Journal of Preventive Medicine and Public Health

Original Articles

Multilevel Analysis of the Relationship Between Prescribing Institutions and Medication Adherence Among Patients With Hypertension and Diabetes in Korea: Haryeom Ghang, Juhyang Lee; J Prev Med Public Health. 2023;56(6):504-514. Published online October 5, 2023; DOI: https://doi.org/10.3961/jpmph.23.252

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Abstract Summary PDF Supplementary Material: Objectives
This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes.
Methods
This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients’ first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%.
Results
The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intraclass correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (p<0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples.
Conclusions
This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.; Summary

Korean summary
2019년 일반건강검진을 통해 발견된 고혈압과 당뇨병의 신규 환자를 대상으로 복약순응도를 분석하였다. 그 결과 검진 후 첫번째 처방기관이 의원인 경우에 비해 다른 종별 의료기관인 경우 복약순응 오즈비가 모두 감소하였는데 상급종합병원이 가장 낮았고(고혈압 0.30, 당뇨병 0.45), 그 다음은 검진전문의원인 것으로 나타났다(고혈압 0.51, 당뇨병 0.46).

Key Message
This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes using general health screening data in Korea in 2019. The results showed that with clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes).

Lung Cancer Screening With Low-dose Chest Computed Tomography: Experience From Radon-contaminated Regions in Kazakhstan: Alexandra Panina, Dilyara Kaidarova, Zhamilya Zholdybay, Akmaral Ainakulova, Jandos Amankulov, Dias Toleshbayev, Zhanar Zhakenova, Arman Khozhayev; J Prev Med Public Health. 2022;55(3):273-279. Published online April 14, 2022; DOI: https://doi.org/10.3961/jpmph.21.600

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Objectives
The aim of this study was to present the baseline results of a pilot project conducted to evaluate the effectiveness of lung cancer screening using low-dose chest computed tomography (CT) in regions with excessive radon levels in the Republic of Kazakhstan.
Methods
In total, 3671 participants were screened by low-dose chest CT. Current, former, and never-smokers who resided in regions with elevated levels of radon in drinking water sources and indoor air, aged between 40 and 75 with no history of any cancer, and weighing less than 140 kg were included in the study. All lung nodules were categorized according to the American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS 1.0).
Results
Overall, 614 (16.7%) participants had positive baseline CT findings (Lung-RADS categories 3 and 4). Seventy-four cancers were detected, yielding an overall cancer detection rate of 2.0%, with 10.8% (8/74) stage I and a predominance of stage III (59.4%; 44/74). Women never-smokers and men current smokers had the highest cancer detection rates, at 2.9% (12/412) and 6.1% (12/196), respectively. Compared to never-smokers, higher odds ratios (ORs) of lung cancer detection were found in smokers (OR,2.48; 95% confidence interval [CI], 1.52 to 4.05, p<0.001) and former smokers (OR, 2.32; 95% CI, 1.06 to 5.06, p=0.003). The most common histologic type of cancer was adenocarcinoma (58.1%).
Conclusions
Implementation of low-dose CT screening for lung cancer in regions with elevated radon levels is an effective method for both smokers and never-smokers.

Summary

Citations

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Lung cancer screening for never smokers: current evidence and future directions
Kay Choong See
Singapore Medical Journal.2024;[Epub] CrossRef
Secondary prevention and treatment innovation of early stage non-small cell lung cancer: Impact on diagnostic-therapeutic pathway from a multidisciplinary perspective
Giulia Pasello, Daniela Scattolin, Laura Bonanno, Francesca Caumo, Andrea Dell'Amore, Elena Scagliori, Mariaenrica Tinè, Fiorella Calabrese, Gaetano Benati, Matteo Sepulcri, Cristina Baiocchi, Michele Milella, Federico Rea, Valentina Guarneri
Cancer Treatment Reviews.2023; 116: 102544. CrossRef
Performance of Lung-RADS in different target populations: a systematic review and meta-analysis
Yifei Mao, Jiali Cai, Marjolein A. Heuvelmans, Rozemarijn Vliegenthart, Harry J. M. Groen, Matthijs Oudkerk, Marleen Vonder, Monique D. Dorrius, Geertruida H. de Bock
European Radiology.2023; 34(3): 1877. CrossRef

Determinants of Adherence to Diabetes Screening in Iranian Adults With a Positive Family History of Diabetes: Narges Malih, Mohammad-Reza Sohrabi, Alireza Abadi, Shahnam Arshi; J Prev Med Public Health. 2021;54(3):190-198. Published online April 7, 2021; DOI: https://doi.org/10.3961/jpmph.20.496

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Abstract PDF Supplementary Material

Objectives
Insufficient evidence exists regarding factors that affect screening adherence among people with a family history of diabetes, who comprise roughly half of all patients with diabetes. Therefore, we aimed to identify the determinants of diabetes screening adherence in adults with a family history of diabetes who had not yet been diagnosed with diabetes.
Methods
This cross-sectional study was conducted at selected urban primary healthcare facilities in Tehran, Iran. The study population was clinically non-diabetic adults above 20 years of age with a family history of diabetes in at least 1 first-degree relative. All eligible people identified on randomly-selected days of the month were invited to join the study.
Results
Among 408 participants, 128 (31.4%) had received a fasting blood glucose check during the last year. Using binary logistic regression, the independent predictors of screening adherence were knowledge of adverse effects of diabetes such as sexual disorders (odds ratio [OR], 3.05) and renal failure (OR, 2.73), the impact of family members’ advice on receiving diabetes screening (OR, 2.03), recommendation from a healthcare provider to have a fasting blood glucose check (OR, 2.61), and intention to have a fasting blood glucose check within the next 6 months (OR, 2.85). Other variables that predicted screening adherence were age (OR, 1.05), job (being a housekeeper; OR, 3.39), and having a college degree (OR, 3.55).
Conclusions
Knowledge of the adverse effects of diabetes, physicians’ and healthcare providers’ advice about the benefits of early disease detection, and family members’ advice were independent predictors of screening adherence.

Summary

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Socio-personal factors affecting adherence to treatment in patients with type 2 diabetes: A systematic review and meta-analysis
Nahid Shahabi, Yadolah Fakhri, Teamur Aghamolaei, Zahra Hosseini, Atefeh Homayuni
Primary Care Diabetes.2023; 17(3): 205. CrossRef
Clinical traits and systemic risks of familial diabetes mellitus according to age of onset and quantity: an analysis of data from the community-based KoGES cohort study
Ju-Yeun Lee, Kyungsik Kim, Sangjun Lee, Woo Ju An, Sue K. Park
Epidemiology and Health.2023; 45: e2023029. CrossRef
BİR ÜNİVERSİTE AKADEMİSYENLERİNİN SAĞLIK DAVRANIŞLARINA VE TARAMA PROGRAMLARINA UYUMU: KESİTSEL BİR ÇALIŞMA
Hatice İKİIŞIK, Sibel SAKARYA
ESTÜDAM Halk Sağlığı Dergisi.2022; 7(1): 98. CrossRef
Association between a family history of diabetes and carotid artery atherosclerosis in Korean adults
Sun Young Shim, Ga Bin Lee, Jee-Seon Shim, Sun Jae Jung, Hyeon Chang Kim
Epidemiology and Health.2021; 43: e2021049. CrossRef

Rates of Change to a Positive Result in Subsequent Screening Mammography in Korean Women: A Retrospective Observational Study: Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim, Yoon-Nam Kim, Chung Mo Nam; J Prev Med Public Health. 2015;48(1):48-52. Published online December 26, 2014; DOI: https://doi.org/10.3961/jpmph.14.042

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Abstract PDF: Objectives
This retrospective cohort study aimed at calculating some parameters of changes in the findings of the subsequent screening mammography (SSM) in female Korean volunteers.
Methods
The study included screenees aged 30 to 79 years who underwent SSM voluntarily after testing negative in the baseline screenings performed between January 2007 and December 2011. A change to a positive result was defined as category 4 or 5 by using the American College of Radiology Breast Imaging Reporting and Data System. The proportion of results that had changed to positive (CP, %) was calculated by dividing the number of cases with results that were positive in the SSM by the total number of study participants. The rate of results that had changed to positive (CR, cases per 100 000 screenee-months) was calculated by dividing the number of cases with results that were positive in the SSM by the total number of months of the follow-up period.
Results
The overall CP and CR in all age groups (n=77 908) were 2.26% and 93.94 cases per 100 000 screenee-months, respectively. The median CP interval in the subjects who had positive SSM results was 30 to 36 months, while that in the age group of 30 to 39 years was shorter.
Conclusions
Different screening intervals should be considered among women aged between 30 and 59 years. In addition, a strategy for a screening program should be developed for the age group of 30 to 39 years, in particular.; Summary

Mean Sojourn Time of Preclinical Gastric Cancer in Korean Men: A Retrospective Observational Study: Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim; J Prev Med Public Health. 2014;47(4):201-205. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.201

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Abstract PDF

Objectives
This retrospective cohort study aimed to estimate the mean sojourn time (MST) of preclinical gastric cancer in Korean men.
Methods
The subjects consisted of voluntary male screenees aged 40 to 69 years who underwent subsequent screening gastroscopies after testing negative at a baseline screening performed between January 2007 and December 2011. A new case was defined if gastric cancer cells were present in the biopsy specimens obtained from gastroscopy. The follow-up period was calculated as the number of person-years between the date of baseline screening gastroscopy and positive findings at a subsequent screening. The MST was calculated using transition rates of gastric cancer to determine the best screening interval.
Results
Of the 171 979 voluntary male screenees, 61 688 (36%) underwent subsequent screening gastroscopies between January 2007 and December 2011. A total of 91 incident cases were found during 19 598 598 person-years of follow-up. The MST of gastric cancer was 2.37 years (95% confidence intervals, 1.92 to 2.96), and those aged 40 to 49 years had a shorter MST than those 50 to 69 years did.
Conclusions
These findings support the 2-year interval of screening recommended by the nationwide gastric cancer screening program in Korea. Further studies for the age-specific MST among women are needed.

Summary

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The Clinical Impact and Cost-Effectiveness of Surveillance of Incidentally Detected Gastric Intestinal Metaplasia: A Microsimulation Analysis
Nikhil R. Thiruvengadam, Shashank Gupta, Seth Buller, Imad Awad, Devika Gandhi, Allison Ibarra, Gonzalo Latorre, Arnoldo Riquelme, Michael L. Kochman, Gregory Cote, Shailja C. Shah, Monica Saumoy
Clinical Gastroenterology and Hepatology.2024; 22(1): 51. CrossRef
Gastric Cancer Incidence and Mortality After Endoscopic Resection of Gastric Adenoma: A Nationwide Cohort Study
Jae Myung Park, Songhee Cho, Ga-Yeong Shin, Jayoun Lee, Minjee Kim, Hyeon Woo Yim
American Journal of Gastroenterology.2023; 118(12): 2166. CrossRef
Effect and cost-effectiveness of national gastric cancer screening in Japan: a microsimulation modeling study
Hsi-Lan Huang, Chi Yan Leung, Eiko Saito, Kota Katanoda, Chin Hur, Chung Yin Kong, Shuhei Nomura, Kenji Shibuya
BMC Medicine.2020;[Epub] CrossRef
Potential of non-invasive breath tests for preselecting individuals for invasive gastric cancer screening endoscopy
Agne Krilaviciute, Christian Stock, Marcis Leja, Hermann Brenner
Journal of Breath Research.2018; 12(3): 036009. CrossRef
Screening Upper Endoscopy for Early Detection of Gastric Cancer
Jeong Seop Moon
Journal of Korean Medical Science.2018;[Epub] CrossRef
Occurrence of gastric cancer in patients with atrophic gastritis during long-term follow-up
Liming Zhang, Yulan Liu, Peng You, Guijian Feng
Scandinavian Journal of Gastroenterology.2018; 53(7): 843. CrossRef
Ischemic Gastritis Improved by Supportive Care
Yun Sun Choi, Chan Soo So, Dong Hee Koh, Min Ho Choi, Hyun Joo Jang, Sea Hyub Kae, Jin Lee, Young Hee Choi
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2017; 17(2): 103. CrossRef
Optimal Interval for Repeated Gastric Cancer Screening in Normal-Risk Healthy Korean Adults: A Retrospective Cohort Study
Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim
Cancer Research and Treatment.2015; 47(4): 564. CrossRef
Methodological issues for determining intervals of subsequent cancer screening
Jong-Myon Bae
Epidemiology and Health.2014; 36: e2014010. CrossRef
Endoscopic Gastric Cancer Screening and Surveillance in High-Risk Groups
Il Ju Choi
Clinical Endoscopy.2014; 47(6): 497. CrossRef
Distribution of Dense Breasts using Screening Mammography in Korean Women: a Retrospecitive Observational Study
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Epidemiology and Health.2014; : e2014027. CrossRef

English Abstracts

Trend of Socioeconomic Inequality in Participation in Cervical Cancer Screening among Korean Women.: Soong Nang Jang, Sung il Cho, Seung Sik Hwang, Kyunghee Jung-Choi, So Young Im, Ji Ae Lee, Minah Kang Kim; J Prev Med Public Health. 2007;40(6):505-511.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.505

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Abstract PDF

OBJECTIVES
While cervical cancer is one of the leading cancers among women worldwide, there are a number of effective early detection tests available. However, the participation rates in cervical cancer screening among Korean women remain low. After the nationwide efforts in 1988 and thereafter to encourage participation in cervical cancer screening, few studies have investigated the effects of socioeconomic inequality on participation in cervical cancer screening. The purpose of this study was to investigate 1) the level of socioeconomic disparities in receiving cervical cancer screening by age group and 2) if there was an improvement in reducing these disparities between 1995 and 2001. METHODS: Using data from the Korean National Health Status, Health Behavior and Belief Survey in 1995, and the Korean National Health and Nutrition Examination Surveys from 1998 and 2001 (sample sizes of 2,297, 3,738, and 3,283), age-standardized participation rates were calculated according to education level, equivalized household income, and job status. Odds ratios and the relative inequality index (RII) were also calculated after controlling for age. RESULTS: Women with lower education levels were less likely to attend the screening test, and the disparities by education level were most pronounced among women aged 60 years and older. The RIIs among women 60 years and older were 3.64, 4.46, and 8.64 in 1995, 1998, and 2001, respectively. Higher rates of participation were reported among those in the highest income category, which was more notable among the middle aged women (40s and 50s). An inconsistent trend in the rate of participation in cervical cancer screening by occupational level was found. CONCLUSIONS: Indicators of socioeconomic position seem to have varying impacts on the inequalities in the rates of participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to eliminate the remaining inequalities.

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Educational Inequality in Female Cancer Mortality in Korea
Mi-Hyun Kim, Kyunghee Jung-Choi, Hyoeun Kim, Yun-Mi Song
Journal of Korean Medical Science.2015; 30(1): 1. CrossRef
Determinants of gastric cancer screening attendance in Korea: a multi-level analysis
Yunryong Chang, Belong Cho, Ki Young Son, Dong Wook Shin, Hosung Shin, Hyung-Kook Yang, Aesun Shin, Keun-Young Yoo
BMC Cancer.2015;[Epub] CrossRef
The Relationship between Socioeconomic Status and Gastric Cancer Screening in the Population of a Metropolitan Area
Hyun-Suk Oh, Sun A Kim, Sun-Seog Kweon, Jung-Ae Rhee, So-Yeon Ryu, Min-Ho Shin
Journal of agricultural medicine and community health.2013; 38(3): 174. CrossRef
Equity in health care: current situation in South Korea
Hong-Jun Cho
Journal of the Korean Medical Association.2013; 56(3): 184. CrossRef
Trends in Cervical Cancer Mortality by Socioeconomic Status in Korean Women between 1998 and 2009
Mi-Hyun Kim, Yun-Mi Song, Bo-Kyoung Kim, Sung-Min Park, Gwang Pyo Ko
Korean Journal of Family Medicine.2013; 34(4): 258. CrossRef
Socioeconomic disparity in cervical cancer screening among Korean women: 1998–2010
Minjee Lee, Eun-Cheol Park, Hoo-Sun Chang, Jeoung A Kwon, Ki Bong Yoo, Tae Hyun Kim
BMC Public Health.2013;[Epub] CrossRef
Predictors Associated with Repeated Papanicolaou Smear for Cervical Cancer Screening
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Asian Oncology Nursing.2013; 13(1): 28. CrossRef
Regional Factors Associated with Participation in the National Health Screening Program: A Multilevel Analysis Using National Data
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Socioeconomic Disparities in Breast Cancer Screening among US Women: Trends from 2000 to 2005
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Journal of Preventive Medicine and Public Health.2008; 41(3): 186. CrossRef

Factors Influencing the Intention to have Stomach Cancer Screening.: Myung Il Hahm, Kui Son Choi, Su Yeon Kye, Min Son Kwak, Eun Cheol Park; J Prev Med Public Health. 2007;40(3):205-212.; DOI: https://doi.org/10.3961/jpmph.2007.40.3.205

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Abstract PDF

OBJECTIVES
The purpose of this study was to identify the factors influencing the intention to have stomach cancer screening using the theory of planned behavior (TPB) in Korea. METHODS: For this population-based study, 1,535 adult respondents (aged 40 to 70 years) were recruited using multi-stratified random sampling and a face-to-face administered questionnaire. This study was based on Ajzen's theory of planned behavior. Intentions were divided into three scenarios for fee payment in the next two years: (1) free of charge, (2) co-payment, and (3) full charge. Multiple linear regression was used to identify the factors influencing the intention to have stomach cancer screening. RESULTS: Perceived behavioral control and attitude toward stomach cancer screening were significant predictors of the intention to have stomach cancer screening. However, subjective norm only influenced the intention to have stomach cancer screening with full charge in the next two years. CONCLUSIONS: The results suggest that attitude and perceived behavioral control are likely to contribute toward increasing the intention to have stomach cancer screening. Especially, perceived behavioral control is a good predictor. Because the study subjects were nation wide residents, the study results can be generalized.

Summary

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Asian Pacific Journal of Cancer Prevention.2014; 15(19): 8461. CrossRef
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Hyung-Kook Yang, Dong-Wook Shin, Seung-Sik Hwang, Juwhan Oh, Be-Long Cho
Journal of Korean Medical Science.2013; 28(3): 348. CrossRef
Factors Associated with Cancer Screening Intention in Eligible Persons for National Cancer Screening Program
Rock-Bum Kim, Ki-Soo Park, Dae-Yong Hong, Cheol-Heon Lee, Jang-Rak Kim
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Original Articles

Availability of the Time and Change Test in Screening for Dementia in the Elderly.: Jung Ae Rhee, Eun Kyung Chung, Min Ho Shin; Korean J Prev Med. 2003;36(2):101-107.

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Abstract PDF: OBJECTIVES
Dementia has emerged as a leading public health problem in elderly persons, and its early detection is important for the treatment of curable cases, and in the educational support for other family members. Although dementia screening tests are available, they have not gained widespread use in community or primary care settings. Our goal was to validate the Time and Change (T and C) Test, -including its validity and reliability in patients, and to assess it as a simple, standardized method for the screening of dementia in the rural elderly. METHODS: The participants in this study comprised of 59 patients from an urban hospital and 405 persons from a rural community aged 65 years or older. The time test evaluated the understanding of clock hands indicating 11: 10, and the change test the ability to make 1, 000 Won from a group of coins, consisting of one 500, seven 100, and seven 50 Won coins. The T and C ratings were validated against a reference standard based on the physician? diagnosis of the patients. The convergent validity in relation to other cognitive measure, test-retest agreement, and inter-observer reliability were assessed. To assess the relationship between the Korean Mini-Mental State Exam (K-MMSE) and the T and C Test, the mean K-MMSE scores were compared with the results of the T and C Test in the elderly from a rural community. RESULTS: The T and C Test had a sensitivity and specificity of 73.0, and 90.9%, and positive and negative predictive values of 93.1, and 66.7%, respectively. The test-retest and inter-observer agreement rates were both 95%. The K-MMSE scores and T and C Test were significantly related in the elderly from a rural community (p< 0.01). The T and C Test was not influenced by the educational status. The Time and Change Tests took a mean of 6.3 and 12.7 seconds, respectively, to complete. CONCLUSION: The T and C Test is a simple, accurate and reliable, performance-based tool in the screening for dementia. Because it is quick, and easy-to-use, it is hoped the T and C Test will be used for the widespread cognitive screening of aging populations.; Summary

Cost-Effectiveness Analysis of a Hyperlipidemia Mass Screening Program in Korea.: Yeon Soon Cha, Young Ho Khang, Moo Song Lee, Weechang Kang, Sung Hoon Jeon, Kee Lak Kim, Sang Il Lee; Korean J Prev Med. 2002;35(2):99-106.

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Abstract PDF: OBJECTIVE
Until now, there have been no evidence-based guidelines produced for the mass screening of hyperlipidemia cases in Korea. This study was done to find the most efficient strategy for a hyperlipidemia-screening program among Korean adults. METHOD: Seven alternative strategies for hyperlipidemia screening were formulated and compared in terms of cost-effectiveness. Cost and effectiveness were estimated from social perspectives and using a two-stage screening process (initial testing and additional testing for positives from the first test). A computerized database (based on persons who had visited a health promotion center in one teaching hospital for a routine health check-up) was used to determine the cost and the outcome of various strategies. Official data was used in calculating direct and indirect costs. Effectiveness was measured according to the number of persons who needed clinical intervention for hyperlipidemia. A stratified analysis, considering age group and sex, was then done. Sensitivity analyses, focusing on several uncertain parameters, were also done. RESULTS: Of the seven test alternatives available, the most cost-effective strategy was a screening program, which consisted of an initial test of total cholesterol,high-density lipoprotein cholesterol and triglyceride. There was some variation in the rank of the cost-effectiveness ratios for the seven alternatives dependent on age group or gender. CONCLUSIONS: Current hyperlipidemia screening practice, for National Health Insurance beneficiaries, tests only the total cholesterol level with a cut-off value of 260mg/dl as an initial screening test. It is not the best strategy for cost-effectiveness, and should be modified. Different screening strategies taking age group and sex into account should be developed and used for the efficient mass screening of hyperlipidemia cases among Korean adults.; Summary

Prevalence of Congenital Heart Disease from the Elementary Student Heart Disease Screening Program.: Hong Jue Lee, Myoung Hee Kim, Jo Won Jung, Seong Ho Kim, Bo Youl Choi; Korean J Prev Med. 2001;34(4):427-436.

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Abstract PDF: OBJECTIVE
To estimate the prevalence of congenital heart disease from the 1998 student heart disease screening program. METHODS: The heart disease screening program for elementary students was conducted in Kyonggi-do, in 1998. The subjects of the present study comprised the 40,402 students who attended the schools in the catchment area of a collaborative university hospital and who participated in the primary examination. The congenital heart disease (CHD) patients were initially identified through a questionnaire about prior medical history, and further through diagnostic tests & medical examinations in the secondary & the tertiary examinations. Certain assumptions were used in the estimation of the number of CHD cases among non-participants of the secondary & tertiary examinations. The overall prevalence of CHD was estimated by adding the CHD detection rates of the participants and the estimated prevalence of the non-participants. RESULTS: Among the 40,402 primary participants, 1,655 were referred further, of whom 79.1% (1,309) participated in the secondary examination. Of these, 121 were referred to the tertiary examination, with a participation rate at this last stage of 80.2%. The positive predictive value (PPV) of the screening tools was the highest when the results of both EKG and the questionnaire were positive. Because 85.9% of the detected cases had a past history of CHD, PPV was higher when the selection criteria in the questionnaire included past CHD history than when it didnt. The CHD detection rate among the participants was 1.76 cases/1,000 and the presumed number of cases among the non-participants was 31; giving an estimated final CHD prevalence of 2.52 cases/1,000 (95% CI : 2.06-3.06). Among the identified cases of CHD, VSD (52.8%) was the most common, followed by PDA (9.7%), TOF (9.7%) & PS (9.7%). CONCLUSION: Because the characteristics of the non-participants differed from those of the participants, the estimation of prevalence was influenced by the participation rate. Of the detected cases, 85.9% had a past history of diagnosis or operation for CHD. These findings suggested that the prevalence estimated in this study may be an underestimation of the actual condition. Therefore, a birth cohort study is required in order to more accurately estimate the prevalence and the effects of the program.; Summary

Analysis of Cancer Screening Recommendations by Physicians for Various Types of Cancer.: Yong Mun Park, Won Chul Lee, Keun Sang Yum, Jung Wan Koo, Hyeon Woo Yim, Kang Sook Lee, Hoon Kyo Kim; Korean J Prev Med. 2000;33(1):99-108.

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Abstract PDF: OBJECTIVES
The purpose of this study was to examine the present status of cancer screening recommendations(beginning age, interval, recommended screening methods, etc.) by physicians and analyze the association between physician's characteristics and the content of their recommendations. METHODS: Data were collected from March 1 to April 30 of 1997, and 373 physicians who were from different hospital settings all over Korea were interviewed by telephone about their screening recommendations for stomach, cervical and breast cancer for those who provided cancer screening services. RESULTS: For stomach cancer screening, respondents recommended that cancer screening begin at 40 years of age(57.8%), with a 1 year interval(77.2%), and by gastrofibroscopy (86.2%). For cervical cancer screening, respondents recommended that cancer screening begin at 25 years of age(42.0%), with a 1 year interval(67.8%), and by using a Pap smear(100.0%). For breast cancer screening, respondents recommended that cancer screening begin at 35 years of age(38.7%), with a 1 year interval(57.3%), and by mammography (97.3%). CONCLUSIONS: To establish appropriate cancer screening recommendations for Korea, it may be useful to consider the above results concerning medical care providers.; Summary

English Abstract

Factors Affecting National Health Insurance Mass Screening Participation in the Disabled.: Jong Hyock Park, Jin Seok Lee, Jin Yong Lee, Ji Young Hong, So Young Kim, Seong Ok Kim, Byong Hee Cho, Yong Ik Kim, Youngsoo Shin, Yoon Kim; J Prev Med Public Health. 2006;39(6):511-519.

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Abstract PDF: OBJECTIVES
As the disabled have higher prevalence rates and earlier onsets of chronic diseases than the nondisabled, their participation in mass screening is important for the early detection and intervention of chronic diseases. Nevertheless, in Korea, the disabled have lower participation rates in mass screening services than the nondisabled. The purpose of the study was to find determinants for the participation in the National Health Insurance (NHI) mass screening program among the disabled. METHODS: In this study, the NHI mass screening data of 423,076 disabled people, which were identified using the National Disability Registry (2003), were analyzed. Of the factors affecting the participation rates in mass screenings, the following variables were included for the analysis: socioeconomic stati, such as sex, age, category of health insurance program, region and income; disability characteristics, such as disability type, and severity. A multiple logistic regression analysis was used to evaluate the association between the participation rates, disability characteristics variables and demographic variables. RESULTS: The participation rate in mass screening of the disabled was 41.3%, but was lower in females, an age of more than 70 years, self-employed and for those with an average monthly insurance premium over 133,500 Won and in metropolitan regions. The participation rate was 1.31 times lower in females than males (95% CI=1.29-1.33); 3.50 times lower in the elderly (more than 70 years) than the younger (95% CI=3.33-3.67); 1.43 times lower in those who live in metropolitan areas (95% CI=1.40-1.46); 2.59 times lower for those in a health insurance program for the self-employed than for employees (95% CI=2.56-2.63); 1.19 times lower for the higher income (more than 133,500) than the lower income group (4,400-22,000) for the average monthly insurance premium (95% CI=1.15-1.23); 2.04 times lower for those with brain palsy and stroke disabilities than with auditory impairments (95% CI= 1.97-2.11) and 3.27 times for those with severe compared to mild disabilities (95% CI=3.15-3.40). CONCLUSIONS: The disabled with high severity, and locomotive and communication disabilities have lower participation rates in mass screening services in Korea.; Summary

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