Postal reminders were as effective as telephone reminders in encouraging women who did not respond to an initial invitation to participate in screening.     

Colorectal Cancer Screening Adherence in African–American Men and Women 50 Years of Age and Older Living in Maryland

African Americans experience disproportionate incidence and mortality rates from colorectal cancer (CRC). This health disparity is partially explained by low participation in screening. This study aimed to identify factors influencing adherence to colorectal cancer screening among African Americans. Telephone interviews were conducted with African Americans living in Maryland (57% response rate). A total of 504 respondents agreed to participate. The survey primarily assessed participation in CRC screening, health beliefs and attitudes about CRC screening, and demographics. Nearly 77% of respondents reported being adherent to CRC screening guidelines. Of those not adherent, nearly 50% reported not ever receiving a physician recommendation to be screened. Having health insurance was a strong correlate of adherence. Study participants with greater perceived CRC risk were more likely to be adherent. Further, those who reported that they were caregivers were less likely to be adherent to screening. Findings indicate that those who were the primary care takers of children or disabled persons were less likely to participate in CRC screening. Efforts are needed to ensure that caregivers do not neglect their own preventive health, including CRC screening. Further, access to care and health insurance coverage also appear to be an important factor for participation in CRC screening. Ensuring that those who do not have adequate healthcare coverage are not excluded from participation in CRC screening due to cost should be an important priority if reduction in CRC health disparity is to be achieved.     

Risk factor and behavioral correlates of willingness to participate in cancer prevention trials

Because of the growing interest in prospective trials of dietary and chemopreventive interventions for cancer, we studied the characteristics of persons likely to participate in such investigations. The study population consisted of a random sample of 576 persons who had previously attended the Prevention-Detection Center at Roswell Park Memorial Institute to receive a cancer screening examination and a risk assessment. Data were collected using a mailed questionnaire. Of the respondents, 77% indicated some degree of interest in participating in a cancer prevention study involving dietary changes, 27% indicated a definite interest and 50% indicated a possible interest. A similar pattern of response was obtained with respect to participation in a cancer prevention study that involves subjects taking medication, such as vitamin supplements. The findings suggest that those who are the most interested in participating in cancer prevention research are more likely to (on average) be younger, better educated, have higher annual family incomes, be regular vitamin users, have greater awareness of the possible link between dietary practices and cancer risk, be more concerned about getting cancer, and be more likely to believe that changes in dietary practices can decrease the cancer risk. These findings may have important implications for the planning and conduct of prospective trials of cancer prophylaxis.     

Risk factor and behavioral correlates of willingness to participate in cancer prevention trials

Because of the growing interest in prospective trials of dietary and chemopreventive interventions for cancer, we studied the characteristics of persons likely to participate in such investigations. The study population consisted of a random sample of 576 persons who had previously attended the Prevention‐Detection Center at Roswell Park Memorial Institute to receive a cancer screening examination and a risk assessment. Data were collected using a mailed questionnaire. Of the respondents, 77% indicated some degree of interest in participating in a cancer prevention study involving dietary changes, 27% indicated a definite interest and 50% indicated a possible interest. A similar pattern of response was obtained with respect to participation in a cancer prevention study that involves subjects taking medication, such as vitamin supplements. The findings suggest that those who are the most interested in participating in cancer prevention research are more likely to (on average) a) be younger, b) better educated, c) have higher annual family incomes, d) be regular vitamin users, e) have greater awareness of the possible link between dietary practices and cancer risk, f) be more concerned about getting cancer, and g) be more likely to believe that changes in dietary practices can decrease the cancer risk. These findings may have important implications for the planning and conduct of prospective trials of cancer prophylaxis.     

Breast cancer beliefs of women participating in a television-promoted mammography screening project.

A survey of breast cancer and breast cancer screening beliefs was mailed to a random sample of 1,000 women who contacted a telephone bank in response to a television-promoted, reduced-cost mammography project. Beliefs and demographics of women in the sample who subsequently completed a mammogram were compared with those who did not. No statistically significant differences were found between participants (persons who completed a mammogram) and nonparticipants with respect to age, race, marital status, income, or educational preparation. Groups also did not differ significantly in the series of beliefs examined. Factor analysis revealed respondents' most salient beliefs about breast cancer and early detection of breast cancer. Evidence is presented to suggest a need for enhanced efforts to recruit minority group women to participate in mammography screening.     

The Influence of Gender on Colorectal Cancer Knowledge,Screening Intention,Perceived Risk and Worry Among African Americans in South Florida

The aim of this study was to examine if gender differences exist for colorectal cancer (CRC) knowledge, intention to screen, perceived risk and cancer worry among African Americans for CRC. African American males and females (N = 336) aged 45 years or older living in southeast Florida were recruited to participate in a cross-sectional survey that assessed intentions to screen as well as CRC knowledge, cancer worry, perceived risk. No significant differences were found between men and women in their intention to screen for CRC or in their worry about cancer. Results did suggest that men and women differed significantly about their understanding of CRC knowledge. Findings also showed that there were differences in perceived risk between genders, with female study participants possessing lower levels of risk than men. Study results suggest that future interventions need to ensure that females understand their risk for CRC and understand the benefits associated with CRC screening. Findings also suggest that interventions promoting CRC screening may need to be tailored if increased participation in CRC screening is to be achieved for women.     

Self-Selection Bias in an Epidemiological Study of Respiratory Health of a Rural Population

ABSTRACT

A common source of bias in epidemiological studies is self-selection or volunteer bias. The self-selection into cohorts for further investigation or for participation in a substudy may be an important source of selection bias. The objectives of this paper were to identify differences in selected demographic characteristics, individual and contextual factors, and variables related to respiratory health between study participants who were willing to participate in subsequent clinical and allergy testing and those who were not willing to participate. One hundred and fourteen households (207 individuals) from a small town and 54 households (99 individuals) from a nearby rural municipality participated in this study. One key informant from each household provided information about each adult in that household. The question being studied was: “We wish to find out more about respiratory health of rural people. We would like to invite you to perform breathing and allergy tests. Would you be willing to be contacted for breathing and allergy tests in a nearby location?” One hundred and four participants said “Yes” they would participate in the clinical studies, 144 said “No” they would not participate in the clinical studies, and 52 said “Would like more information” about the clinical studies. More than one half (53.8%) of male participants and 46.2% of female participants indicated that they would like to participate in breathing and allergy tests. A higher proportion of study participants (26.1% males, 30.8% females) in the lowest income category requested more information compared to those answering either “Yes” (15.7% for males, 20.5% for females) or “No” (18.5% males, 23.3% females) to the question being studied. Study participants who were willing to participate in further breathing and allergy tests had a higher proportion of self-reported chronic phlegm and ever had allergic reaction to things eaten than those who either said “No” or “Would like more information.” Among male study participants who said “Yes” to further participation, a higher proportion was exposed to one of the occupational exposures of interest compared to those who said either “No” or “Would like more information.” This pattern was not observed for females.     

Self-selection bias in an epidemiological study of respiratory health of a rural population

A common source of bias in epidemiological studies is self-selection or volunteer bias. The self-selection into cohorts for further investigation or for participation in a substudy may be an important source of selection bias. The objectives of this paper were to identify differences in selected demographic characteristics, individual and contextual factors, and variables related to respiratory health between study participants who were willing to participate in subsequent clinical and allergy testing and those who were not willing to participate. One hundred and fourteen households (207 individuals) from a small town and 54 households (99 individuals) from a nearby rural municipality participated in this study. One key informant from each household provided information about each adult in that household. The question being studied was: "We wish to find out more about respiratory health of rural people. We would like to invite you to perform breathing and allergy tests. Would you be willing to be contacted for breathing and allergy tests in a nearby location?" One hundred and four participants said "Yes" they would participate in the clinical studies, 144 said "No" they would not participate in the clinical studies, and 52 said "Would like more information" about the clinical studies. More than one half (53.8%) of male participants and 46.2% of female participants indicated that they would like to participate in breathing and allergy tests. A higher proportion of study participants (26.1% males, 30.8% females) in the lowest income category requested more information compared to those answering either "Yes" (15.7% for males, 20.5% for females) or "No" (18.5% males, 23.3% females) to the question being studied. Study participants who were willing to participate in further breathing and allergy tests had a higher proportion of self-reported chronic phlegm and ever had allergic reaction to things eaten than those who either said "No" or "Would like more information." Among male study participants who said "Yes" to further participation, a higher proportion was exposed to one of the occupational exposures of interest compared to those who said either "No" or "Would like more information." This pattern was not observed for females.     

Long-Term Follow-Up Effects of a School-Based Drug Abuse Prevention Program on Adolescent Risky Driving

This study examined long-term follow-up data from a large-scale randomized trial to determine the extent to which participation in a school-based drug abuse prevention program during junior high school led to less risky driving among high school students. Self-report data collected from students in the 7th, 10th, and 12th grades were matched by name to students' department of motor vehicles (DMV) records at the end of high school. The DMV data included the total number of violations on students' driving records as well as the number of "points" that indicate the frequency and severity of the violations. A series of logistic regression analyses revealed that males were more likely to have violations and points on their driving records than females, and regular alcohol users were more likely to have violations and points than those who did not use alcohol regularly. Controlling for gender and alcohol use, students who received the drug prevention program during junior high school were less likely to have violations and points on their driving records relative to control group participants that did not receive the prevention program. Findings indicated that antidrinking attitudes mediated the effect of the intervention on driving violations, but not points. These results support the hypothesis that the behavioral effects of competence-enhancement prevention programs can extend to risk behaviors beyond the initial focus of intervention, such as risky driving.     

西安地区肝癌高危人群筛查依从性调查及影响因素研究

目的 调查西安地区≥40岁肝癌高危人群筛查依从性,并探讨其相关影响因素。方法 采用方便抽样方法抽取西安市≥40岁且在当地居住时间≥3年的居民参与肝癌高危人群评估,并对评估结果为肝癌高危的居民进行血液甲胎蛋白检测和腹部超声检查,采用描述性分析和多因素分析方法对筛查结果、筛查依从情况及其影响因素进行分析。结果 本研究对西安地区36 187名常住居民进行肝癌高危人群筛查,其中6 514例居民评估为肝癌高危,肝癌高危率为18.00%。其中男性高危者比例高于女性,99.08%为汉族,96.65%为已婚,年龄≥60岁人群的肝癌风险更高,多为初中及以上文化程度,88.12%的BMI值为18.5～27.9 kg/m2,58.40%有吸烟史,43.71%有饮酒习惯,44.00%有家族肿瘤史,71.17%伴有慢性丙型肝炎,97.19%伴有慢性乙型肝炎。6 514例肝癌高危人群中有3 192例参加肝癌筛查,肝癌筛查依从性为49.00%。多因素Logistic回归分析结果显示年龄（OR=0.444）、BMI(OR=0.694、0.820)、吸烟（OR=1.177）、饮酒（OR=1.178）、伴有慢性乙型肝炎（...     

Views of a general population on mass screening for colorectal cancer: the Burgundy Study.

BACKGROUND. The success of a screening program depends on a number of factors, including the validity of the test, its efficacy, its feasibility, and the rate of compliance. Thus, it is important to determine the factors influencing compliance to the screening test in order to obtain a high participation rate. METHODS. A mass screening campaign for colorectal cancer using the Hemoccult test was conducted in Burgundy, France. One year later, a questionnaire was mailed to a random sample of the population to assess the views of the general public (870 persons who had not completed the Hemoccult test, 750 persons who had a negative test, and 100 persons who had a positive test). The compliance rate of this survey was 32.2% among persons who had not completed the screening test, 88.2% among persons with a negative result, and 98.0% among persons with a positive result. RESULTS. The main reason for not participating was not wanting to know more about their health status (34.3%). Of the factors credited with encouraging persons to perform the test, the most important ones were the practitioner's explanations (55.7%) and the leaflet sent by mail (42.5%). The impact of the media campaign was weak. A small portion of the population (4.3%) said that they were very anxious while waiting for the results. Among persons with a positive screening test, only 1.2% regretted having taken it. Among those who took the test, 94.2% said they were ready to do it again; and among those who did not take it, 36.7% would accept it at a second screening. CONCLUSIONS. The data suggest that overall the Hemoccult is well accepted, that the campaign did not upset the population, and that it is worthwhile at the second screening to include those who did not participate in the first screening test.     

Cancer prevention and screening behaviors in lesbians

The incidence of cancer diagnosis has increased in the United States highlighting the need for astute cancer prevention and screening behaviors. Previous literature has suggested that lesbians may not follow the American Cancer Society's (ACS) guidelines regarding prevention and screening for cancer due to disparity in access to care and increased use of alcohol and tobacco. The purpose of this study was to examine the cancer prevention and screening behaviors of lesbians using the ACS guidelines as the standards for comparison, and to determine factors that influence mammography screening. A 102-item self-report survey was distributed to lesbians nationwide using various methods including snowballing sampling techniques. The sample included 1139 self-identified lesbians from 44 states. In general, healthy lifestyle behaviors were followed. The majority of the women did not smoke, ate plenty of fruits and vegetables, ate protein sources low in fat and consumed alcohol at a moderate rate. However, safe sex practices were often not used by participants. Most women did have mammograms and Papanicolaou smears (PAP) as recommended; however, adherence to self-breast examination guidelines was not followed. Women who were older, had higher yearly incomes, did not smoke, performed regular self breast exams and had regular physical exams were most likely to have a mammogram. Over half of the women met American Cancer Society guidelines for prevention and screening for breast and cervical cancer. However, strategies are needed to increase compliance with these guidelines in order to improve cancer health outcomes.     

The Effectiveness of Alcohol Policies in 4-Year Public Universities

The objective of this study was to evaluate the type of alcohol policy in place in 4-year public universities against the odds of heavy drinking. Data was collected during the months of April-June 2010 using the Core Alcohol and Drug Survey. The participants included a random sample of undergraduate students from 4 public universities in the Midwest. Two of the universities had policies in place allowing the sale and use of alcohol on campus, and 2 universities had policies in place prohibiting the sale and use of alcohol. There were a total of 186 participants which included 63 males and 123 females. There was statistical significance in gender, age, and participation in sports against the odds of heavy drinking (P < .05). The type of policy in place was not significantly associated with the odds of heavy drinking. Even though there was an association between gender, age, and participation in sports with the odds of heavy drinking among college students in this sample, the type of alcohol policy (wet or dry) had no association. The results demonstrate the need for the implementation of alcohol prevention strategies, in addition to policy, to reduce the number of college students who drink heavily. It may be beneficial to target those alcohol intervention programs to the high risk groups such as males, over the age of 21, and those students who participate in sports.     

Public attitudes regarding willingness to participate in medical research studies

The recruitment of adequate numbers of people to participate in medical research studies is an ongoing problem for biomedical researchers. Although the general public has come to expect and demand that the biomedical community develop new, safe and effective approaches to the prevention and treatment of diseases, that same public is not aware of the important role that public participation plays in the development of medical advances. Much is known about willingness to participate in research studies from the perspectives of patients, survivors, and those at-risk for getting a particular disease. However, little is known about the attitudes and willingness of the general public to participate in medical research. Yet, it is this population that comprises the potential pool of participants for future treatment and prevention studies. In order to examine public attitudes toward and support for medical research, a random digit dial telephone survey was conducted with 489 persons in southwestern Pennsylvania. The survey measured the respondent's stated willingness to take part in a medical research study and the factors associated with willingness to participate. These included the respondent's health status, demographic characteristics, attitudes and beliefs about participation and their knowledge about the conduct of medical research. The results of the study indicate that 46% of those surveyed said that they would be willing to take part in a medical research study focusing on a new treatment for a specific disease that was of concern to them, 25% stated that they would not be willing and 29% stated that they were undecided regarding participation. However, under certain circumstances, such as having cancer, over half of those who were undecided said they would be willing to participate. The characteristics of those willing to participate in a medical research study differ from those not willing. Determinants of willingness include: having a relative or friend who has an illness, being middle aged (between 35-64 years old), prior experience with participation in a medical research study, having a favorable attitude toward the use of human subjects in medical research and beliefs that diverse types of persons participate in clinical trials. Those respondents who were undecided about joining a clinical trial, also have different characteristics than those who are not willing. The determinants of being undecided in contrast to not willing include: having at least a college degree, having a favorable or neutral attitude toward the use of humans in medical research and, believing that the well-being of participants is the primary concern of researchers. The findings of this study have both public policy and practice implications. From a policy perspective, medical research designed to develop new treatments for disease requires an evidenced-based approach for decision making. Such an approach can only succeed if adequate numbers of individuals are willing to participate in these studies. From a practice perspective, the current study suggests that opportunities exist to increase participation by targeting recruitment efforts not only toward the willing but also toward those who are undecided about participation in medical research studies. This would involve tailoring the content of communications to meet the specific characteristics and concerns of each of these two groups of individuals.     

2015—2019年陕西省居民恶性肿瘤死亡流行特征及减寿分析

目的了解陕西省居民恶性肿瘤死亡流行病学特征及寿命损失情况,为制定恶性肿瘤防治策略提供依据。方法数据来源于陕西省人口死亡信息登记管理系统中13个国家级死因监测点报告的恶性肿瘤死亡个案。运用Excel 2016和SPSS 25.0软件计算陕西省居民恶性肿瘤死亡率、标化死亡率、构成比、年度变化百分比(APC)及潜在减寿年数(PYLL)、潜在减寿率(PYLLR)、标化潜在减寿率(SPYLLR)、平均减寿年数(AYLL)、潜在工作损失年(WPYLL)、平均潜在工作损失年(AWPYLL)。结果2015—2019年陕西省居民恶性肿瘤年均死亡率为134.06/10万,标化死亡率为121.50/10万,占全死因的21.48%。男性年均死亡率(166.00/10万)高于女性(100.30/10万),差异有统计学意义(P<0.01)。2015—2019年陕西省居民恶性肿瘤死亡率呈上升趋势(APC=1.41%,P<0.01)。0~44岁年龄组恶性肿瘤死亡率处于较低水平,45岁后随年龄增长逐渐升高,75岁以后迅速升高。陕西省居民恶性肿瘤前5位死因依次为肺癌、胃癌、肝癌、食管癌、结直肠和肛门癌,共占恶性肿瘤死亡构成的72.35%。2015—2019年陕西省居民恶性肿瘤PYLL为393996.33人年、PYLLR为14.98‰,AYLL为11.17年,且男性均高于女性。2015—2019年陕西省居民恶性肿瘤WPYLL为149978人年,AWPYLL为4.25年,WPYLL男性高于女性,AWPYLL女性高于男性。结论肺癌、胃癌、肝癌、食管癌、结直肠和肛门癌是陕西省恶性肿瘤预防控制的重点工作,同时宫颈癌和乳腺癌对女性健康的影响不可忽视,应针对主要恶性肿瘤和重点人群开展综合防控措施。     

Participation in breast screening programs: a review

Despite recommendations by the American Cancer Society and other organizations for use of screening mammography, data on reported utilization of this procedure by American women show that these guidelines are not being met. We reviewed published studies that reported participation rates or that examined factors associated with participation in selected breast screening programs. In general, women at high risk due to age and family or personal history of breast disease were not more likely to participate in breast screening programs than women without those risk factors. The one group of variables that was fairly consistently associated with participation was the practice of other preventive health behaviors. Women who expressed more concern about their health and who were more knowledgeable about breast cancer screening and its benefits also were more likely to complete mammography. Approaches to increasing participation are discussed in the context of the literature on this subject.     

A population survey on a mass screening program for gastric cancer. 1. Population characteristics related to examination rates for the screening program

The types of examination received for gastric cancer during the past 3 years have been surveyed by a self-administered questionnaire among residents of a small town near Kitakyushu City. Among 3660 surveyed, 2205 subjects who completed the questionnaire are analyzed in this study. Examination rates of mass screening for males were higher than those for females. Males in their forties and fifties and females in their forties through sixties have higher examination rates than other age groups. Higher examination rates were seen in public officials and employees who have opportunities to receive the screening program at work site. On the other hand, among people without a job and housewives who have opportunities to receive a screening program offered only by the town hall, examination rates of the mass screening program were low. More people with a family history of cancer death were examined than those without a similar family history. There was no difference in the examination rates by the mass screening program between the people who took care of their health and those who did not. In order to raise examination rates for the mass screening program, it is essential to improve the systems of this program which can be easily accepted, and to educate residents in order to stimulate motivation for screening.     

Krebsfrüherkennungsuntersuchungen in Deutschland: Angebot und Inanspruchnahme

In Germany, approximately 227,000 women and 249,000 men developed cancer in 2014, and nearly 223,000 patients died from the disease that year. Many cancers are curable or have a very good prognosis when they are diagnosed at an early stage. This is where the concept of early detection examinations comes into play.This article describes the current conditions of and participation in examinations for the early detection of cervical, breast, skin, prostate, and colon cancer as provided by Germany’s statutory health services. Participation was derived from claims data from the statutory health insurance system as well as from Germany’s mammography screening program (MSP). The survey “German Health Update” (GEDA 2014/2015-EHIS) served as an additional data source. According to the claims data and considering the intended intervals, participation quotas among insured persons who are entitled to participate lie between 16% (colonoscopy) and 48% (Pap test). In 2015, 51.5% of invited women participated in the MSP. The results according to self-reports of the GEDA survey lie in part substantially higher. The results according to the claims data, the MSP, as well as the self-reports suggest that a large part of the population utilizes the examinations. Colon and cervical cancer examinations will be expanded as organized and quality-assured early detection programs with regular invitations and information on benefits and risks. These efforts should contribute to reaching eligible people who have thus far not participated.