Health Screening Participants Research Articles

From the IASLC Early Detection and Screening Committee Terminology Issues in Screening and Early Detection of Lung Cancer – IASLC Early Detection and Screening Committee Expert Group Recommendations

IntroductionTo facilitate global implementation of lung cancer (LC) screening and early detection in a quality assured and consistent manner, common terminology is needed. Researchers and clinicians within different specialties may use the same terms but with different meanings, or different terms for the same intended meanings. MethodsThe Diagnostics Working Group of the International Association for the Study of Lung Cancer Early Detection and Screening Committee has analyzed and discussed relevant terms used on a regular basis and suggests recommendations for consensus definitions of terminology applicable in this setting. We explored how to reach consensus to define relevant and unambiguous terminology for use by health care providers, researchers, patients, screening participants and family. ResultsTerms and definitions for epidemiological and health-economical purposes included: Standardized incidence and mortality rates, LC specific survival, long-term survival and cure rates, and overdiagnosis, overtreatment, undertreatment. Terms and definitions for defining screening findings included: Positive, false positive, negative, false negative and indeterminate findings and additional and incidental findings. Terms and definitions for describing parameters in screening programmes included: Opportunistic vs programmatic screening, screening rounds, interval/interim diagnoses, invasive and minimally invasive procedures. Terms and definitions for shared decision making included: LC screening – possible harms and risks and LC risk and modifiers prior and posterior to a measure. ConclusionsA common set of terminology with standard definitions is recommended for describing clinical LC screening programmes, the discussion about effectiveness and outcomes, or the clinical setting. The use of the terms should be clearly defined and explained.

Establishment of CA19-9 reference intervals in an apparently healthy adult population in Singapore.

CA19-9 is elevated in pancreatic cancer and other malignancies, and commonly used in clinical practice. Unfortunately, CA19-9 immunoassays are not harmonized, and reference intervals may differ between assays. The aim of this study was to establish the reference interval of the ADVIA Centaur/Atellica IM CA19-9 assay in an apparently healthy Singapore adult population. This is a retrospective cross-sectional study. De-identified data from Health Screening participants were extracted from our database. Subjects with biochemical results suggesting anaemia, diabetes mellitus, viral hepatitis or abnormal liver, and renal and tumour markers were excluded. Outlier and subclass analyses by age and sex were performed. CA19-9 reference limits and 90% confidence intervals were then determined for candidate subclasses. Data from 12,174 subjects (5846 males and 6328 females) were available after exclusion criteria were applied. CA19-9 results did not follow a normal distribution and were higher in females compared to males (P < .001). Although CA19-9 means were statistically different between certain age groups, the evaluable 99th percentile reference limits were not statistically different. The overall 99th percentile reference limits for the Centaur/Atellica CA19-9 assay was 37 U/mL for males 21-80years, and 60U/mL for females 21-80years. Our results suggest that separate CA19-9 reference intervals should be applied for males and females.

Development and validation of multivariable quantitative ultrasound for diagnosing hepatic steatosis

This study developed and validated multivariable quantitative ultrasound (QUS) model for diagnosing hepatic steatosis. Retrospective secondary analysis of prospectively collected QUS data was performed. Participants underwent QUS examinations and magnetic resonance imaging proton density fat fraction (MRI-PDFF; reference standard). A multivariable regression model for estimating hepatic fat fraction was determined using two QUS parameters from one tertiary hospital (development set). Correlation between QUS-derived estimated fat fraction(USFF) and MRI-PDFF and diagnostic performance of USFF for hepatic steatosis (MRI-PDFF ≥ 5%) were assessed, and validated in an independent data set from the other health screening center(validation set). Development set included 173 participants with suspected NAFLD with 126 (72.8%) having hepatic steatosis; and validation set included 452 health screening participants with 237 (52.4%) having hepatic steatosis. USFF was correlated with MRI-PDFF (Pearson r = 0.799 and 0.824; development and validation set). The model demonstrated high diagnostic performance, with areas under the receiver operating characteristic curves of 0.943 and 0.924 for development and validation set, respectively. Using cutoff of 6.0% from development set, USFF showed sensitivity, specificity, positive predictive value, and negative predictive value of 87.8%, 78.6%, 81.9%, and 85.4% for diagnosing hepatic steatosis in validation set. In conclusion, multivariable QUS parameters-derived estimated fat fraction showed high diagnostic performance for detecting hepatic steatosis.

Abstract P357: Hypertension At Rural Worksites - An Ongoing Problem

Introduction: The objective of this study is to determine the prevalence of undiagnosed or uncontrolled hypertension in participants through worksite-based health screening assessments in rural areas. It is estimated that, in rural communities, the prevalence of hypertension is 10% higher than urban areas. Through our SERVIRE Outreach Screening Program ( S topping E arly R eversible V ital organ damage I n R ural E astern North Carolina) we provide worksite-based health screenings for low-wage workers throughout eastern North Carolina. These screenings include assessment for hypertension and other associated comorbidities. Hypothesis: There are elevated rates of hypertension among those working in rural worksites in Eastern North Carolina. Methods: Rural worksites were identified for health screenings that included a series of questionnaires and biometrics. Screenings concluded with a one-on-one provider meeting to discuss attitudes about preventative care, screening results, and referrals as needed. Results: A total of 1132 individuals (45.2% Black) (56.2% male) participated in our ongoing screening clinics. Nearly seventy percent (68.1%) of participants reported seeing a healthcare professional within the previous year. Undiagnosed hypertension (SBP ≥140) was found in 259 (23.4%) participants and 185 (16.7%) participants had diagnosed but uncontrolled hypertension. Blood samples were obtained from 974 participants; elevated serum creatinine was found in 101 (9.6%) individuals. Conclusion: In conclusion, nearly half of the health screening participants had uncontrolled or undiagnosed hypertension. These high rates of hypertension were evident despite the majority of participants reporting having visited a healthcare provider within the previous year. Among screened patients, nearly one in ten had elevated serum creatinine, a marker of end organ damage. Future screenings will implement on site retinal exams as an additional tool to assess end organ damage. Our SERVIRE program provides convenient, worksite-based health screening to identify untreated hypertension among low-wage, rural workers in eastern North Carolina.

노인의 우울 증상이 일반 및 암 건강검진 수검에 미치는 영향

Objective: In this study, we investigate the effect of depressive symptoms in elderly on general and cancer health screening participation using the large epidemiological study data in South Korea.&#x0D; Methods: This study was conducted on 1,977 people who responded to a health examination questionnaire among 2,360 adults aged 60 or older who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) in 2020. Depressive symptoms were measured by the Patient Health Questionnaire-9 and classified as minimal (0-4), mild (5-9), and moderate and severe (10-27). To investigate the relationship between depressive symptoms and health screening participation, a multiple logistic regression model controlling covariates was used.&#x0D; Results: Compared to the group with minimal depressive symptoms, the mild group did not show a significant difference (odd ratio [OR]=0.71, 95% confidence interval [95% CI]=0.45-1.13), but the moderate to severe group showed a significant negative relationship with general health screening participation (OR=0.59, 95% CI=0.35-0.99). There was a significant negative relationship between depressive symptoms and cancer health screening participation (mild group OR=0.77, 95% CI=0.48-1.23; moderate to severe group OR=0.50, 95% CI=0.28-0.87).&#x0D; Conclusion: This study showed that people with depressive symptoms are less likely to get a general and cancer health screening. In order to promote health screening participation, policies that consider health behavior promotion programs and psychiatric interventions targeting moderate to severe depressive symptom groups are necessary

Factors Associated with Lack of Health Screening among People with Disabilities Using Andersen’s Behavioral Model

People with disabilities often have poorer health than the general population, and many do not participate in preventive care. This study aimed to identify the health screening participation rates of such individuals and investigate why they did not receive preventive medical services based on Andersen's behavioral model, using data from the Survey on Handicapped Persons with Disabilities. The non-participation health screening rate for people with disabilities was 69.1%. Many did not in health screening because they showed no symptoms and were considered healthy, in addition to poor transportation service and economic limitations. The binary logistic regression result indicates that younger age, lower level education, and unmarried as predisposing characteristics; non-economic activity as the enabling resources; and no chronic diseases, severe disability grade, and suicidal ideation as need factor variables were the strongest determinants of non-participation health screening. This indicates that health screening of people with disabilities should be promoted while takings into account the large individual differences in socioeconomic status and disability characteristics. It is particularly necessary to prioritize ways to adjust need factors such as chronic disease and mental health management, rather than focusing on uncontrollable predisposing characteristics and enabling resources among barriers to participation in health screening for people with disabilities.

Regional differences in health screening participation between before and during COVID-19 pandemic

Health screening is a preventive and cost-effective public health strategy for early detection of diseases. However, the COVID-19 pandemic has decreased health screening participation. The aim of this study was to examine regional differences in health screening participation between before and during COVID-19 pandemic and vulnerabilities of health screening participation in the regional context. Administrative data from 229 districts consisting of 16 provinces in South Korea and health screening participation rate of each district collected in 2019 and 2020 were included in the study. Data were then analyzed via descriptive statistics and geographically weighted regression (GWR). This study revealed that health screening participation rates decreased in all districts during COVID-19. Regional vulnerabilities contributing to a further reduction in health screening participation rate included COVID-19 concerns, the population of those aged 65+ years and the disabled, lower education level, lower access to healthcare, and the prevalence of chronic disease. GWR analysis showed that different vulnerable factors had different degrees of influence on differences in health screening participation rate. These findings could enhance our understanding of decreased health screening participation due to COVID-19 and suggest that regional vulnerabilities should be considered stringent public health strategies after COVID-19.

Factors associated with cervical cancer screening behaviors among young married female (aged 20-29) immigrants in South Korea.

To identify factors that affect the participation of female immigrants in their 20s in the national cervical cancer screening programs. Data were obtained from the National Health Insurance Services from 2016 to 2017. A total of 17,730 women who agreed to undergo cervical cancer screening during 2016-2017 were included in the study. Of the 17,730 women, 8,149 (46%) participated in cervical cancer screening, whereas, 9,581 (54%) did not. Logistic regression analysis of factors related to cervical cancer screening showed that the odds ratio (OR) of screening was higher in short duration of stay (OR, 1.18; 95% confidence interval [CI], 1.03-1.35), Chinese nationality (OR, 1.43; 95% CI, 1.28-1.59), unemployment (OR, 1; 95% CI, reference), participation in general health screening (OR, 4.16; 95% CI, 3.24-5.33), and comorbidities (OR, 1.16; 95% CI, 1.09-1.24) when compared to the other populations. The highest OR was associated with participation in general health screening. Appropriate programs should be developed to increase participation of socially vulnerable groups in cervical cancer screening. Such programs will improve awareness regarding cervical cancer screening and reduce disparities in healthcare.

Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions.

Screening is an essential prevention practice for a number of health conditions. However, screening coverage remains generally low. Studies that investigate determinants of screening participation are becoming more common, but oftentimes investigate screening for health conditions in an individualized rather than integrated fashion. In routine clinical practice, however, healthcare professionals are often confronted with situations in which several screening procedures are recommended for the same patient. The consideration of their common determinants may support a more integrated screening approach. The objectives of this umbrella review were therefore to examine: 1) the determinants (barriers and facilitators) that have been identified in relation to recommended health screening procedures; and 2) the modifiable determinants (in primary care) common across health conditions or specific to individual procedures. Results were presented through a narrative synthesis. PubMed, PsycInfo and Cochrane weresearched up to January 2022. Systematic reviews reporting determinants of participation in health screening procedures with grade A or B recommendation according to the US Preventive Services Task Forcewere included. A total of 85 systematic reviews were included, most which contained both qualitative and quantitative studies on determinants that describe individual factors (961 occurrences), social factors (113 occurrences, healthcare professional factors (149 occurrences), health system factors (105 occurrences) and screening procedure factors (99 occurrences). The most studied screening procedures concerned cervical cancer/human papillomavirus (n = 33), breast cancer (n = 28), colorectal cancer (n = 25) and the human immunodeficiency virus (n = 12). Other conditions have been under-studied (e.g. cardiovascular problems, lung cancer, syphilis). The individual domain, including determinants such as knowledge, beliefs and emotions, was the most covered across health conditions. Healthcare professional's recommendations and the quality of patient-provider communication were identified to have a strong influence on screening participation in most conditions. The other three domains included determinants which were more specific to a condition or a population. Various determinants modifiable in primary care were found in the individual domain and in the health system, healthcare professional and screening procedure domains. Quality was assessed as low for most systematic reviews included. The identification of various modifiable determinants common across conditions highlights the potential of an integrated screening participation approach. Interventions may address common determinants in a broader person-centred framework within which tailoring to specific procedures or populations can be considered. This approach needs to be explored in intervention studies. The systematic review registration is PROSPERO CRD42019126709.

The Relationship Between Health Changes and Community Health Screening Participation Among Older People.

The utilization of health screening and other community health services has been a hot topic in China. Thus, this study examined the effect of health changes (self-rated health, physical health, and mental health) on older people's community health screening participation in China. We derived the data from the 2016 and 2018 waves of the Chinese Longitudinal Aging Social Survey (CLASS). This paper included 10,992 observations in two waves. We tested the causal relationship using the fixed effects model. Approximately 29.56% of the respondents participated in a health screening. Notably, after controlling for covariates, changes in mental and physical health both significantly influenced seniors' participation in health screenings (self-rated health: β = 0.188, 95% CI [−0.037, −0.413]; physical health: β = 0.078, 95% CI [0.032, −0.124]; mental health: β = 0.034, 95% CI [−0.057, −0.002]). The findings showed age, educational level, income level, and family support to be significant factors associated with community health screening participation. Additionally, we identified a partial mediating effect of mental health between self-rated health and health screening participation and a partial mediating effect of depression between physical health and health screening participation. The results highlight the important role of health changes in influencing participation and promoting health screening in China. On this basis, healthcare providers in the community may consider health changes as a screening criterion to promote health screening, guiding other health promotion and prevention programs while promoting healthy aging.

An analysis of health inequalities depending on educational level using nationally representative survey data in Japan, 2019

BackgroundIn recent years, socioeconomic differences in health statuses and behaviors have not been investigated from the nationally representative survey data in Japan. In this study, we showed differences in representative health behaviors and statuses depending on educational level using a nationally representative survey data in Japan.MethodsAggregated (not individual level) data from the Comprehensive Survey of Living Conditions in 2019 were used to examine the association between educational level and outcome status of psychological distress (K6 scores > = 5), self-rated health, smoking, alcohol drinking, and cancer screening participation (stomach, lung, colorectal, breast, and uterine cancers). Data of 217,179 households in Japan were aggregated by the Ministry of Health, Labour, and Welfare in the survey, and the data of the estimated number of household members and persons corresponding to each response option for the questions in all of Japan were used. Five-year age groups from 20 to 24 to 80–84 years and over 84 years were analyzed, and the prevalence or participation rate by educational level were calculated. In addition, the age-standardized prevalence or participation rate according to educational level were also calculated by sex. Moreover, a Poisson regression model was applied for evaluating an association of educational level with the outcomes.ResultsAs a result, a clear gradient by educational level was observed in almost all the age groups for the prevalence of psychological distress, poor self-rated health, and smoking and participation rates in cancer screening, and high educational level were associated with better health-related behaviors and statuses. Conversely, drinking prevalence was shown to be higher rather in highly educated people. In addition, a statistically significant association of educational level with all the outcomes was observed.ConclusionIt was shown that disparities in health behaviors and statuses still persisted in recent years, and the findings suggested that further measures should be taken to tackle this disparity.

Trends in obesity and blood lipid abnormalities in school-age children in Japan.

Obesity in children is a public health concern in Japan. To evaluate the current state of the obesity problem and inform future directions, we aimed to provide an updated account of secular trends in the percentage of overweight (POW) children by gender and school grade, and evaluate changes in POW after participation in the obesity health screening. The current study utilized aggregated data from the Setagaya Ward, Tokyo, public elementary and middle school populations from 2009 to 2018. Data on the percentage of overweight ≥ 30% (POW-30) and percentage of abnormal blood test results were examined by year, gender, and school grade level. Individual-level data from 2015 to 2017 in children who participated in a follow-up obesity health screening were evaluated for changes in median POW. A decreasing trend in students with a POW-30 was observed from 2009 to 2011, with rates stabilizing thereafter. The highest proportions of POW-30 were observed in 2010 (4.8% in middle school boys; 2.8% in middle school girls). From third grade, the difference in percentage by gender appeared to get increasingly larger until the beginning of middle school. Among obesity health screening participants, abnormal blood tests for total cholesterol and triglycerides showed a slightly increasing trend over time, and changes in POW after screening were greatest for middle school students. Increases in obesity were not observed in Setagaya Ward public school students since 2010, but disparities exist by gender and grade level, suggesting that tailored intervention strategies may be useful to optimize aspects of the obesity health screening program.

Efficacy of Healthy Aging Interventions for Adults With Intellectual and Developmental Disabilities: A Systematic Review.

There is a lack of information on intervention strategies employed for health promotion and disease prevention for older adults with intellectual and developmental disabilities (IDDs), who usually experience poorer health compared to their peers without IDDs. We carried out the first systematic review to scrutinize the impact of intrinsic factors (e.g., cognitive, mental, and physical health) on the health status of older adults with IDDs. To assess the efficacy of such interventions, we examined 23 articles including prospective "healthy aging" interventions designed for adults with IDDs. Searches were carried out in the databases Web of Science, Scielo, and PsycINFO in April 2020. Articles were organized in thematic areas: (a) physical activity and health nutrition (n = 10), (b) health education and health screening (n = 6), (c) social inclusion and community participation (n = 3), and (d) multicomponents (n = 4). Except for 5 randomized controlled trial studies, the designs were mainly nonrandomized, involving small sample sizes (Nrange = 8-379 participants), and lacking follow-up. The studies included 2,398 men and women with IDDs (ranging in age from 18 to 86 years [mean age: 44.3 years]). Overall, intervention outcomes were mostly positive; however, some negative outcomes were reported. In brief, healthy aging interventions for people with IDDs remain scarce, incipient, and sporadic. We recommend that more attention needs to be given to active health promotion with people with IDDs as a program practice among organizations and as a focal public policy among governments.

Lack of a bridge between screening and medical management for hypertension: health screening cohort in Japan

BackgroundPatient journeys for hypertensive individuals after detection at screening have not been well examined in a general population. Thus, we aimed to assess the medical treatment status and subsequent longitudinal changes in blood pressure in a middle-aged Japanese population.MethodsWe conducted a cohort study using a nationwide Japanese health screening cohort, from April 2014 to March 2019. Among health screening participants aged 40–74 years who had not previously received treatment for hypertension, hypertensive patients were newly identified based on screening results, and their medical treatment status for hypertension during the year following their initial screening was assessed. The main outcomes were longitudinal changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) over 4 years after initial screening.ResultsOf the 153,523 screening participants (mean age = 49.7 years), 16,720 (10.9%) and 4150 (2.7%) were newly detected as having hypertension, with baseline SBP of 140–159 mmHg (grade 1) and ≥ 160 mmHg (grade 2–3), respectively. Among them, 15.9% of the grade 1 hypertensive participants and 36.3% of the grade 2–3 hypertensive participants started receiving medical treatment during the year following initial screening. A linear generalised estimating equation with propensity score matching showed that receiving medical treatment was associated with 5.77 mmHg lower SBP (95% CI − 6.64 to − 4.90) and 3.82 mmHg lower DBP (95% CI − 4.47 to − 3.16) in the grade 1 hypertensive group, and 14.69 mmHg lower SBP (95% CI − 16.35 to − 13.04) and 8.42 mmHg lower DBP (95% CI − 9.49 to − 7.34) in the grade 2–3 hypertensive group.ConclusionsHealth screenings detected hypertension in a substantial percentage of the middle-aged population in this study. However, detection was often followed by insufficient medical treatment and inappropriate blood pressure management. These findings indicate an inadequate link between health screenings and medical treatments in patients with hypertension.

Explaining the Rationale of Deep Learning Glaucoma Decisions with Adversarial Examples

To illustrate what is inside the so-called black box of deep learning models (DLMs) so that clinicians can have greater confidence in the conclusions of artificial intelligence by evaluating adversarial explanation on its ability to explain the rationale of DLM decisions for glaucoma and glaucoma-related findings. Adversarial explanation generates adversarial examples (AEs), or images that have been changed to gain or lose pathologic characteristic-specific traits, to explain the DLM's rationale. Evaluation of explanation methods for DLMs. Health screening participants (n= 1653) at the Seoul National University Hospital Health Promotion Center, Seoul, Republic of Korea. We trained DLMs for referable glaucoma (RG), increased cup-to-disc ratio (ICDR), disc rim narrowing (DRN), and retinal nerve fiber layer defect (RNFLD) using 6430 retinal fundus images. Surveys consisting of explanations using AE and gradient-weighted class activation mapping (GradCAM), a conventional heatmap-based explanation method, were generated for 400 pathologic and healthy patient eyes. For each method, board-trained glaucoma specialists rated location explainability, the ability to pinpoint decision-relevant areas in the image, and rationale explainability, the ability to inform the user on the model's reasoning for the decision based on pathologic features. Scores were compared by paired Wilcoxon signed-rank test. Area under the receiver operating characteristic curve (AUC), sensitivities, and specificities of DLMs; visualization of clinical pathologic changes of AEs; and survey scores for locational and rationale explainability. The AUCs were 0.90, 0.99, 0.95, and 0.79 and sensitivities were 0.79, 1.00, 0.82, and 0.55 at 0.90 specificity for RG, ICDR, DRN, and RNFLD DLMs, respectively. Generated AEs showed valid clinical feature changes, and survey results for location explainability were 3.94 ± 1.33 and 2.55 ± 1.24 using AEs and GradCAMs, respectively, of a possible maximum score of 5 points. The scores for rationale explainability were 3.97 ± 1.31 and 2.10 ± 1.25 for AEs and GradCAM, respectively. Adversarial example provided significantly better explainability than GradCAM. Adversarial explanation increased the explainability over GradCAM, a conventional heatmap-based explanation method. Adversarial explanation may help medical professionals understand more clearly the rationale of DLMs when using them for clinical decisions.

82-LB: Including Continuous Glucose Monitoring (CGM) to Provide Personalized Glycemic Profiles as Part of a Pilot Worksite Health Screening

Incorporating CGM into worksite health screenings may help employees gain insight into their glycemic patterns. This observational study piloted a voluntary health screening at a large employer that included 10 days of blinded Dexcom G6 CGM wear. At enrollment, HbA1c values and participants’ reports were used to assign diabetes status. Participants and their primary care providers received summaries of their CGM-based glucose profiles. A total of 207 participants (mean (sd) age = 50.7 (10), 84% female, 15% African American, 15% Hispanic, 56% obese) enrolled in the screening from April through August 2019, and 85% (175) wore the CGM for ≥4 days. HbA1c identified 7 and 24 participants with previously undiagnosed T2D and prediabetes, respectively. The final diabetes prevalence was 61 (35%) with T2D, 5 (3%) with T1D, 35 (20%) with prediabetes, and 74 (42%) with no diabetes. Among those with T2D, 27 (44%) met consensus-based goals for TIR. The Table shows CGM-based metrics from health screening participants compared to Shah’s (2019) normative sensor glucose data of people without diabetes. Those with prediabetes had higher mean glucose and lower TIR than the normative sample. Health screenings that include blinded CGM provide personalized feedback regarding glycemic patterns, even among people without known diabetes. Disclosure I.J. Klein: Consultant; Self; Dexcom, Inc. M. Crawford: Employee; Self; Dexcom, Inc. G.J. Norman: Employee; Self; Dexcom, Inc. K.C. Hames: Employee; Self; Dexcom, Inc. J.I. Justus: None. S. Treadwell: Employee; Self; Dexcom, Inc. T.M. Combee: None. S. Kinzler: Research Support; Self; Dexcom, Inc. J. Welsh: Employee; Self; CSL Behring. M. Johnson: Employee; Self; Dexcom, Inc.

Copattern of depression and alcohol use in medical care patients: cross-sectional study in Germany.

ObjectiveTo predict depressive symptom severity and presence of major depression along the full alcohol use continuum.DesignCross-sectional study.SettingAmbulatory practices and general hospitals from three sites in Germany.ParticipantsConsecutive patients aged 18–64 years were proactively approached for an anonymous health screening (participation rate=87%, N=12 828). Four continuous alcohol use measures were derived from an expanded Alcohol Use Disorder Identification Test (AUDIT): alcohol consumption in grams per day and occasion, excessive consumption in days per months and the AUDIT sum score. Depressive symptoms were assessed for the worst 2-week period in the last 12 months using the Patient Health Questionnaire (PHQ-8). Negative binomial and logistic regression analyses were used to predict depressive symptom severity (PHQ-8 sum score) and presence of major depression (PHQ-8 sum score≥10) by the alcohol use measures.ResultsAnalyses revealed that depressive symptom severity and presence of major depression were significantly predicted by all alcohol use measures after controlling for sociodemographics and health behaviours (p<0.05). The relationships were curvilinear: lowest depressive symptom severity and odds of major depression were found for alcohol consumptions of 1.1 g/day, 10.5 g/occasion, 1 excessive consumption day/month, and those with an AUDIT score of 2. Higher depressive symptom severity and odds of major depression were found for both abstinence from and higher levels of alcohol consumption. Interaction analyses revealed steeper risk increases in women and younger individuals for most alcohol use measures.ConclusionFindings indicate that alcohol use and depression in medical care patients are associated in a curvilinear manner and that moderation by gender and age is present.

Trends in health screening participation and lifestyle behaviours after participation in a free, access-enhanced screening intervention in a low-income Singaporean rental-flat community.

Our objective was to evaluate the impact of an access-enhanced health screening intervention on screening adherence in a rental-flat community. In Singapore, public rental flats provide heavily subsidised rentals for the needy who cannot afford to own their own homes; with a majority of Singaporeans (≥85%) staying in owner-occupied public housing. We observed trends in health screening adherence and health behaviours among residents of a multi-ethnic public rental-flat community in Singapore from 2013 to 2017, after participation in a free, access-enhanced multi-modality screening programme in 2011. Residents staying in neighbouring owner-occupied housing who participated in the same screening programme served as a basis of comparison. A total of 478 rental-flat residents and 505 owner-occupied flat residents participated. In the rental-flat community, hypertension screening rates improved from 18.3% (24/131) in 2013, to 61.2% (52/85) in 2015 and 44.2% (34/77) in 2017 (p<.001). For diabetes, rates improved from 26.2% (43/164) → 47.0% (54/115) → 49.5% (45/91; p<.001). For dyslipidaemia screening, rates improved from 18.2% (31/170) → 39.6% (38/96) → 47.5% (38/80; p<.001). In the owner-occupied community (n=505), screening rates largely remained stagnant (hypertension: 52.2% → 75.0% → 54.5%, p=.059; diabetes: 66.0% → 56.5% → 66.7%, p=.434; dyslipidaemia: 53.1% → 50.0% → 57.1%, p=.818). In the rental-flat community, unhealthy behaviours increased from 2013 to 2017, with higher proportions of overweight (30.4% → 24.8% → 52.1%, p<.001), higher smoking (11.7% → 36.9% → 32.5%, p<.001) and higher drinking rates (1.4% → 0.7% → 8.1%, p<.001). This shift was also reflected in the owner-occupied community, with higher percentages of overweight and higher drinking rates (p<.001).

Factors Associated with General Health Screening Participation among Married Immigrant Women in Korea.

Background: The number of married female immigrants living in Korea has been increasing and is expected to increase further. This study was performed to identify factors associated with national general health screening participation among married immigrant women living in South Korea. Methods: The Korean National Health Insurance System’s (NHIS) customized database for the years 2014 and 2015 was used. The targets of this study were women aged 19 years old and above. To identify factors associated with national general health screening participation, the following analyses were employed: frequency, chi-square, simple regression, and multiple regression. Results: A total of 11,213 women were identified in the NHIS database. Overall, 67.4% participated in national general health screenings, lower than the 74.6% participation rate of the entire women’s health screening program. Married immigrant women with a job had higher health screening participation than those without a job (OR = 2.822, p < 0.0001). Age, socioeconomic status, and duration of stay were related to health screening behaviors among employed married immigrant women. Nationality, socioeconomic status, duration of stay, and disease status were associated with general health screening behaviors among unemployed immigrant women. The odds ratios decreased as the length of stay increased, regardless of employment status. Conclusion: The results of this study showed that employment status and duration of stay in Korea are significantly associated with general health screening participation. Accordingly, to improve awareness about health screening and health care disparities, programs promoting health screening participation for socially vulnerable classes, including immigrant women and unemployed women, should be instigated.

Primary Drivers of Willingness to Continue to Participate in Community-Based Health Screening for Chronic Diseases

Background: As the average age of the population continues to rise in the 21st century, chronic illnesses have become the most prominent threats to human health. Research has shown that early screenings for chronic diseases are an effective way of lowering incidence and mortality rates. However, low participation rates for health screening is one of the main challenges for preventive medicine. The objective of this study was to determine the primary drivers which: (1) first motivate people to participate in community-based health screening for chronic diseases; and (2) increase their willingness to continue to participate. Methods: A total of 440 individuals between 30 and 75 years of age were invited to undergo a health screening and then complete an interview questionnaire. Screenings and interviews were conducted in four regions in northern Taiwan. The questionnaire was separated into three sections, which explored sociodemographic differences, drivers of willingness to participate, and willingness to continue to participate respectively. Raw data was analyzed using the statistical software package SPSS (SPSS Inc., Chicago, IL, USA). Main Outcome Measures: Effects of sociodemographic factors on health screening participation rate, drivers of willingness to participate, and willingness to continue to participate. Results: Seventy-three percent of participants responded that they would be willing to continue to join in future health screenings. Notably, elderly people and married people were respectively more likely to participate in preventive health screening than were younger people and people who were single, divorced, separated, or widowed. Level of education was another key driver of willingness to participate in health screening for chronic diseases, as were the concern of relatives/friends and the provision of participation incentives. Discussion: Some of our findings, such as the key drivers of willingness to continue to participate in health screening that we identified, were different from findings of many previous studies conducted in other countries. The current study also found that a higher percentage of participants would be willing to join a similar health screening in the future if the service design is considered in advance and is well-implemented.