tbuckley/cabot-search huggingface dataset:
Grade III-IV cytokine release syndrome is associated with inferior survival in patients undergoing haploidentical donor stem cell transplants.
Authors: Omar Albanyan, Seongho Kim, Abhinav Deol, Asif Alavi, Andrew Daniel Kin, Lois Jeanne Ayash, Voravit Ratanatharathorn, Joseph P. Uberti, Dipenkumar Modi
Journal: Journal of Clinical Oncology (2020)

7546 Background: Haploidentical transplant (HIDT) with post-transplant cyclophosphamide (pCY) is being increasingly used because of the universal availability of donor and rapid graft acquisition time. Cytokine release syndrome (CRS) is one of the commonly occurring complications in this population. The information on the impact of CRS on the post-HIDT outcomes is limited. Methods: We retrospectively evaluated 91 patients who underwent HIDT between June 2012 and June 2019 for the onset and severity of CRS. CRS was graded per ASTCT guidelines. The primary objective was to compare RFS (relapse-free survival), NRM (non-relapse mortality), OS (overall survival) and GVHD in patients with no CRS, CRS grade 1-2 and 3-4. Results: All received peripheral blood stem cells and pCY/tacrolimus/mycophenolate as GVHD prophylaxis. Fifty-six (62%) received reduced intensity and 35 (38%) received full intensity conditioning regimen. Ten (10.9%) had no CRS, 74 (81.3%) developed grade 1-2 CRS and seven (7.7%) experienced grade 3-4 CRS. Median time to onset of CRS was one day post-transplant. The most common symptoms were fever (87%), fatigue (30%), nausea/vomiting (24%), rigors (24%), diarrhea (20%) and rash (11%). Fifteen (20%) with grade 1-2 and six (85%) with grade 3-4 CRS received tocilizumab. Day +100 cumulative incidence of grade III-IV acute GVHD for no CRS, grade 1-2 and grade 3-4 CRS was 0%, 2.7%, and 14.3%, respectively (P = 0.36). One-year cumulative incidence of chronic GVHD for no CRS, grade 1-2 and grade 3-4 CRS was 30%, 31.9% and 14.3%, respectively (P = 0.70). One-year NRM for no CRS, grade 1-2 and grade 3-4 CRS was 30%, 16.5%, and 57.1%, respectively (P = 0.002). One-year RFS for no CRS, grade 1-2 and grade 3-4 CRS was 48%, 63.4% and 28.6%, respectively (p = 0.03). OS at 1-year for no CRS, grade 1-2 and grade 3-4 CRS was 60%, 73.9%, and 28.6%, respectively (P = 0.008). Multivariable analysis revealed that grade 3-4 CRS was associated with significantly higher NRM (HR 5.54, P = 0.002), worse RFS (HR 3.41, P = 0.011) and worse OS (HR 4.91, P = 0.001). Conditioning regimen, degree of HLA match and disease risk index did not affect post-transplant outcomes and were not predictors for developing CRS. Conclusions: Our study showed that grade 3-4 CRS was associated with inferior post-transplant outcomes. However, no impact on acute or chronic GVHD was noted. Therefore, early recognition and prompt management of CRS may help improve outcomes.
Patient-reported care satisfaction and symptom burden in hospitalized patients with cancer.
Authors: Emilia R. Kaslow-Zieve, Carolyn L. Qian, Chinenye C. Azoba, Irene Wang, Emily E. Van Seventer, Richard Newcomb, Vicki A. Jackson, David P. Ryan, Joseph A. Greer, Areej El-Jawahri, Jennifer S. Temel, Ryan David Nipp
Journal: Journal of Clinical Oncology (2020)

2013 Background: Hospitalized patients with cancer often experience high symptom burden, which may impact their care satisfaction and use of health care services. Yet, studies describing these patients’ care satisfaction, symptom burden, and health care utilization are lacking. Methods: We prospectively enrolled patients with cancer and unplanned hospitalizations from 9/2014-4/2017. Upon admission, patients self-reported their care satisfaction (FAMCARE items asking about satisfaction regarding speed with which symptoms are treated and coordination of care) and physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire 4 [PHQ4]) symptom burden. We used regression models to identify patient factors associated with care satisfaction. We also explored associations between patients’ care satisfaction, symptom burden, and hospital length of stay (LOS) in models adjusted for age, sex, marital status, comorbidity score, cancer type, cancer documented as curable/incurable, time since cancer diagnosis, and admission to a dedicated oncology service. Results: We enrolled 1,576 of 1,749 (90.1%) consecutive patients (mean age = 63.19±13.39 years, 46.3% female). Most reported being very satisfied/satisfied with the speed with which symptoms are treated (89.0%) and coordination of care (90.1%). Older age (B = 0.01, P &lt; .02 for both) and admission to a dedicated oncology service (B = 0.20, P &lt; .01 for both) were each independently associated with higher satisfaction with the speed with which symptoms are treated and coordination of care. Higher satisfaction with the speed with which symptoms are treated was associated with lower PHQ4 depression (B = -0.14, P = .01), PHQ4 anxiety (B = -0.11, P &lt; .01), ESAS physical (B = -1.30, P &lt; .01), and ESAS total (B = -2.44, P &lt; .01) symptoms. Higher satisfaction with coordination of care was associated with lower PHQ4 depression (B = -0.14, P = .02), PHQ4 anxiety (B = -0.16, P &lt; .01), ESAS physical (B = -1.30, P &lt; .01), and ESAS total (B = -2.75, P &lt; .01) symptoms. Satisfaction with the speed with which symptoms are treated (B = -0.47, P = .03) and coordination of care (B = -0.50, P = .03) were both associated with shorter hospital LOS. Conclusions: Most hospitalized patients with cancer reported high care satisfaction, which was associated with older age and admission to a dedicated oncology service. We found relationships among higher care satisfaction, lower symptom burden, and shorter hospital LOS, underscoring the importance of efforts to enhance symptom management and care coordination in this population.
Evaluation of awareness of hypertension prevention and treatment knowledge before and after intensive training in physicians from hospitals at different levels in Xinjiang
Authors: Nan-fang Li, Jing Hong, Jun-li Hu, Hong-mei Wang, Sha Tao
Journal: BMJ (2010)

Objective To investigate awareness of hypertension prevention and treatment knowledge in physicians from hospitals at varied levels in Xinjiang. Methods In total, 150 voluntary physicians were selected randomly from hospitals at varied levels in Xinjiang for an anonymous close-book baseline survey on hypertension knowledge with questionnaire. Then, an intensive training on hypertension prevention and treatment based on Guidelines on Prevention and Treatment for Hypertension in China was offered for them.After training, another survey was conducted among them with the same questionnaire to examine improvement in their awareness of hypertension prevention and treatment knowledge and evaluate effectiveness of the training. Results At baseline, 89. 3 percent (134/150) of physicians could correctly know diagnostic criteria for hypertension, 78. 3 percent ( 18/23 ) of them from primary-care hospitals, and 52. 0 percent (78/150) could correctly know level of blood pressure under control, only 34. 8 percent (8/23) of them from primary-care hospitals. Only 67 (44. 7% ) physicians surveyed could know criteria for non-antihypertensive drug treatment, 27 of then from secondary-care hospitals and nine from primary-care ones, significant less in that among those from tertiary-care ones ( 88. 6%, 31/35 ) ( P ＜ 0. 05 ). After training, their awareness of hypertension prevention and treatment knowledge improved significantly ( P ＜0. 01). Conclusions Awareness of hypertension prevention and treatment knowledge differed considerably in physicians from hospitals at varied levels, poorer in those from primary-care hospitals, and more importance should be attached to them, especially to those from primary-care hospitals.

Key words: 
Hypertension; Questionnaires; In-service training
食品交换份治疗40例糖尿病疗效观察
Authors: 刘淑意, 刘茜, 刘迎梅, 丁学兵
Journal: BMJ (2005)

控制饮食、运动、药物治疗是治疗糖尿病的三要素.控制饮食又是三要素的基础,其方法包括公式计算法和主食固定法,这两种方法都不易掌握和控制.20世纪80年代以后,国际上多数学者主张以控制总热量为主,应用食品交换份,即以供热376 kJ(90 kcal)的食品质量为1单位交换份,根据患者所需热量,按营养成分比例计算出主辅食量,并可等份交换,这样可设计出多样化的食谱.我们应用此法治疗2型糖尿病患者40例,血糖控制良好,现报告如下。
Evaluation of spatiotemporal heterogeneity of PDL1 expression in gastroesophageal adenocarcinoma (GEA) at baseline diagnosis and after chemotherapy.
Authors: Katherine I. Zhou, Bryan Peterson, Anthony Serritella, Natalie Reizine, Yan Wang, Daniel V.T. Catenacci
Journal: Journal of Clinical Oncology (2020)

4528 Background: PDL1 expression is a predictive marker for response to anti-PD1/PDL1 agents (IO) for GEA. As a prognostic biomarker, data are conflicting. Molecular heterogeneity of various biomarkers for GEA has been established. To characterize heterogeneity of PDL1 expression and its clinical relevance, we compared PDL1 expression in primary (1 0 ) and metastatic (met) tumors of newly diagnosed stage IV advanced GEA (aGEA), and before and after chemotherapy treatment (tx) for stage II–IV GEA. We assessed the prognostic relevance of PDL1 expression in aGEA. Methods: We retrospectively reviewed a cohort of 130 patients (pts) diagnosed with GEA in 2013–2019, with a total of 328 tumor samples with PDL1 expression data. PDL1 was defined as positive if combined positive score (CPS) was ≥1 using the 22C3 pharmDx assay. Analysis was performed by McNemar’s test for paired PDL1 and univariate Cox proportional-hazards model for overall survival (OS). Results: Of 328 tumors, 45% were PDL1+ and 55% PDL1-. CPS ranged 0–100 (median 1, IQR 0–5), and CPS was ≥10 for 19% of tumors. Concordance between PDL1 status of paired baseline 1 0 and baseline met tumors was 63% (32/51) (Table). Of 31 PDL1+ baseline 1 0 tumors, 52% (16/31) had PDL1- paired baseline met tumors, while of 20 PDL1- baseline 1 0 tumors, only 15% (3/20) had PDL1+ paired baseline met tumors. Only 35% (18/51) of met tumors were PDL1+, compared to 61% (31/51) PDL1+ 1 0 tumors ( p&lt; 0.003). Post-tx tumors exhibited 62% (46/74) concordance of PDL1 status compared to pre-tx 1 0 tumors. Of 43 PDL1+ baseline tumors, 35% (15/43) were PDL1- post-tx; of 31 PDL1- baseline tumors, 42% (13/31) were PDL1+ post-tx ( p= 0.71). In pts with aGEA at diagnosis, OS did not significantly differ depending on baseline 1 0 tumor PDL1 status (median OS of 17.9 [95% CI 14.6–26.5] months for PDL1- and 16.7 [12.0–26.3] months for PDL1+; p= 0.6), nor depending on baseline met PDL1 status. Conclusions: PDL1 expression demonstrated notable baseline discordance between 1 0 and met tumors, particularly directional from PDL1+ 1 0 tumor to PDL1- met. Discordance before and after chemotherapy was also observed, but with similar proportions of PDL1+ pre-tx and post-tx tumors. These findings may have predictive IO therapeutic implications if confirmed in larger independent analyses. [Table: see text]
Amide proton transfer MRI can accurately stratify gliomas according to their IDH mutation and 1p/19q co-deletion status.
Authors: Sotirios Bisdas, Stefano Casagranda, Diana Roettger, Sebastian Brandner, Lewis Thorne, Laura Mancini
Journal: Journal of Clinical Oncology (2020)

2561 Background: Amide proton transfer (APT) MRI provides sensitive metrics at the amides and amines offsets from the water resonance and has been shown in small cohorts to differentiate low from high grade gliomas with better diagnostic performance than diffusion- and perfusion-weighted MRI. The purpose of our study was to assess APT-MRI performance to stratify gliomas according to their IDH mutation and 1p/19q status. Methods: Forty-five patients with primary gliomas and diffuse astrocytomas (26 WHO grade II, 11 WHO grade III, 8 WHO grade IV) underwent prospectively multi-parametric MRI with APT imaging at 3T scanner. The molecular classification identified 9 patients with IDH-wildtype, 1p/19q retained and 36 with IDH-mutant (22 had 1p/19q-retained, 14 had 1p/19q-codeleted). Tumour segmentations were manually created and the masks were superimposed on the calculated magnetisation transfer ratio asymmetry (MTR asym ) spectra and proton transfer ratio APT maps. Individual and group analysis was conducted to analyse the statistical differences between quantitative imaging parameters for the IDH mutation and 1p/19q codeletion statuses. Results: The MTR asym spectra showed a clear difference between IDH-wildtype and IDH-mutant gliomas, with the IDH-mutant gliomas presenting a stronger contribution in the amines (p &lt; 0.001). In IDH-mutant 1p/19q-retained and IDH-mutant 1p/19q-codeleted, the MTR asym spectra showed similarities in shape with higher intensity (approx. 60%) for the IDH-mutant 1p/19q-retained gliomas over the entire spectrum indicating an increased content in amines and amides in IDH-mutant 1p/19q-retained (p &lt; 0.01). Notably, the latter entities showed higher amides levels than the IDH-wildtype gliomas (p &lt; 0.03). Conclusions: APT-MRI shows a remarkable potential to disentangle the protein metabolism in gliomas, to link metabolic patterns to the IDH and 1p/19q status and hence provide robust surrogate biomarkers for non-invasive histomolecular classification with potential use as treatment monitoring tools.
The positive correlation between tumor mutation burden and the purity of tumor samples in non–small cell lung cancer and colorectal cancer.
Authors: Jian Tong, Xiaoni Zhang, Hongyue Qu, Qing Yang, Jingxian Duan, Mingyan Xu
Journal: Journal of Clinical Oncology (2020)

e13683 Background: Tumor mutation burden (TMB) is reported to be a biomarker for predicting immunotherapy responses in patients with non–small cell lung cancer (NSCLC). To provide a more accurate calculation of TMB, the correlation between tumor purity and TMB was investigated. Methods: 959 patients were enrolled in this study from July 2019 to January 2020, including 663 patients with primary NSCLC and 296 patients with primary colorectal cancer (CRC). Formalin-Fixed Paraffin-Embedded (FFPE) and paired white blood cells were collected from each patient. These FFPE samples were stained with HE for the evaluation of tumor purity. DNA was extracted from samples and sequenced using a 605-gene panel on the Illumina platform (approximately 3,000× coverage). TMB was calculated for each sample based on the sequencing data. Results: The median TMB of 663 NSCLC patients was 2.29mut/Mb, and the TMB is positively correlated with the purity of tumor samples. Among samples in which tumor cells accounted for ≥40% of the sample cells (n = 456), the median TMB reached 2.29 mut/Mb, and 90.35% (412/456) patients had a TMB higher than 0 mut/Mb. In samples that tumor cells accounted for 20% to 40% of sample cells (n = 120), the median TMB was 1.53mut/Mb and 72.5% (87/120) of patients had a TMB larger than 0 mut/Mb. The median TMB was 0.76 mut/Mb for samples contained less than 20% of tumor cells, and only 50.57% (44/87) patients had a TMB larger than 0 mut/Mb. Similar results were obtained in 296 CRC samples, which exhibited a median TMB of 3.55mut/Mb. Tumor cells accounted for 40% of the sample cells in 191 cases. The median TMB of those samples was 4 mut/Mb, and 96.34% (184/191) samples had a TMB larger than 0 mut/Mb. When tumor cells accounted for 20% to 40% of total sample cells, the median TMB was 2.94mut/Mb, and 94.44% (51/54) of patients had a TMB larger than 0 mut/Mb. In 50 samples that contained less than 20% of tumor cells, the median TMB was 2.29mut/Mb, and 80 % (40/50) samples had a TMB larger than 0 mut/Mb. Conclusions: TMB is positively correlated with the purity of tumor samples. Moreover, data suggest that the TMB is more reliable when tumor cells account for more than 40% of the sample population.
医生告知与患者知情同意的案例分析
Authors: 陈志华
Journal: BMJ (2004)

患者知情权是指患者知悉与其生命健康相关信息的权利,属于患者人身权的组成部分,是一种与公民生命健康权相关的人格权利.其作为一项法定权利已经受到我国现有法律的保护.1999年5月1日施行的 第26条明确规定,医师应当如实向患者或者家属介绍病情.2002年9月1日施行的 第11条也明确规定,在医疗活动中,医疗机构及其医务人员应当将患者的病情、医疗措施、医疗风险等如实告知患者.任何侵害患者知情权并造成损害后果的行为,均可构成对患者人身权利的侵害,应依法承担法律责任。
A noninvasive multi-analytic approach for lung cancer screening of patients with pulmonary nodules.
Authors: Hong Zheng, Tiancheng Han, Quanxing Liu, Dong Zhou, Li Jiang, Bin Hou, Xiao Lu, Qingyuan Li, Pei Zhihua, Yuanyuan Hong, Yaxi Zhang, Weizhi Chen, Ji He, Jigang Dai
Journal: Journal of Clinical Oncology (2020)

1550 Background: Low-dose computed tomography (LDCT) is an effective approach for lung cancer screening of high-risk patients with pulmonary nodules, however with varying false positive rates depending on the somewhat subjective judgement of the practice professional. Artificial intelligence derived from machine learning of comprehensive patient profiles, including multi-omics and clinical data, has the potential to provide more objective assessment of patient’s risk in order to aid clinician’s decision making. We have developed a multi-analyte algorithm-based assay (MAAA) that incorporates ctDNA mutation, ctDNA methylation, and protein biomarker profiles evaluated through non-invasive blood-based testing, as well as patient’s clinical information, to improve the diagnostic efficacy of lung cancer. Methods: 98 high-risk patients with pulmonary nodules were enrolled in two independent cohorts (68 for training/testing and 30 for independent validation). The malignancy of the pulmonary nodules were established through pathology of surgical-removed nodules. Prior to surgery, each patient was also subject to cell-free DNA-based sequencing for DNA mutation and DNA methylation profiling, as well as serum protein biomarker profiling. On the training/testing patient cohort, machine-learning-based predictive models were first built for malignancy status prediction based on each type of molecular or clinical features. A final ensemble model was then constructed to incorporate the measurements based on molecular and clinical markers to provide the ultimate recommendation on the malignancy of the pulmonary nodule. The performance of each individual model and the final ensemble model was benchmarked on the training/testing cohort, and also validated on the independent validation cohort. Results: On the 30-patient independent validation cohort, individual prediction models based on clinical information, protein marker, ctDNA mutation, and ctDNA methylation profiles achieved predictive AUC of 0.59, 0.48, 0.71, and 0.84, respectively. The final ensemble model achieved predictive AUC of 0.86, which has strongly indicated that an integrative, algorithm-based approach of multi-analytic molecular and clinical profiles greatly outperforms any single-analytic profiling. Conclusions: Multi-analyte algorithm-based approach can be utilized to assist in lung cancer screening for patients with pulmonary nodules. It has demostrated a high accuracy through independent validation, and has outperformed any single-analyte testing in our study.
Complete responses (CR) in patients receiving atezolizumab (atezo) + bevacizumab (bev) versus sorafenib (sor) in IMbrave150: A phase III clinical trial for unresectable hepatocellular carcinoma (HCC).
Authors: Richard S. Finn, Shukui Qin, Masafumi Ikeda, Peter R. Galle, Michel Ducreux, Tae-You Kim, Masatoshi Kudo, Ho Yeong Lim, Valeriy Vladimirovich Breder, Philippe Merle, Ahmed Omar Kaseb, Daneng Li, Yin-Hsun Feng, Wendy Verret, Derek-Zhen Xu, Sairy Hernandez, Beiying Ding, Andrew X. Zhu, Ann-Lii Cheng
Journal: Journal of Clinical Oncology (2020)

4596 Background: In the Phase III IMbrave150 trial, statistically significant and clinically meaningful improvements in OS and PFS were seen with atezo + bev vs sor in pts with unresectable HCC who had not received prior systemic therapy (Cheng, ESMO Asia, 2019). Historically, CR rates have been low in HCC clinical trials. Here we report the baseline characteristics for IMbrave150 pts with a CR. Methods: IMbrave150 enrolled systemic treatment-naive pts with unresectable HCC. Pts were randomized 2:1 to receive either atezo 1200 mg IV q3w + bev 15 mg/kg IV q3w or sor 400 mg BID until unacceptable toxicity or loss of clinical benefit per investigator. Co-primary endpoints were OS and PFS by independent review facility (IRF)–assessed RECIST 1.1. The key secondary endpoints IRF ORR per RECIST 1.1 and IRF ORR per HCC mRECIST were also part of the study statistical testing hierarchy. Results: The ITT population included 336 pts randomized to atezo + bev and 165 pts randomized to sor. With a median follow-up of 8.6 mo (data cutoff, Aug 29, 2019), OS HR was 0.58 (95% CI: 0.42, 0.79; P = 0.0006) and PFS HR was 0.59 (95% CI: 0.47, 0.76; P &lt; 0.0001) with atezo + bev vs sor. ORR was 27% vs 12% ( P &lt; 0.0001) per IRF RECIST 1.1 and 33% vs 13% ( P &lt; 0.0001) per IRF HCC mRECIST with atezo + bev vs sor, respectively. For responders (per IRF RECIST 1.1), median time to response was 2.8 mo (range, 1.2-11.3) with atezo + bev and 3.3 mo (range, 1.2-7.2) with sor. CR per IRF-assessed RECIST 1.1 was achieved by 18 pts in the atezo + bev arm and 0 pts in the sor arm. The baseline characteristics for atezo + bev CR pts are shown in the table. Additional characteristics will be shown. Conclusions: IMbrave150 demonstrated statistically significant and clinically meaningful improvement in both OS and PFS with atezo + bev vs sor in pts with unresectable HCC who have not received prior systemic therapy. Pts achieved CRs regardless of poor prognostic factors or etiology. Atezo + bev may be a practice-changing treatment for pts with unresectable HCC. Clinical trial information: NCT03434379 . [Table: see text]
Efficacy and safety of laterally extended endopelvic resection for the pelvic side wall gynecologic tumors: A four-year prospective cohort study with historical comparison.
Authors: Haerin Paik, Soo Jin Park, Hee Seung Kim, Jae-Weon Kim
Journal: Journal of Clinical Oncology (2020)

6092 Background: Although laterally extended endopelvic resection (LEER) has been introduced to control the pelvic sidewall tumors, there is a lack of evidence about its efficacy and safety despite high skillful procedure, compared with the other treatments. Thus, we performed a prospective cohort study with historical comparison for four years. Methods: One gynecologic oncologist performed LEER consecutively for patients with the pelvic sidewall tumors between March 2014 and July 2018. We compared clinicopathologic characteristics and survival between patients who received primary LEER and with those treated with other treatments. Results: We enrolled 37 patients treated with LEER. Among them, 22 (59.5%) and 15 (40.5%) had recurrent and primary disease. Among perioperative outcomes, there was more estimated blood loss, and hospitalization was longer in recurrent disease and previous surgery (p &lt; 0.05). In recurrent disease, previous progression-free survival &lt; 8 months was related to poor recurrence-free survival after LEER (median, 5.4 vs. 10.2 months; p &lt; 0.05). When LEER was applied for the first recurrence of cervical cancer, recurrence-free survival and overall survival after treatment seemed to be longer in LEER (n = 9) than in palliative chemotherapy (n = 27) without statistical significance (median, 12.2 vs. 4.7 months and 23.2 vs. 12.4 months; p = 0.13 and p = 0.63). In 15 patients with primary locally advanced cervical cancer, LEER after partial response to neoadjuvant chemotherapy showed longer progression-free survival than LEER after stable or progressive disease to neoadjuvant chemotherapy and primary radiotherapy (p = 0.012). After LEER, grade 3 and 4 complications developed in 15 (23.1%) and 2 (3.1%) patients. Conclusions: Compared with palliative chemotherapy, LEER followed by palliative chemotherapy may improve progression-free survival in patients with recurrent cervical cancer located in the pelvic sidewall. If possible, it is more effective to apply LEER without preceding palliative chemotherapy for recurrent cervical cancer located in the pelvic sidewall.
社区居民健康体检影响因素分析
Authors: 马岩, 张宝恩, 赵海燕, 范雪梅, 黎燕铭, 杨培蔚
Journal: BMJ (2007)

对采用多阶段抽样方法随机抽取的307户、925名居民进行入户调查,组织2次8～10人的小组访谈,了解社区居民的体检意识和体检行动情况.结果,居民中75.78%(701/925)有体检意识,16.11%(149/925)有体检行动;15岁及以上妇女中60.83%(278/457)有体检意识,18.82%(86/457)有体检行动.未进行体检的主要原因是认为没必要、经济困难、无法报销.小组访谈提示社区居民中,部分居民认为自己身体很好或内心害怕发现疾病而拒绝健康体检.提示,主观觉察易感性、主观觉察严重性、主观觉察障碍及经济因素是影响社区居民进行健康体检的主要因素。