NECESSITY AND SIGNIFICANCE OF ESTABLISHING GUIDELINES FOR CERVICAL CANCER PREVENTION AND TREATMENT IN CHINA Cervical cancer remains a significant threat to the health and lives of Chinese women.In 2022 alone,national cancer registry data reported 150700 new cervical cancer cases and 55 700 deaths,with a global age-standardised incidence rate of 13.83/100 000 and a mortality rate of 4.54/100 000,repre-senting 6.58％and 5.89％of all female cancer cases and deaths,respectively.

BackgroundAnxiety is widespread among adolescents, and research has shown that this condition can profoundly affect their mental, emotional, and physical well-being. The purpose of this study was to analyze gender differences in anxiety levels among adolescents and to explore the influencing factors and pathways.MethodsA total of 3601 adolescents were included in this study (age: 15.14±1.97 years; male: 48.76%). Gender, age, school category, grade, duration of sleep, duration on Internet, anxiety and several social factors were investigated by online questionnaire. Teachers were responsible for organizing students to fill out the questionnaire. The Generalized Anxiety Disorder (GAD-7) was applied to measure participants’ anxiety levels over the past 2 weeks. An Ordinal Logistic Regression measured risk factors of anxiety, while a path analysis was used to estimate the structural relationship between risk factors and anxiety.ResultsThe severity of anxiety in female was higher. Approaching graduation, lack of sleep, poor peer relationships, poor ability to complete tasks, and unwillingness to seek help when in a bad mood were risk factors for anxiety in both male and female adolescents. Among female, prolonged Internet access is a risk factor for anxiety. The fit indices for the modified models were appropriate (male: GFI=0.999, IFI=0.996, TLI=0.976, CFI=0.995, AGFI=0.990, RMSEA=0.021, SRMR=0.016; female: GFI=0.997, IFI=0.990, TLI=0.971, CFI=0.990, AGFI=0.990, RMSEA=0.020, SRMR=0.018).ConclusionThe female adolescents might have higher levels of anxiety, that academic stress, sleep, peer relationships, competence, and level of social support might be influence factors on anxiety in adolescents, and that “daily duration on Internet” might not be the risk factor in male adolescent.

Abstract Background To evaluate the diagnostic performance of radiologists on breast cancer with or without artificial intelligence (AI) support. Methods A retrospective study was performed. In total, 643 mammograms (average age: 54 years; female: 100%; cancer: 62.05%) were randomly allocated into two groups. Seventy‐five percent of mammograms in each group were randomly selected for assessment by two independent radiologists, and the rest were read once. Half of the 71 radiologists could read mammograms with AI support, and the other half could not. Sensitivity, specificity, Youden's index, agreement rate, Kappa value, the area under the receiver operating characteristic curve (AUC) and the reading time of radiologists in each group were analyzed. Results The average AUC was higher if the AI support system was used (unaided: 0.84; with AI support: 0.91; p < 0.01). The average sensitivity increased from 84.77% to 95.07% with AI support (p < 0.01), but the average specificity decreased (p = 0.07). Youden's index, agreement rate and Kappa value were larger in the group with AI support, and the average reading time was shorter (p < 0.01). Conclusions The AI support system might contribute to enhancing the diagnostic performance (e.g., higher sensitivity and AUC) of radiologists. In the future, the AI algorithm should be improved, and prospective studies should be conducted.

目的 通过分析北京市2011年至2020年适龄妇女免费乳腺癌筛查数据,了解北京市乳腺癌筛查效果及潜在意义.方法 分析北京市两癌筛查信息系统中5个周期(2011年至2020年)内共16个区上报的免费乳腺癌筛查数据,比较各筛查周期的筛查覆盖率、乳腺癌筛查知识知晓情况和乳腺癌及癌前病变检出情况.结果 北京市5个周期的乳腺癌筛查覆盖率由20.24％ 下降至13.06％(Z=-213.54,P<0.001);乳腺癌筛查知识的总知晓率水平保持在95％ 以上,但核心区及生态涵养区以部分知晓率提高为主,而全知晓率占比较低;乳腺癌检出率由第一周期的28.54/10万上升至第五周期的82.41/10万(Z=10.00,P<0.001),且该趋势在各板块间保持一致;而癌前病变检出率在前四个周期中逐步下降,但第五周期检出率显著提高至20.66/10万(χ2=67.40,P<0.001).根据TNM分期计算的早期乳腺癌占比为76.42％ ～82.62％.结论 北京市2011至2020年五个周期的乳腺癌、癌前病变检出率显著提高,但仍存在筛查覆盖率和全知晓率不足、各区筛查知识普及疾病检出水平不均衡等问题.

目的 通过分析北京市适龄妇女免费乳腺癌筛查中确诊为乳腺原位癌和浸润癌妇女的筛查情况,评价乳腺超声和乳腺X射线摄影检查在乳腺癌筛查中的应用效果,为提高乳腺癌筛查工作质量提供参考依据.方法 采用2011-01-01-2018-12-31北京市乳腺癌筛查的数据,选择病理确诊为乳腺原位癌和浸润癌的1339名妇女作为研究对象,回顾性分析确诊妇女乳腺超声检查和X射线摄影检查的乳腺影像报告和数据系统(BI-RADS)分类结果与病理确诊结果的符合情况.结果 病理确诊为乳腺原位癌和浸润癌的妇女中,共有1264名妇女在指定筛查和转诊机构接受了全部检查,其中1209名妇女检出原位癌或浸润癌,漏诊率为4.35％.2017-2018年,漏诊率下降到2.79％.接受超声检查的1337名妇女中,697人检查结果为BI-RADS分类≥4类,符合率为52.13％,159人超声筛查结果为1或2类,超声漏诊率为11.89％.接受乳腺X射线摄影检查的1166名妇女中,909人检查结果为≥4类,符合率为77.96％,257人检查结果为1或2类,乳腺X射线摄影检查漏诊率为7.20％.乳腺癌筛查工作开展以来,乳腺超声检查和乳腺X射线摄影检查的漏诊率均呈下降趋势.2017-2018年,乳腺超声漏诊率为8.33％,乳腺X射线摄影检查漏诊率为4.81％.结论 乳腺超声及X射线摄影检查作为中国女性乳腺癌筛查常规的影像学检查方式具有诊断符合率稳定、漏诊率低的优点,应进一步加强对筛查人员的技术培训,规范检查技术,加强质量控制,重点提高对于乳腺恶性病变的识别能力.

目的 了解中学生健康认知、健康行为及健康水平现状,为开展中学生健康教育与健康促进工作提供依据.方法 采用多阶段分层整群抽样方法,于2018年1-6月在北京市随机抽取4500名初中、高中学生开展现场调查,采用x2检验比较三组间两两比较分布差异.结果 中学生对合理膳食、健康饮品、吸烟危害、饮酒危害和艾滋病传播途径的认知正确率分别为50.12％、47.43％、68.39％、65.25％和83.03％,合理膳食认知正确率在各组间差异均有统计学意义(P＜0.017).中学生中水果、豆/奶制品和蔬菜摄入频率小于1次/天以及快餐摄入频率至少每周1次者分别占35.88％、38.43％、9.44％和54.25％,每日睡眠时长至少8h、每周参加体育锻炼至少5d者分别占32.37％、39.13％,有吸烟经历者占13.51％,除初中与普高组的快餐摄入频率外(x2=9.45,P=0.024),各组间比较差异均有统计学意义(P＜0.017).中学生中有13.66％超重者、15.69％肥胖者、3.04％重度焦虑者和4.96％抑郁高风险者,除初中与普高组的体型分布(x2=1.36,P=0.715)及普高与职高组的焦虑水平分布(x2=1.94,P=0.585)外,其他组间比较差异均有统计学意义(P＜0.017).中学生获取健康知识最主要的理想途径和实际途径分别是医务人员和电信/网络,除初中与职高组(x2=7.34,P=0.062)及普高与职高组(x2=7.24,P=0.065)的理想途径分布外,其他组间分布差异均有统计学意义(P＜0.017).结论 北京市中学生对健康饮食、烟酒危害等认知水平不足,在饮食、睡眠、运动等方面的行为习惯有待改善,超重肥胖、焦虑抑郁等健康问题依然存在.健康教育和健康促进工作应切实提高中学生健康认知、综合干预中学生健康行为、努力改善中学生健康状况.

目的 了解中学生网络沉溺现状及其与抑郁水平的关系,为开展中学生网络成瘾三级预防提供依据.方法 采用多阶段整群抽样方法,于2018年1-6月在北京市随机抽取4 500名中学生,采用现场调查法调查其网络沉溺情况、抑郁情况等.结果 在4 234份有效问卷中,显示具有网络可替代性差、优先性高、游戏需求大,日均上网不少于4h特质的占比分别为22.19％,19.62％,18.60％和21.37％.网络沉溺程度相对较重的组,其上网行为中选择玩游戏的比例也较高.有43.33％自觉有网络成瘾行为,家长是其最主要的求助对象.网络优先性高(OR=1.63,95％CI:1.36～1.95)、网络游戏需求大(OR=1.33,95％CI:1.10～1.60)、日均上网时长长(2～3 h/d:OR=1.40,95％CI:1.09～1.80;3～4 h/d:OR=1.32,95％CI:1.01～1.75;≥4 h/d:OR=1.80,95％CI:1.38～2.36)是中学生抑郁的独立危险因素.结论 中学生网络沉溺情况不容乐观,网络成瘾可能是中学生抑郁的风险因素,家长应加强预防中学生网络成瘾.

目的 评价国内两种实时荧光聚合酶链反应(PCR)方法在不同实验室间检测人乳头瘤病毒(HPV)的可重复性.方法 选取210例接受宫颈癌筛查或门诊就诊的患者,在不同实验室中对既往留存的细胞学标本进行透景HPV和凯普HPV检测.结果 透景HPV和凯普HPV试剂在不同实验室间检测高危型人乳头瘤病毒(HR-HPV)、HPV16、HPV18以及其他HR-HPV的总一致率均超过98％,Kappa值均超过0.97.结论 透景HPV和凯普HPV试剂在不同实验室间检测HPV的一致率和Kappa值远超过国际法规所要求的一致率≥87％、Kappa值≥0.5,是可靠的HPV检测技术,未来可能用于宫颈癌筛查.

计划生育技术服务管理,是母婴保健技术管理的重要内容之一,是现代医疗质量管理的重要组成部分,是落实好计划生育基本国策的重要保障.北京市自1985年正式成立北京市计划生育技术研究指导所后,对医疗保健机构实行计划生育技术全行业管理,至今已有30余年.在实践中形成了一整套实施属地化管理,区县级卫生行政部门审批、市级卫生行政部门备案、市区两级妇幼保健机构协助卫生行政部门进行日常管理的管理模式.通过制定统一的技术和管理规范,统一计划生育医疗文书,每3年对机构和人员执业资质考核,明确依法管理的计划生育技术项目,运用培训、审批、督导、考核等手段对机构及人员实施精细化管理,重视服务质量,从而保证了提供计划生育技术服务时人员机构有条件、房屋设备有标准、技术操作有常规、质量评价有指标,使此项技术服务的管理更加科学规范.

Background: Cervical cancer is a very common gynecological malignancy. The incidence of cervical cancer in Beijing increased rapidly, the local government launched free cervical cancer screening in 2008 as a pilot, and then the program covered all register eligible women in 16 districts since 2009. Our study assessed the free screening program in Beijing from 2008 to 2018. Methods: Analyzed the data of all women aged 35-64 years old who received free cervical cancer screening in Beijing from January 2008 to December 2018. Results: Since 2008, Beijing has conducted five cycles of cervical cancer screening among 35-64 years old women. During the period, target population has adjusted and service management kept on improved. Totally 2,624,129 person times have received the services. The average detection rate of abnormal cervical cytology was 2.3%, the rate of colposcopy referral was 1.8%, and the rate of abnormal colposcopy result was 63.5%. The detection rate of CIN2+ and cervical cancer was 208.5 / 100,000, of which 5228 cases of CIN 2+ were detected, the detection rate of 199.2 / 100,000; 244 cases of cervical cancer were detected and the rate was 9.3 / 100,000. Conclusions: Free cervical cancer screening can effectively serve the grassroots women, improve women's health awareness, and realize the early detection and early treatment of cervical cancer. The coverage of the screening population and the screening strategies need to be further explored to achieve the goal of decreasing cervical cancer incidence and mortality in the future.

目的 对拟参与北京市适龄女性免费子宫颈癌筛查的人乳头瘤病毒(HPV)检测试剂与实验室进行评估.方法 2016年11月至2017年5月期间对自愿参与北京市适龄女性免费子宫颈癌筛查的HPV检测试剂与实验室进行资料审核、实验室质控及样本检测.结果 8种试剂检测HR-HPV、HPV16和18的Kappa值均达到了0.800以上,一致性较好;检测CIN2+的敏感度、特异度、阳性预测值和阴性预测值各组之间相比均无统计学差异(P＞0.05).63.1％的实验室通过了室间质评.8种试剂与6家实验室组合具备参与北京市适龄女性免费子宫颈癌筛查的资质.结论 通过评估分析参与北京市免费子宫颈癌筛查的各种HPV检测方法的临床准确性,掌握了HPV实验室的服务能力,初步筛选出了8种HPV检测试剂和6家PCR实验室承担北京市宫颈癌筛查工作,为完善适龄女性免费子宫颈癌筛查方案提供依据.

目的 了解北京地区门诊收集的青少年女性流产情况,为制定北京市青少年综合保健服务内容以及针对在校青少年的宣传策略提供理论依据.方法 利用自行设计的调查登记表,对2017年10月1日至12月30日在北京市3个区的计划生育技术服务机构,对孕10周内人工流产的所有妇女的情况进行登记.结果 共收集流产个案信息2 895例,其中14～24岁青少年女性531例,占总流产人数的18.4％.北京地区≤17岁流产的青春期女性例数很少,从18岁开始,随年龄增加流产例数逐渐增加,24岁最多.门诊流产青少年学历以高中、中专及职高为主(37.1％).青少年既往有过流产史的共215例,占40.5％;最多的流产5次,3次及以上高危流产史的30例,占5.7％.青少年中有分娩史的109例,占20.5％.在采用避孕方法方面,青少年未避孕的比例较高,为34.7％;采用现代高效避孕方法的比例仅为42.9％.青少年流产原因中无妊娠意愿、未避孕的比例较高,为57.8％.结论 建议学校及相关机构在高中阶段前对青少年进行性与生殖健康的全面教育,同时整合学校、社区和妇幼保健资源,建立关爱青少年生殖健康的服务网络.

目的 通过绩效考核结果分析,了解绩效考核效果,发现工作中的问题,不断提高政府部门对妇幼卫生工作重要性认识,促进妇幼卫生体系建设与发展.规范妇幼卫生各项服务,提高服务能力与水平,推动医药卫生体制改革相关政策的落实.方法 通过听取相关部门汇报、查阅资料、问卷调查、现场查看与日常工作相结合等方式,对辖区卫生行政部门、妇幼保健机构,助产机构、基层卫生服务机构、托幼机构等部门的妇幼卫生工作,进行整体评估.结果 6年的北京市妇幼卫生绩效考核发现,大部分区县在政府保障、妇幼保健网络建设、妇幼健康状况、妇幼保健管理与服务均有不同程度提升,实现持续改进.但部分远郊区县发展相对滞后,妇幼工作有待持续改进.结论 通过绩效考核,进一步推动妇幼卫生事业发展,及时发现工作中的问题,明确责任单位,督促积极整改,实现北京市妇幼卫生工作持续改进.

目的:了解北京市大学生不安全性行为的现状及相关危险因素,为制定有针对性的干预措施提供依据.方法:在“北京市关爱青少年生殖健康综合防治项目”的4个试点区采用方便抽样的方法调查未婚大学生1069名.采用自行设计的问卷调查大学生的性行为、避孕方法等情况,分析不安全性行为的相关因素.结果:大学生婚前性行为发生率为13.2％.非意愿首次性行为发生率为10.9％.首次性行为不避孕者占31.9％,采用低效避孕措施者占18.3％.最近一次性行为不避孕者占11.6％,采用低效避孕措施占18.8％.多性伴行为发生率为25.7％.多因素分析显示,在首次性行为和近期性行为中,年龄较小的大学生发生避孕措施不当的风险较高(OR =3.631,95％CI 1.600～8.240;OR=2.807,95％CI 1.146～6.879).女大学生发生非意愿首次性行为的风险高于男性(OR=3.596,95％CI1.045～12.379).结论:大学生不安全性行为问题形势严峻,应加强对年龄偏低的大学生及女大学生的关注.

Low-cost, accurate high-risk human papillomavirus (HR-HPV) tests are needed for cervical cancer screening in limited-resource settings. More than 200 cervical cytological specimens from hospital patients were collected and analyzed for a real-world study. We evaluated the analytical and clinical performance of four widely used HR-HPV test (Tellgen, Hybribio, Liferiver, and Sansure) based on real-time polymerase chain reaction technology platforms, compared with the cobas test. Cervical intraepithelial neoplasia grade 2 or worse lesions (CIN2+) were set as the disease endpoint, and all the five HPV tests were performed with equal sensitivity (McNemar's test; P = 0.971) and specificity (McNemar's test; P = 0.953). All genotyping using the INNO-LiPA HPV test showed that HPV-16, -52, and -54 were the most common types among CIN2+ cases. Overall, the four HR-HPV tests analyzed appear to be as effective as the cobas HPV test in both agreement and clinical performance. Therefore, each of these low-cost HPV test kits could be implemented in limited-resource settings to accelerate the control of cervical cancer. However, we suggest that there is a need to further standardize and optimize testing around clinical sensitivity and specificity.

Background: To evaluate and compare the results of three different cervical cancer screening strategies including cytology screening, HR-HPV screening which taking HR-HPV testing as primary test and co-testing which taking both tests at the same time, then provide evidence to explore whether the cervical cancer screening can be conducted in community healthcare centers in Beijing. Methods: 182,119 women aged between 35 and 64, who were screened in the primary healthcare facilities of nine districts in Beijing from January 2014 to March 2015, were enrolled in this study. Cytology screening was performed in participants during January 2014 and December 2014 as a conventional arm. HR-HPV screening strategy and co-testing were randomly allocated to participants on districts level as experimental arm 1 and 2 during January 2015 and March 2015. Cervical Intraepithelial Neoplasia grade 2 or worse (CIN 2+) was defined as endpoint. The screening results and costs to detect a case of three strategies were calculated. Results: The positivity rate, colposcopy referral rate and biopsy referral rate of co-testing were 8.46%, 6.36% and 4.65% respectively, which were all significantly higher than the other two screening strategies. The detection rate of CIN 2+ by co-testing was 5.06%o and was much more than the other two screening strategies, while the HR-HPV screening had the highest PPV of 14.40%. The HR-HPV screening ignores some lesion which can be found by co-testing. Co-testing refers a woman to colposcopy with a positive screening result at the least cost, but it costs the most to detect a CIN 2+ case. Conclusions: To detect more cases of CIN 2+, co-testing performs better although with the most cost. And the primary healthcare facilities in Beijing have the capability to carry out the cervical cancer screen programs and prompts women with positive screen results to the hospital. (C) 2019 The Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences.

目的 探索建立宫颈癌筛查宫颈细胞学机构事前质控评估方法,并用该方法对参与北京市宫颈癌免费筛查的宫颈细胞学检查机构进行事前质控评估,掌握机构服务现况及存在问题,筛选出宫颈细胞学产品、制片、阅片质量良好的机构,参与北京市宫颈癌免费筛查,提高筛查质量.方法 采用资料审核、现场评价两种方法对影响细胞学检查质量的机构资质、硬件条件、制度、保存液质量、制片操作流程、人员能力等进行综合评价,筛选出宫颈细胞学产品、制片、阅片质量良好的机构.结果 16家机构参与了事前质控.通过专家组统一对资料进行审核剔除资料不全、字迹模糊、无相关资质、不符合技术要求的机构,最终6家机构5种产品进入现场评价阶段.保存液质量评估发现1家机构的产品不合格;2家机构的保存液取材后应在1周内尽快制片;2家机构的保存液可以4周内完成制片.现场评价基本具备承担筛查的硬件条件,但细胞学检查机构制度不健全,5家机构制订了质控方案,5家机构未对可疑病例进行追访;检查机构间人员的阅片能力有差异,人员阅片考核的平均分为64.6分;细胞学检查机构阅片质量复核符合率为95％,制片的操作流程欠规范.结论 通过事前质控评估方法,筛选出了合格的细胞学检查机构及产品,要求各区从评估合格的机构中择优选择承担本区宫颈癌免费筛查中宫颈细胞学检测工作.同时通过评估发现宫颈细胞学检查机构管理及操作欠规范,阅片人员的技能需加强.下一步将针对存在问题,组织统一培训,规范服务流程,加强对筛选合格机构的日常监管和内部质控,不断提高筛查质量和技术水平.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的分析采用不同模式对北京市适龄妇女进行宫颈癌免费筛查结果。方法在2014年12月—2015年3月北京市接受宫颈癌免费筛查的182 119例35～64岁妇女中,采用整群随机抽样法,分别采用联合筛查、高危型人乳头瘤病毒（HPV）初筛以及细胞学初筛方法筛查宫颈癌,使用SPSS 11.0软件对数据进行描述性分析和X²检验。结果在35～64岁妇女中进行的免费宫颈癌筛查结果显示,联合筛查癌及癌前病变检出率最高,为505.9/10万,高于HPV初筛的334.6/10万及细胞学初筛的246.3/10万,不同模式宫颈癌检出率和早诊率差异无统计学意义。联合筛查的初筛阳性率为8.5%,显著高于HPV初筛及细胞学初筛。高危型HPV检出阳性率为7.4%,其中HPV16型检出率为0.53%,HPV18型检出率为0.15%。结论初筛手段中增加HPV检测具有可行性。</span>

Objective To understand the effect and problems of cervical cancer screening by cytology as the primary screening method in Beijing from 2008 to 2014,in order to further improve cervical cancer screening strategy.Methods A Three-cycle-data of cervical cancer screening of Beijing in years of 2008-2009,2011-2012 and 2013-2014 was collected from the Beijing cervical and breast cancer screening information system,which was reported annually from 18 districts and counties of Beijing.The data was analyzed retrospectively.Results Coverage rate of the first,second and third cycle was 19.2％ (728 704/3 787 748),18.8％(495 814/2 630 818) and 15A％(467 863/3 032 690),respectively.Cervical cytology positive detection rate of the three cycles were 2.3％ (16 587/728 704),2.0％ (10 095/495 814) and 2.2％ (10 073/467 863),respectively.The detection rate of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesion (HSIL) gradually increased.Cervical lesion detection rate rising from 70.4/100 000 (513/72 870) of the first cycle increased to 224.2/100 000 (1 049/467 863) in the third cycle,which had risen by 218.5％.Rate of early diagnosis was 92.0％(552/602) of the first cycle,increased to 97.1％(1 061/1 093) in the third cycle,which increased by 5.5％.The detection rate of cervical cancer was fluctuated,the highest was in the first cycle,which was 12.2/100 000(89/728 704),while it declined to 9.4/100 000(44/467 863) in the third cycle.Conclusions Beijing cervical cancer screening program has shown great progress.The detection rate of cervical lesions and the rate of early diagnosis gradually increased which was due to improving screening technology of health care institutions in the grassroots level.Meanwhile,issues on the low screening coverage and low cervical cytology detection rate should be paid more attention to.