Incidence, Risk Factors, and Temporal Trends of Small Intestinal Cancer: A Global Analysis of Cancer Registries.

BACKGROUND & AIMS: Small intestinal cancer is a rare cancer, with limited studies exploring its epidemiology. To our knowledge, this study is the first effort to comprehensively analyze the incidence, risk factors, and trends for small intestinal cancer by sex, age, and country. METHODS: Global Cancer Observatory, Cancer Incidence in Five Continents Plus, and Global Burden of Disease were accessed to estimate the age-standardized rates of small intestinal cancer incidence (International Classification of Diseases, 10th Revision, Clinical Modification: C17) and prevalence of lifestyle risk factors, metabolic risk factors, and inflammatory bowel disease (IBD). Risk factor associations were assessed by linear and logistic regressions. Average annual percent change was calculated using joinpoint regression. RESULTS: A total of 64,477 small intestinal cancer cases (age-standardized rate, 0.60 per 100,000) were estimated globally in 2020, with a higher disease burden found in North America (1.4). Higher small intestinal cancer incidence was associated with higher human development index; gross domestic product; and prevalence of smoking, alcohol drinking, physical inactivity, obesity, diabetes, lipid disorder, and IBD (ß = 0.008-0.198; odds ratios, 1.07-10.01). There was an overall increasing trend of small intestinal cancer incidence (average annual percent change, 2.20-21.67), and the increasing trend was comparable among the 2 sexes but more evident in the older population aged 50-74 years than in the younger population aged 15-49 years. CONCLUSION: There was a substantial geographic disparity in the burden of small intestinal cancer, with higher incidence observed in countries with higher human development index; gross domestic product; and prevalence of unhealthy lifestyle habits, metabolic disorders, and IBD. There was an overall increasing trend in small intestinal cancer incidence, calling for the development of preventive strategies.

Global burden, risk factors, and temporal trends of ureteral cancer: a comprehensive analysis of cancer registries.

BACKGROUND: Ureteral cancer is a rare cancer. This study aimed to provide an up-to-date and comprehensive analysis on the global trends of ureteral cancer incidence and its association with lifestyle and metabolic risk factors. METHODS: The incidence of ureteral cancer was estimated from the Cancer Incidence in Five Continents Plus and Global Cancer Observatory databases. We analyzed the (1) global incidence of ureteral cancer by region, country, sex, and age group by age-standardized rates (ASR); (2) associated risk factors on a population level by univariable linear regression with logarithm transformation; and (3) incidence trend of ureteral cancer by sex and age group in different countries by Average Annual Percentage Change (AAPC). RESULTS: The global age-standardized rate of ureteral cancer incidence in 2022 was 22.3 per 10,000,000 people. Regions with higher human development index (HDI), such as Europe, Northern America, and East Asia, were found to have a higher incidence of ureteral cancer. Higher HDI and gross domestic product (GDP) and a higher prevalence of smoking, alcohol drinking, physical inactivity, unhealthy dietary, obesity, hypertension, diabetes, and lipid disorder were associated with higher incidence of ureteral cancer. An overall increasing trend of ureteral cancer incidence was observed for the past decade, especially among the female population. CONCLUSIONS: Although ureteral cancer was relatively rare, the number of cases reported was rising over the world. The rising trends among females were more evident compared with the other subgroups, especially in European countries. Further studies could be conducted to examine the reasons behind these epidemiological changes and confirm the relationship with the risk factors identified.

Incidence distributions, risk factors and trends of vaginal cancer: A global population-based study.

OBJECTIVE: This study aimed to investigate the incidence, risk factors and trends for vaginal cancer. DESIGN: Retrospective observational design. SETTING: Data were collected from multiple sources, including the Global Cancer Observatory, Cancer Incidence in Five Continents Plus, Global Burden of Disease, World Bank and the United Nations. POPULATION: Individuals diagnosed with vaginal cancer. METHODS: The study collected data on vaginal cancer from the specified sources. The age-standardised rate (ASR) of vaginal cancer was calculated for different regions and age groups. Multivariable and univariable linear regression analyses were performed to examine the associations between risk factors and the incidence of vaginal cancer. Trend analysis was conducted using joinpoint regression analysis, and the average annual percentage change (AAPC) was calculated to quantify the temporal trend. MAIN OUTCOME MEASURES: The main outcome measures of the study were the incidence of vaginal cancer, risk factors associated with the disease and the trend of its incidence over time. RESULTS: There were 17 908 newly reported cases of vaginal cancer (ASR = 0.36, 95% CI 0.30-0.44) in 2020, with the highest ASRs reported in South-Central Asia and Southern Africa. Risk factors associated with a higher incidence of vaginal cancer included a higher prevalence of unsafe sex and human immunodeficiency virus (HIV) infection. The temporal trend showed an overall rising incidence globally, with Iceland (AAPC = 29.56, 95% CI 12.12-49.71), Chile (AAPC = 22.83, 95% CI 13.20-33.27), Bahrain (AAPC = 22.05, 95% CI 10.83-34.40) and the UK (AAPC = 1.40, 95% CI 0.41-2.39) demonstrating the most significant rising trends. CONCLUSIONS: The significant regional disparities and risk factors associated with vaginal cancer underscore the necessity for targeted interventions and education, particularly in regions with a lower human development index (HDI) and a higher prevalence of human papillomavirus (HPV) infection. The increasing incidence trend emphasises the need for enhanced HPV vaccination rates to prevent the development of vaginal cancer.

Global incidence, risk factors and trends of vulvar cancer: A country-based analysis of cancer registries.

Vulvar cancer is an uncommon malignancy. Vulvar cancer alarmed the public health problem in terms of the cost of diagnostic and medical treatments and psychical health of females. Our study aims to provide a thorough analysis of the global disease burden, related risk factors and temporal incidence trends of vulvar cancer in population subgroups. Data from Global Cancer Observatory and the Cancer Incidence in Five Continents Plus were used for the vulvar cancer incidence. Age-standardized rates (ASR) were used to depict the incidence of vulvar cancer. The 10-year trend of incidence was assessed using joinpoint regression with average annual percentage change and 95% confidence intervals in various age groups, while its correlations with risk factors were investigated using linear regression. Higher ASR were found in Western Europe (2.4), Northern America (1.9), Northern Europe (1.9), Australia and New Zealand (1.8) and Eastern Africa (1.4). The associated risk factors of higher vulvar cancer incidence were gross domestic product per capita, Human Development Index, higher prevalence of smoking, alcohol drinking, unsafe sex and human immunodeficiency virus infection. The overall trend of vulvar cancer incidence was increasing. An increasing trend was found in older females while a mixed trend was observed in younger females. The disease burden of vulvar cancer follows a bimodal pattern according to its two histologic pathways, affecting women in both developed and developing regions. Smoking cessation, sex education and human papillomavirus vaccination programs should be promoted among the general population. Subsequent studies can be done to explore the reasons behind the increasing trend of vulvar cancer.

Factors Associated With the Acceptance of an eHealth App for Electronic Health Record Sharing System: Population-Based Study.

BACKGROUND: In the second stage of the Electronic Health Record Sharing System (eHRSS) development, a mobile app (eHealth app) was launched to further enhance collaborative care among the public sector, the private sector, the community, and the caregivers. OBJECTIVE: This study aims to investigate the factors associated with the downloading and utilization of the app, as well as the awareness, perception, and future improvement of the app. METHODS: We collected 2110 surveys; respondents were stratified into 3 groups according to their status of enrollment in the eHRSS. The primary outcome measure was the downloading and acceptance of the eHealth app. We collected the data on social economics factors, variables of the Technology Acceptance Model and Theory of Planned Behavior. Any factors identified as significant in the univariate analysis (P<.20) will be included in a subsequent multivariable regression analysis model. All P values ≤.05 will be considered statistically significant in multiple logistic regression analysis. The structural equation modeling was performed to identify interactions among the variables. RESULTS: The respondents had an overall high satisfaction rate and a positive attitude toward continuing to adopt and recommend the app. However, the satisfaction rate among respondents who have downloaded but not adopted the app was relatively lower, and few of them perceived that the downloading and acceptance processes are difficult. A high proportion of current users expressed a positive attitude about continuing to adopt and recommend the app to friends, colleagues, and family members. The behavioral intention strongly predicted the acceptance of the eHealth app (ß=.89; P<.001). Attitude (ß=.30; P<.001) and perceived norm; ß=.37; P<.001) played important roles in determining behavioral intention, which could predict the downloading and acceptance of the eHealth app (ß=.14; P<.001). CONCLUSIONS: Despite the high satisfaction rate among the respondents, privacy concerns and perceived difficulties in adopting the app were the major challenges of promoting eHealth. Further promotion could be made through doctors and publicity. For future improvement, comprehensive health records and tailored health information should be included.

Usage of electronic health record (eHR) viewer among healthcare professionals (HCProfs): A territory-wide study of 3972 participants.

BACKGROUND: The Electronic Health Record Sharing System (eHRSS) is an electronic platform for two-way communication between the public and private sectors in Hong Kong. The authorised healthcare professionals (HCProfs) could access and upload patients' health records on the eHR Viewer in the eHRSS. This study aims to evaluate the usage of eHR viewer among the HCProfs from the private sector by 1) examining the correlation of various factors and the data access of eHR viewer; 2) investigating the trend on data access and upload to eHR viewer by time period and domain. METHODS: A total of 3972 HCProfs from private hospitals, group practice, and solo practice were included in the study. Regression analysis was performed to identify the correlation between various factors and the data access to eHR viewer. Trends on accessing and data uploading to eHR viewer by time period and domains were evaluated. Trends on data uploading to eHR viewer by time period and domains were presented in the line chart as well. FINDINGS: All types of HCProfs had a higher likelihood of accessing the eHR viewer as compared to those from private hospitals. HCProfs with specialities (apart from anaesthesia) had a higher possibility of accessing the eHR viewer than general practitioners without specialities. HCProfs participating in the Public-Private Partnership (PPP) Programme and the eHealth System (Subsidies) (eHS(S)) were more likely to access the eHR viewer. The overall trend of accessing eHR viewer was rising notably from 2016 to 2022, every domain showed rising trends, especially the laboratory domain with a 5-times increase between 2016 and 2022. CONCLUSION: HCProfs with speciality were more likely to access the eHR viewer (except anaesthesiology), compared with the general practitioners. Participation in the PPP programmes and eHS(S) also increased the access rate of the eHR viewer. Besides, the use of eHR viewer (accessing and data uploading) would be influenced by social policy and the epidemic. Future research should focus on the impact of government programmes on eHRSS adoption.

Enabling Factors, Barriers, and Perceptions of Pneumococcal Vaccination Strategy Implementation: A Qualitative Study.

Invasive pneumococcal disease (IPD) is a leading cause of disability and mortality worldwide, particularly in the elderly population. With the implementation of the Government Vaccination Programme (GVP) and the Vaccination Subsidy Scheme (VSS), enabling factors and barriers in service provider scheme participation and vaccination uptake were examined in 32 interviews with doctors and 16 interviews with vaccine recipients. Interview data were analysed in NVivo 11.0 with reference to the Consolidated Framework for Implementation Research (CFIR) and the REAIM Framework to develop codes and themes. Barriers to pneumococcal vaccination uptake included concerns on vaccine efficacy and poor understanding of the disease and vaccine schemes, whilst service provider participation was hindered by ill-defined parameters for patient eligibility and time, location, and logistical constraints. Enabling factors to improve intervention implementation were involvement of the government and physicians to encourage participation, clarifying eligibility criteria, and improving individual knowledge of IPD and vaccination schemes. As participation rates in the GVP and VSS remains low in Hong Kong, efforts concentrating on health promotion strategies encouraging pneumococcal vaccination amongst the elderly population are recommended.