Gastric cancer screening is common in countries with high prevalence rates of gastric cancer. However, data supporting the effectiveness of gastric cancer screening are lacking. Thus, the aim of this review was to examine the current evidence on gastric cancer screening. Herein, we reviewed radiographic and endoscopic tests as methods of gastric cancer screening. Previous cohort studies and case-control studies have demonstrated reduced gastric cancer mortality in study populations that had undergone gastric cancer screening with radiographic tests. Recently, a case-control study in Japan reported a 30% reduction in gastric cancer mortality when screening was undertaken via endoscopy. Also, endoscopic screening for gastric cancer exhibited higher sensitivity and specificity than radiographic screening. Moreover, most cost-effectiveness analyses on the best strategy for detecting early gastric cancer have generally concluded that endoscopy is more cost-effective than radiographic testing. Although data on the impact of endoscopy screening programs on gastric cancer mortality are limited, recent study results suggest that gastric cancer screening by endoscopy in average-risk populations performs better than radiography screening. Further evaluation of the impact of these screening methods should take into account cost and any associated reduction in gastric cancer mortality.
Case-Control Studies ; Cohort Studies ; Endoscopy* ; Japan ; Mass Screening* ; Mortality ; Prevalence ; Radiography ; Sensitivity and Specificity ; Stomach Neoplasms*

OBJECTIVES: The objectives of this study were to examine the difference in attitude toward health-specific locus-of-control and medical care among western medical students, oriental medical students, and non-medical school students. METHODS: The subjects of this study were 667 students who agreed to respond the questionnaire : 212 western medical school students, 190 oriental medical school students, and 265 non-medical school students. The health-specific locus of control was measured by the structured questionnaire developed by Lau and Ware. The attitude toward western and oriental medicine was also measured by the questionnaire. RESULTS: Western medical students and non-medical school students were more likely than oriental medical students to place high value on 'the provider control over health' and 'the general threat to health' scales (F=20.47, F=19.98). But oriental medical school students ranked 'the self control of health' scale as more important than any other locus of control scale (F=19.34). The health specific locus of control was also different from the grade. When the grade was increased, 'the provider control over health' scale was slowly decreased, especially in western medical students and non medical school students. However, the 'general threat to health' scale was increased in oriental medical students. Western medical school students expressed more positive attitude toward western medicine. Oriental medical school students put a higher score on oriental medicine. Nevertheless, as the grade was increased, the positive attitude toward oriental medicine slightly decreased in oriental medical school students. CONCLUSIONS: There is a difference in health-specific locus of control and attitude toward medicine among western medical students, oriental medical students, and non-medical students. The locus of control and attitude of medical students towards medicine may affect both how they behave towards patients and how they help shape future public policy. Therefore, interdisciplinary educational initiatives may be the best way to handle this issue.
Complementary Therapies ; Humans ; Internal-External Control ; Medicine, East Asian Traditional ; Public Policy ; Schools, Medical* ; Self-Control ; Students, Medical ; Weights and Measures

OBJECTIVES: The SERVQUAL scale is based on gap theory, which suggests the difference between consumers' expectations and the quality of the medical service actually received. However, problems in the implementation of the SERVQUAL scale have been identified by several researchers. Some researchers have proposed a simple performance-based measure (SERVPERF) or an expectation-controlled performance-based measure(Non-Diff) as alternatives to the SERVQUAL scale. On the basis of the theoretical concerns discussed, we examined the capability of each of the three scales(SERVQUAL, Non-Diff, SERVPERF) to explain variations in consumer satisfaction. METHODS: Data was gathered from a self-administered questionnaire in a 430 bed hospital. Questionnaires evaluating medical services were distributed to 180 ambulatory patients. A total of 167 usable questionnaires were gathered. The questionnaire was composed of 10 expectation, performance and expectation-controlled performance items. In addition, overall satisfaction and purchase intention were measured. RESULTS: Compared with the SERVQUAL scale, the Non-Diff and SERVPERF scales better explained the observed variations in consumer satisfaction(SERVQUAL, R2=0.29; Non-Diff, R2=0.51; SERVPERF, R2=0.48) and purchase intention(SERVQUAL, R2=0.22; Non-Diff, R2=0.33; SERVPERF, R2=0.34). CONCLUSION: The major conclusion from our study is that the Non-Diff and SERVPERF scales are more efficient in assessing consumer satisfaction than the SERVQUAL scale. Therefore we suggest that consumer satisfaction be measured by the Non-Diff or SEVPERF scales.
Consumer Satisfaction* ; Delivery of Health Care* ; Humans ; Intention ; Questionnaires ; Weights and Measures

OBJECTIVES: To determine the relationships among quality, satisfaction, value and purchase intention in health care service. METHODS: The data were gathered from out-patients who had used hospital services. They were asked to assess service quality, satisfaction, service value, and purchase intention. A total of 557 usable questionnaires were gathered. The data were analyzed using SAS version 6.12. The analytic methods employed in the study were confirmatory analysis and covariance structural analysis. RESULTS: Service quality exhibited a significant and positive relationship with satisfaction, service value, and purchase intention. Furthermore, satisfaction had a significant and positive relationship with purchase intention. And finally, service value had a significant and positive relationship with both satisfaction and purchase intention. Based on these findings, it is evident that satisfaction was a mediator between service quality and purchase intention. Also service value played a mediating role between service quality and satisfaction. CONCLUSIONS: These results suggest that service quality is an antecedent of satisfaction and service value, and exerts a stronger influence on purchase intentions than satisfaction and service value do. Thus, managers may need to emphasize service quality in health care.
Delivery of Health Care* ; Humans ; Intention* ; Models, Structural* ; Negotiating ; Outpatients ; Surveys and Questionnaires

By expanding health insurance, customers will carry a smaller burden of medical costs. As a result, the number of visits to a physician increase and this result in the improvement of medical accessibility. But medical care utilization may be changed not only by insurance status but also by socio-demographic factor, economic status and other factors. The question thus remains, at which level of accessibility and what price of medical care service in health insurance will the customer and the medical care service be satisfied. The price of medical care service is comprised of the customer's out-of-pocket money and the costs not covered by health insurance. If the price of medical care services in health insurance are appropriate, medical care utilization should not differ because of the difference in income status or the acuteness of illness. But If the price is not adequate, low income groups will receive relatively low medical care utilization, particularly in the case of chronic disease. The purpose of this study is to evaluate the differences in medical care utilization among the various income groups and those with varying acuteness of illness. The major hypotheses to test in this study are : (I) whether there are differences in medical care utilization among different income groups exist, (II) whether differences in medical care utilization among different income groups exist with the hospital type. (III) whether differences in medical care utilization among different income groups exist with the acuteness of illness and with age. The data was collected from the JongRo District Health Insurance Society in Seoul. A total of 118,336 persons were selected as the final sample for this study. The major findings of this study were as follows ; 1. The volume of ambulatory utilization among users was statistically significant by income level. 2. Among different income groups, the volume of ambulatory utilization was statistically significant by the acuteness of illness. 3. Higher income groups with chronic diseases had a greater volume of ambulatory utilization than other groups.
Chronic Disease ; Humans ; Insurance Coverage ; Insurance, Health* ; Seoul

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted cancer screening services worldwide. We aimed to measure the impact of COVID-19 on gastric cancer screening rates based on age, sex, household income, and residential area. Materials and Methods: We analyzed data from the Korean National Cancer Screening Survey from 2017 to 2021 for adults aged 40–74 years. We evaluated the gastric cancer screening rate within two years in accordance with the National Cancer Screening Program protocol recommendations and that within the previous year. We compared the trends in the pre- and post-COVID-19 outbreak periods. Results: Before the COVID-19 outbreak, there was little change in the gastric cancer screening rates until 2019. After the COVID-19 outbreak, the screening rate as per recommendation decreased from 70.8% in 2019 to 68.9% in 2020 and that for one year decreased from 32.7% in 2019 to 27.2% in 2020. However, as the COVID-19 pandemic continued after 2020, both gastric cancer screening rates as per recommendations and for one year rebounded. Although a similar trend was observed for the upper endoscopy screening rate, the upper gastrointestinal series screening rate decreased from 7.8% in 2020 to 3.1% in 2021. During the pandemic, the screening rate decreased among younger adults (40–49), those residing in metropolitan regions, and those with high incomes. Conclusions Despite a decline in gastric cancer screening rate during the COVID-19 pandemic, the rate surged in 2021. Further studies are needed to estimate the impact of cancer screening delays on future cancer-related mortalities.

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.
Adult ; Aged ; Female ; Health Expenditures ; Health Knowledge, Attitudes, Practice ; Humans ; Korea ; Male ; Middle Aged ; *Patient Acceptance of Health Care ; Stomach Neoplasms/*diagnosis

PURPOSE: The National Cancer Screening Program (NCSP) in Korea supports cancer screening for stomach, liver, colorectal, breast, and cervical cancer. This study was conducted to assess trends in participation rates among Korean men and women invited to undergo screening via the NCSP as part of an effort to guide future implementation of the program in Korea. MATERIALS AND METHODS: Data from the NCSP for 2002 to 2012 were used to calculate annual participation rates with 95% confidence intervals (CI) by sex, insurance status, and age group for stomach, liver, colorectal, breast, and cervical cancer screening. RESULTS: In 2012, participation rates for stomach, liver, colorectal, breast, and cervical cancer screening were 47.3%, 25.0%, 39.5%, 51.9%, and 40.9%, respectively. The participation rates increased annually by 4.3% (95% CI, 4.0 to 4.6) for stomach cancer, 3.3% (95% CI, 2.5 to 4.1) for liver cancer, 4.1% (95% CI, 3.2 to 5.0) for colorectal cancer, 4.6% (95% CI, 4.1 to 5.0) for breast cancer, and 0.9% (95% CI, –0.7 to 2.5) for cervical cancer from 2002 to 2012. CONCLUSION: Participant rates for the NCSP for the five above-mentioned cancers increased annually from 2002 to 2012.
Breast ; Breast Neoplasms ; Colorectal Neoplasms ; Early Detection of Cancer* ; Female ; Humans ; Insurance Coverage ; Korea* ; Liver ; Liver Neoplasms ; Male ; Mass Screening ; Stomach ; Stomach Neoplasms ; Uterine Cervical Neoplasms

PURPOSE: The National Cancer Screening Program (NCSP) in Korea supports cancer screening for stomach, liver, colorectal, breast, and cervical cancer. This study was conducted to assess trends in participation rates among Korean men and women invited to undergo screening via the NCSP as part of an effort to guide future implementation of the program in Korea. MATERIALS AND METHODS: Data from the NCSP for 2002 to 2012 were used to calculate annual participation rates with 95% confidence intervals (CI) by sex, insurance status, and age group for stomach, liver, colorectal, breast, and cervical cancer screening. RESULTS: In 2012, participation rates for stomach, liver, colorectal, breast, and cervical cancer screening were 47.3%, 25.0%, 39.5%, 51.9%, and 40.9%, respectively. The participation rates increased annually by 4.3% (95% CI, 4.0 to 4.6) for stomach cancer, 3.3% (95% CI, 2.5 to 4.1) for liver cancer, 4.1% (95% CI, 3.2 to 5.0) for colorectal cancer, 4.6% (95% CI, 4.1 to 5.0) for breast cancer, and 0.9% (95% CI, –0.7 to 2.5) for cervical cancer from 2002 to 2012. CONCLUSION: Participant rates for the NCSP for the five above-mentioned cancers increased annually from 2002 to 2012.
Breast ; Breast Neoplasms ; Colorectal Neoplasms ; Early Detection of Cancer* ; Female ; Humans ; Insurance Coverage ; Korea* ; Liver ; Liver Neoplasms ; Male ; Mass Screening ; Stomach ; Stomach Neoplasms ; Uterine Cervical Neoplasms

Purpose: High breast cancer incidence and dense breast prevalence among women in forties are specific to Asian. This study examined the natural history of breast cancer among Korean women. Materials and Methods: We applied a three-state Markov model (i.e., healthy, preclinical, and clinical state) to fit the natural history of breast cancer to data in the Korean National Cancer Screening Program. Breast cancer was ascertained by linkage to the Korean Central Cancer Registry. Disease-progression rates (i.e., transition rates between three states), mean sojourn time (MST) and mammographic sensitivity were estimated across 10-year age groups and levels of breast density determined by the Breast Imaging, Reporting and Data System. Results: Overall prevalence of dense breast was 53.9%. Transition rate from healthy to preclinical state, indicating the preclinical incidence of breast cancer, was higher among women in forties (0.0019; 95% confidence interval [CI], 0.0017 to 0.0021) and fifties (0.0020; 95% CI, 0.0017 to 0.0022), than women in sixties (0.0014; 95% CI, 0.0012 to 0.0017). The MSTs, in which the tumor is asymptomatic but detectable by screening, were also fastest among younger age groups, estimated as 1.98 years (95% CI, 1.67 to 2.33), 2.49 years (95% CI, 1.92 to 3.22), and 3.07 years (95% CI, 2.11 to 4.46) for women in forties, fifties, and sixties, respectively. Having dense breasts increased the likelihood of the preclinical cancer risk (1.96 to 2.35 times) and decreased the duration of MST (1.53 to 2.02 times). Conclusion This study estimated Korean-specific natural history parameters of breast cancer that would be utilized for establishing optimal screening strategies in countries with higher dense breast prevalence.