To measure the effects of faecal immunochemical test (FIT) for colorectal cancer (CRC) screening on overall and site-specific long-term effectiveness of population-based organised service screening.
...A prospective cohort study of Taiwanese nationwide biennial FIT screening was performed. A total of 5 417 699 eligible subjects were invited to attend screening from 2004 through 2009 and were followed up until 2014. We estimated the adjusted relative rates (aRRs) on the effectiveness of reducing advanced-stage CRC (stage II+) and CRC death by Bayesian Poisson regression models with the full adjustment for a cascade of self-selection factors (including the screening rate and the colonoscopy rate) and the completeness of colonoscopy together with demographic features.
FIT screening (exposed vs unexposed) reduced the incidence of advanced-stage CRC (48.4 vs 75.7 per 100 000) and mortality (20.3 vs 41.3 per 100 000). Statistically significant reductions of both incidence of advanced-stage CRCs (aRR=0.66, 95% CI 0.63 to 0.70) and deaths from CRC (aRR=0.60, 95% CI 0.57 to 0.64) were noted. FIT screening was more effective in reducing distal advanced-stage CRCs (aRR=0.61, 95% CI 0.58 to 0.64) and CRC mortality (aRR=0.56, 95% CI 0.53 to 0.69) than proximal advanced CRCs (aRR=0.84, 95% CI 0.77 to 0.92) and CRC mortality (aRR=0.72, 95% CI 0.66 to 0.80).
A large-scale population-based biennial FIT screening demonstrates 34% significant reduction of advanced-stage CRCs and 40% reduction of death from CRC with larger long-term effectiveness in the distal colon than the proximal colon. Our findings provide a strong and consistent evidence-based policy for supporting a sustainable population-based FIT organised service screening worldwide. The disparity of site-specific long-term effectiveness also provides an insight into the remedy for lower effectiveness of FIT screening in the proximal colon.
Background and Aim
The aim of this study is to identify gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in ...Indigenous communities.
Methods
First, we quantified the health disparities in gastric cancer in Indigenous peoples using data from the cancer registries during the period of 2006–2014. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy.
Results
Gastric cancer incidence (24.4 vs 12.3 per 100 000 person‐years) and mortality rates (15.8 vs 6.8 per 100 000 person‐years) were higher in Indigenous than in non‐Indigenous, with 2.19‐fold (95% confidence interval CI: 2.06–2.33) and 2.47‐fold (2.28–2.67) increased risk, respectively. In Indigenous communities, H. pylori infection was more prevalent in Indigenous than in non‐Indigenous (59.4% vs 31.5%, P < 0.01). Regression analyses consistently showed that either the mountain or plain Indigenous had 1.89‐fold (95% CI: 1.34–2.66) and 1.73‐fold (95% CI: 1.24–2.41) increased risk for H. pylori infection, respectively, as compared with non‐Indigenous, adjusting for other baseline characteristics. The high infection rates were similarly seen in young, middle‐aged, and older adults. Program eradication rates using clarithromycin‐based triple therapy were suboptimal (73.7%, 95% CI: 70.0–77.4%); the habits of smoking (1.70‐fold, 95% CI: 1.01–2.39) and betel nut chewing (1.54‐fold, 95% CI: 0.93–2.16) were associated with the higher risk of treatment failure.
Conclusion
Gastric cancer burden is higher in Indigenous Taiwanese peoples than in their non‐Indigenous counterparts. Eliminating the prevalent risk factor of H. pylori infection is a top priority to reduce this health disparity.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Outreach (i.e., to invite those who do not use, or who under use screening services) and inreach (i.e., to invite an existing population who have already accessed the medical system) approaches may ...influence people to increase their use of screening test; however, whether their outcomes would be equivalent remains unclear.
A total of 3,363,896 subjects, 50-69 years of age, participated in a colorectal cancer (CRC) screening program using biennial fecal immunochemical tests; 34.5% participated during 2004-2009 when the outreach approach alone was used, and 65.5% participated from 2010-2013 when outreach was integrated with an inreach approach. We compared the outcomes of the two approaches in delivery of screening services.
Coverage rates increased from 21.4% to 36.9% and the positivity rate increased from 4.0% to 7.9%, while referral for confirmatory diagnostic examinations declined from 80.0% to 53.3%. The first period detected CRC in 0.20% of subjects screened, with a positive predictive value (PPV) of 6.1%, and the second detected CRC in 0.34% of subjects, with a PPV of 8.0%. After adjusting for confounders, differences were observed in the PPV for CRC (adjusted relative risk, 1.50; 95% confidence interval CI, 1.41-1.60), cancer detection rate (1.20; 95% CI, 1.13-1.27), and interval cancer rate (0.72; 95% CI, 0.65-0.80). When we focused on the comparison between two approaches during the same study period of 2010-2013, the positivity rate of fecal testing (8.2% vs. 7.6%) and the PPV for CRC detection remained higher (1.07; 95% CI, 1.01-1.12) in subjects who were recruited from the inreach approach.
Outcomes of screening were equivalent or better after integration of outreach and inreach approaches.
The results will encourage makers of health-care policy to adopt the integration approach to deliver screening services.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background: Effectiveness of oral cancer screening depends on identifying high-risk groups. People with betel quid chewing or cigarette smoking habits are often reluctant to attend screenings. Given ...that use of both substances is associated with certain occupations, a targeted approach should be applied to improve the effectiveness of screening programs. Objectives: This study sought to identify occupations with a high prevalence of betel quid chewing and cigarette smoking and to investigate their changing trends using the Taiwan National Health Interview Survey (NHIS) database. Methods: The NHIS database for 2009 and 2013 were used. We estimated prevalence of current betel quid and/or cigarette use among those aged 20-64 years old. Occupations were classified using the International Standard Classification of Occupations (ISCO-88). Statistical analyses included indirect standardized rates and cluster analysis of chewing/smoking habits. Results: Drivers, mobile-plant operators, and extraction and building trades workers had the highest prevalence of betel quid chewing and cigarette smoking (chewing: 30.92% and 29.62%; smoking: 61.16% and 62.22%). Many occupations had large indirect standardized rates for chewing but not smoking. Both habits are associated with each other (r = 0.81, p < 0.001). Use appeared to decrease based on comparison between 2009 and 2013. Conclusions: Drivers and construction laborers showed high prevalence of betel chewing and cigarette smoking. The chewing habit is actually more prevalent in several sub-occupations. The survey results also revealed lower attendance by construction laborers at oral cancer screenings. Oral cancer screening and awareness should be emphasized in the identified occupations.
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DOBA, FSPLJ, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
This study aimed to increase workers' awareness of betel quid cessation. Methods: Using community and workplace resources, a workplace health promotion program was developed in accordance with the ...five action areas of the Ottawa Charter. Questionnaires were administered to examine the changes in the knowledge and attitudes of 714 workers in different occupations before and three months after the intervention. Results: Regardless of subjects' pre-intervention chewing status, their knowledge and attitude scores relating to betel quid cessation increased significantly after the intervention. The effect of occupation was significant on the post-intervention knowledge and attitude scores among chewers. Furthermore, 16 (11.6%) of the 138 study subjects who chewed betel quid before the intervention and had no willingness to quit, did quit betel quid chewing following the intervention. The factors contributing to an unwillingness to quit among chewers with no intention to quit before the intervention were examined. Workers in the electronic material manufacturing industry had a greater willingness to quit compared to those in the metal, machinery, and related trades (odds ratio OR = 0.15; 95% confidence interval CI = 0.02-0.94). Travel attendants, tour guides, cleaners, and helpers were the least willing to quit (OR = 21.29; 95% CI = 2.51-180.81). Conclusions: This study promoted workers' awareness of betel quid cessation by adopting the five action areas of the Ottawa Charter framework, the effectiveness of the intervention varied in different occupations. Workers with a high-income and better education level had a higher awareness of betel quid cessation.
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DOBA, FSPLJ, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To what extent the risk for colorectal cancer (CRC) death among noncompliers of colonoscopy is elevated following positive fecal immunological testing and whether the elevated risk varies with the ...fecal hemoglobin concentration (f-Hb) and location of CRC have not been researched.
We used data on 59 389 individuals (4.0%) among 1 489 937 Taiwanese screenees age 50 to 69 years with f-Hb 20 μg hemoglobin or more per gram of feces from 2004 to 2009. They were classified into 41 995 who received colonoscopy and 10 778 who received no confirmatory examination; the latter was categorized into three risk groups according to f-Hb (20-49, 50-99, and 100+). Mortality from CRC as the primary end point was monitored until December 31, 2012.
A 1.64-fold (95% confidence interval CI = 1.32 to 2.04) increased risk for CRC death for the noncolonoscopy group as opposed to the colonoscopy group adjusting for differences in baseline characteristics. A gradient relationship was noted between cumulative mortality and age- and sex-adjusted f-Hb categories with 1.31-fold (95% CI = 1.04 to 1.71), 2.21-fold (95% CI = 1.55 to 3.34), and 2.53-fold (95% CI = 1.95 to 3.43) increased risk, respectively, for the 20-49, 50-99, and 100+ risk groups in the noncolonoscopy group compared with the colonoscopy group. The noncolonoscopy group led to a statistically significant 1.75-fold increased risk (95% CI = 1.35 to 2.33) for CRC of the distal colon but a statistically nonsignificant 1.11-fold increased risk (95% CI = 0.70 to 1.75) for the proximal colon, compared with the colonoscopy group. When the comparator was limited to subjects whose colonoscopy was completed to the cecum, the statistically significantly elevated risk for CRC mortality was seen for both distal and proximal colon in the noncolonoscopy group.
After a positive fecal immunochemical test, colonoscopy can reduce by about half the number of deaths from CRC. Among colonoscopy noncompliers, higher f-Hb is associated with an increased risk of mortality from CRC in a dose-response manner.
We sought to examine changes in the magnitude of social inequality in the uptake of cervical cancer screening between 2001 and 2009 in Taiwan.
We used data from the 2001 and 2009 Taiwan National ...Health Interview Surveys to calculate the absolute (slope of index of inequality, SII) and relative (relative index of inequality, RII) summary measures of social inequality in the uptake of Pap smear tests to indicate the magnitude of social inequality.
The prevalence of having had a Pap smear during the previous 3 years increased in each age and socioeconomic group from 2001 to 2009. The SII and RII by urbanization and education level decreased significantly, while the SII and RII by income level increased significantly between the two study years. The largest increase in inequality of prevalence from 2001 to 2009 was between women living in suburban and rural areas with highest income level and women live in metropolitan areas with lowest income level.
The changes in magnitude of social inequality in the uptake of cervical cancer screening differed by indicators of socioeconomic position. Further studies are needed to explore the mechanisms that result in social inequality by different indicators of socioeconomic position.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
High-level waste (HLW), one of the most poisonous materials known to science, includes spent fuel from nuclear power plants. Therefore, nuclear engineers seek to isolate HLW from the Earth's ...biosphere by using multibarrier systems, including engineered and natural barriers deep below the surface of the earth. Typically, disposal holes are drilled into intact rocks. Canisters and buffer materials are then placed in the drilled holes. These highly stable canisters should not be easily affected by the natural environment, human activities, and tectonic movement. However, Taiwan is located in the Ring of Fire of the Pacific Ocean; thus, earthquakes threaten Taiwan frequently. Consequently, scholarly investigations must expand knowledge regarding the effects of earthquake-induced vibration on the canisters and buffer materials placed in the drilled holes and on the disposal system. This study assumes that the relevant disposal holes are created in granite deposit layers and have no deformations and cracks. The methods and geometry of the KBS-3 V system were examined; in this study a physical apparatus one-tenth the size of the KBS-3 V system was designed. The one-tenth-scale physical apparatus was subjected to an artificial acceleration field of 10 g as a simulation of the in-situ stress between the canisters and buffer material. The physical model was positioned on a shaking table and subjected to simulated seismic events. During shaking, sensors measured the acceleration, pore water pressure, and total pressure values to determine the interactive behavior between canisters and buffer materials during seismic activity. Six models were developed with different initial water content and hydration conditions; these models simulated the state of the buffer material after construction, after underground water invasion of the disposal hole, and after saturation of the buffer material. After centrifuge modeling had been conducted, the container was disassembled to check for crack development in the surrounding buffer material. The results can be used to distinguish the difference between each stage of buffer blocks and to determine the behavior of canisters during shaking; thus, these results can be employed to design HLW repositories in seismically active zones.
•Repositories of spent nuclear fuel were simulated with a centrifuge modeling technique.•Dynamic loading, acceleration, and water pressure were monitored during artificial shaking.•Water plays an essential role in building and confining pressure in the buffer layer of a repository.•Appearance of cracks was strongly related to the water content of buffer blocks.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives: This study was conducted to explore a viable model for establishing health-promoting community pharmacies in Taiwan, where pharmacists can provide amiable and professional health ...promotion services within a community environment. Methods: Semi-structured interviews were conducted with six licensed pharmacists and six customers hailing from chain, non-owner-managed, and independent community pharmacies in central Taiwan. Following these interviews, several expert meetings were scheduled to discuss the collected information. The obtained data were analyzed through deductive content analysis, utilizing descriptive, in vivo, and pattern coding techniques. Drawing upon the insights gleaned from our analysis, we formulated standard operating procedures and a self-assessment performance checklist for pharmacists, with the ultimate goal of enhancing health promotion in community settings. Results: The services, which primarily centered around dispensing medications, exhibited variation across the included
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