A prospective study on effect of periodic health examination for prevention of chronic diseases

组织了两组社区人口和一名工作人员，以评估定期健康检查对慢性病一级和二级预防的有效性。社区队列的成员是从1989年和/或1990年参加老年人保健方案提供的定期健康检查的人中挑选出来的，并提交了成为该队列成员的书面协议。地级市的工人组成了工人队列。根据同一计划，118个直辖市之一的22,478名工人将接受定期健康检查。从健康教育和项目管理两个方面阐述了早期发现疾病的各项检查的有效性和检查的有效性。对于第一个分析，对社区队列检查后平均117天的发病率调查显示，47%的成员在此期间至少去过一次医疗机构。只有15%的人被检查发现。根据结果，建立了一个数学模型，以估计当筛查测试应用于给定人群时可检测到的亚临床疾病的比例。模型引入的变量包括检查间隔、亚临床阶段的长度、测试的特异性和敏感性。对职业队列的测试的阳性预测值进行了估计。估计值的范围相当广泛，从20%到96‘/。。对6920名无糖尿病病史的职工进行了详细的糖尿病调查，发现空腹血糖检测阳性379例。平均而言，在检查后的一年内，这一阳性组只有126人去看医生。考后对社区队列的问卷调查证明，如果与考试前相比，生活方式有了实质性的改善。

Two cohorts of a community population and a working poplation have been organized to evaluate effectiveness of periodic health examination for primary and secondary prevention of chronic diseases. The member of the community cohort was selected from those who attended periodic health examinations offered by the Health Care Program for Senior Person in 1989 and/or 1990 and submitted written agreement to become a member of the cohort. Workers of municipalities in a prefecture composed the worker's cohort. A total of 22, 478 workers who belong one of 118 municipalities are offered periodic health examination under a same program. Analysis is done to clarify 1)effectiveness of each test of the examination for early detection of disease and 2)effectiveness of the examination from aspect of health education and program management. For the first analysis, a survey of incidence for average of 117 days after an examination of the community cohort revealed 47% of the member visited medical facilities at least once during the period. Only 15% of them were detected by the examination. Based on the results, a mathematical model was created to estimate detectable proportion of a subclinical disease when a screening test is applied to a given population. Introduced variables for the model are interval of the examination, length of subclinical stage, specificity and sensitivity of the test. Positive predictive values of the tests are estimated for the occupational cohort. The range of estimated values distributed rather widely from 20% to 96'/. . A detailed survey on diabetes mellitus revealed 379 positive cases on fasting blood sugar test among 6920 workers who have no history of diabetes. Amonly this positive group only 126 visited physicians during one year after the examination. A postexamination questionnaire survey of the community cohort proved a substantial improvement in life style if it is compared to the preexamination.