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In February 2013, Japan became the first country in the world to cover Helicobacter pylori eradication for chronic gastritis under its National Health Insurance (NHI) system. Now that eradication therapy is covered by NHI, its usage has increased dramatically, and gastric cancer deaths have begun to decrease. We undertook a detailed epidemiological analysis to investigate effects of expanded NHI coverage for H. pylori eradication therapy on gastric cancer deaths in specific age groups. Numbers of gastric cancer deaths were determined by referencing data from Ministry of Health, Labour and Welfare reports and “Cancer Statistics in Japan – 2018” published by the Foundation for Promotion of Cancer Research. Gastric cancer deaths across all age groups have been clearly decreasing since 2013, but deaths of people aged 80 years and older are still increasing. The number of gastric cancer deaths in people aged in their 80s was 2 times higher than in people aged in their 70s and 4 times higher than in people aged in their 60s. The number of people in their 80s who had an endoscopy was less than half that of people in their 60s and 70s. The eradication therapy has increased dramatically, and gastric cancer deaths are clearly decreasing in Japan. However, this decrease in deaths has not extended to elderly adults aged in their 80s, which suggests that measures to prevent gastric cancer in people aged 80 years and older will be critical to achieving the mission of eliminating gastric cancer in Japan. Japan became the first country to cover H. pylori eradication for chronic gastritis under its insurance system. The eradication therapy has increased dramatically, and gastric cancer deaths are clearly decreasing.

In a multicenter trial, 20,332 patients who had recently had an ischemic stroke were randomly assigned to receive either telmisartan or placebo. All patients also received medications for blood-pressure control at the investigators' discretion. At a mean follow-up of 2.5 years, there was no significant difference between the two study groups in the rates of recurrent stroke or major cardiovascular events. Patients who had recently had an ischemic stroke were randomly assigned to receive either telmisartan or placebo. At a mean follow-up of 2.5 years, there was no significant difference between the study groups in the rates of recurrent stroke or major cardiovascular events. Stroke is the second most frequent cause of death in the world and is responsible for about 5 million deaths each year. 1 An additional 15 million persons have nonfatal strokes, with about a third having disabling consequences. Elevated blood pressure is the strongest risk factor for stroke, and lowering of blood pressure, especially in patients with substantially elevated levels (e.g., systolic pressure, >160 mm Hg), reduces the risk of stroke. 2 After a stroke, lowering blood pressure with a combination of an angiotensin-converting–enzyme (ACE) inhibitor and a diuretic reduced rates of recurrent stroke in the Perindopril Protection against Recurrent Stroke Study . . .

BackgroundFatal mass shootings, defined as four or more people killed by gunfire, excluding the perpetrator, account for a small percentage of firearm homicide fatalities. Research has not extensively focused on the role of domestic violence (DV) in mass shootings in the United States. This study explores the role of DV in mass shootings in the United States.MethodsUsing 2014–2019 mass shooting data from the Gun Violence Archive, we indexed our data by year and mass shooting and collected the number of deaths and injuries. We reviewed news articles for each mass shooting to determine if it was 1) DV-related (i.e., at least one victim of a mass shooting was a dating partner or family member of the perpetrator); 2) history of DV (i.e., the perpetrator had a history of DV but the mass shooting was not directed toward partners or family members); or 3) non-DV-related (i.e., the victims were not partners or family members, nor was there mention of the perpetrator having a history of DV). We conducted descriptive analyses to summarize the percent of mass shootings that were DV-related, history of DV, or non-DV-related, and analyzed how many perpetrators died during the incidents. We conducted one-way ANOVA to examine whether there were differences in the average number of injuries or fatalities or the case fatality rates (CFR) between the three categories. One outlier and 17 cases with unknown perpetrators were excluded from our main analysis.ResultsWe found that 59.1% of mass shootings between 2014 and 2019 were DV-related and in 68.2% of mass shootings, the perpetrator either killed at least one partner or family member or had a history of DV. We found significant differences in the average number of injuries and fatalities between DV and history of DV shootings and a higher average case fatality rate associated with DV-related mass shootings (83.7%) than non-DV-related (63.1%) or history of DV mass shootings (53.8%). Fifty-five perpetrators died during the shootings; 39 (70.9%) died by firearm suicide, 15 (27.3%) were killed by police, and 1 (1.8%) died from an intentional overdose.ConclusionsMost mass shootings are related to DV. DV-related shootings had higher CFR than those unrelated to DV. Given these findings, restricting access to guns by perpetrators of DV may affect the occurrence of mass shootings and associated casualties.

Background Prostate cancer represents a significant global health issue, yet our understanding of its impact in the Middle East remains limited. This study aimed to assess the incidence and mortality of prostate cancer in the Middle East, and compare these rates to those in Europe and North America. Materials and Methods We utilized the 2020 Global Cancer Observatory data, compiling incidence and mortality rates of prostate cancer in 20 Middle Eastern countries. We calculated mortality‐to‐incidence ratios (MIR) and compared the age‐standardized incidence rate (ASIR) and MIR between the Middle East and the combined regions of North America and Europe. The countries were further stratified based on the Human Development Index (HDI) and income level for additional analysis. Results In 2020, the Middle East documented an estimated 51,649 new prostate cancer diagnoses, accounting for 3.7% of global cases. Despite a significantly lower ASIR in the Middle East compared with Europe and North America (10.50 vs. 21.50, p = 0.0087), the region had a higher MIR (12.35 vs. 3.00, p = 0.0476). When stratified based on HDI or income levels, there was no significant difference in MIRs; however, a significant trend of increasing MIR with decreasing HDI (p = 0.028) and income levels (p = 0.016) was observed. Conclusions Despite a lower incidence, our analysis showed a significantly higher MIR for prostate cancer in the Middle East compared with Europe and North America. These findings underscore the unique challenges posed by prostate cancer in the Middle East and emphasize the necessity of tailored strategies to address this pressing public health issue.

Aims The aim of this systematic literature review was to provide updated information on human papillomavirus (HPV) prevalence in locally and regionally advanced (LA) and recurrent/metastatic (RM) head and neck cancer (HNC) worldwide. Methods Electronic searches were conducted on clinicaltrials.gov, MEDLINE/PubMed, Embase, and ASCO/ESMO journals of congresses for interventional studies (IS; Phase I–III trials) as well as MEDLINE and Embase for non‐interventional studies (NIS) of LA/RM HNC published between January 01, 2010 and December 31, 2020. Criteria for study selection included: availability of HPV prevalence data for LA/RM HNC patients, patient enrollment from January 01, 2010 onward, and oropharyngeal cancer (OPC) included among HNC types. HPV prevalence per study was calculated as proportion of HPV+ over total number of enrolled patients. For overall HPV prevalence across studies, mean of reported HPV prevalence rates across studies and pooled estimate (sum of all HPV+ patients over sum of all patients enrolled) were assessed. Results Eighty‐one studies (62 IS; 19 NIS) were included, representing 9607 LA/RM HNC cases, with an overall mean (pooled) HPV prevalence of 32.6% (25.1%). HPV prevalence was 44.7% (44.0%) in LA and 24.3% (18.6%) in RM. Among 2714 LA/RM OPC patients from 52 studies with available data, mean (pooled) value was 55.8% (50.7%). The majority of data were derived from Northern America and Europe, with overall HPV prevalence of 46.0% (42.1%) and 24.7% (25.3%) across studies conducted exclusively in these geographic regions, respectively (Northern Europe: 31.9% [63.1%]). A “p16‐based” assay was the most frequently reported HPV detection methodology (58.0%). Conclusion Over the last decade, at least one quarter of LA/RM HNC and half of OPC cases studied in IS and NIS were HPV+. This alarming burden is consistent with a potential implication of HPV in the pathogenesis of at least a subgroup of HNC, underscoring the relevance of HPV testing and prophylaxis to HNC prevention and management.

Background Adults aged 65 years and above account for over half of all cancer diagnoses in the United States, but little is known about trend of elderly cancer survival in the United States. We aimed to assess the survival trend for elderly cancer in the United States from 1995 to 2014. Methods We used data from Surveillance, Epidemiology, and End Results 12 registries and included 1,112,441 eligible patients aged 65 years or older who were diagnosed between 1995 and 2014 with cancer and followed up until December 2019. Overall and stage‐specific 5‐year relative survival, ratio of observed survival to expected survival, with 95% confidence intervals (CIs) of elderly cancer patients stratified by age were estimated during four periods (1995–1999, 2000–2004, 2005–2009, and 2010–2014). Cox proportional hazards models were used to estimate hazard ratios for cancer‐specific death among patients diagnosed during 2000–2004, 2005–2009, 2010–2014, compared diagnoses in 1995–1999. We also calculated stage distribution and treatment rate during four periods. Results In the United States, 5‐year relative survival for elderly cancer patients improved from 57.3% (95% CIs 57.0–57.5) in 1995–1999 to 60.7% (60.5–60.9) in 2010–2014. After controlling for sociodemographic and tumor characteristics, about a 19% reduction in cancer‐specific deaths among diagnoses in 2010–2014 compared with 1995–1999. Cancer survival improved for elderly patients in all age groups, with exception of stable survival for patients aged 85 and above. Comparing 1995–1999 with 2010–2014, relative survival improved from 84.7% (84.3–85.1) to 86.7% (86.3–87.0) for localized stage and from 12.4% (12.1–12.7) to 18.7% (18.4–19.0) for distant stage for all cancers combined. The trends in stage distribution and treatment rate for all cancers combined were relatively stable. Conclusions In the United States, survival for elderly cancer patients has improved slightly from 1995 to 2014, possibly mainly due to advances in treatment. Further studies are warranted to explore interventions to improve elderly cancer survival.

Given that oropharyngeal squamous cell carcinoma (OPSCC) have now surpassed cervical cancer as the most common human papillomavirus (HPV)‐driven cancer, there is an interest in developing non‐invasive predictive biomarkers to early detect HPV‐driven OPSCC. In total, 665 cancer‐free individuals were recruited from Queensland, Australia. Oral HPV16 DNA positivity in those individuals was determined by our in‐house developed sensitive PCR method. Individuals with (n = 9) or without (n = 12) oral HPV16 infections at baseline were followed for a median duration of 24 mo. Individuals with persistent oral HPV16 infection (≥ 30 mo) were invited for clinical examination of their oral cavity and oropharynx by an otolaryngologist. Oral HPV16 DNA was detected in 12 out of 650 cancer‐free individuals (1.8%; 95% confidence interval [CI]: 1.0‐3.2). Of the 3 individuals with persistent oral HPV16 infection, the first individual showed no clinical evidence of pathology. The second individual was diagnosed with a 2 mm invasive squamous cell carcinoma (T1N0M0) positive for both p16INK4a expression and HPV16 DNA. The third individual was found to have a mildly dysplastic lesion in the tonsillar region that was negative for p16INK4a expression and HPV16 DNA and she continues to have HPV16 DNA in her saliva. Taken together, our data support the value of using an oral HPV16 DNA assay as a potential screening tool for the detection of microscopic HPV‐driven OPSCC. Larger multicenter studies across various geographic regions recruiting populations at a higher risk of developing HPV‐driven OPSCC are warranted to extend and confirm the results of the current investigation. 1. This study gives unique insights into the use of serial saliva sampling to detect human papillomavirus as a screening tool.2. The serial measurements of HPV16 viral load in oral rinse samples can identify individuals at risk of developing oropharyngeal lesions.

Background Retinoblastoma is a rare malignancy involving the retina, although, more common among children, with genetic inheritance explaining the incidence as well as acquired forms. The incidence varies among race and sex as well as mortality and survival. The current study aimed to assess retinoblastoma cumulative incidence (CMI), mortality, and survival by sex. Methods A retrospective cohort design was used to assess the CMI, mortality, and survival in this pediatric malignancy based on the Surveillance Epidemiology and End Results (SEER) data 2000–2017. The binomial regression model was used to examine sex differentials in mortality, as well as other study variables, while Cox proportional hazard model was used for the survival variability by sex. Results The CMI during this period was higher among males relative to females (males n = 249, 56.7%; females n = 190, 43.3%, χ2 = 2.90, df = 1, p = 0.089). There were sex differences in mortality, with excess mortality observed among males compared to females, risk ratio = 3.40, 95% CI [1.0–15.72]. The survival differences by sex indicated decreased survival among males relative to females, hazard ratio (HR) = 3.39, 95% CI [1.0–15.72]. After controlling for the potential confoundings, namely tumor grade, urbanity, and median income the survival disadvantage of males persisted. Compared to females’, males were more than three times as likely to die, adjusted HR = 3.42, 99% CI [0.37–31.60]. Conclusion In a representative sample of pediatric retinoblastoma, there was a sex differential in survival with excess risk of dying identified among males relative to females, which may be explained in part by male X‐linkage. Retinoblastoma is a rare malignancy involving the retina, although more common among children, with genetic inheritance explaining the incidence as well as acquired forms. The incidence varies among race and sex as well as mortality and survival. The current study aimed to assess retinoblastoma cumulative incidence, mortality, and survival by sex. In a representative sample of pediatric retinoblastoma, there was a sex differential in survival with excess risk of dying identified among males relative to females, which may be explained in X‐linkage in males.

Although intake of highly sugary foods is considered to be a potential risk factor for colorectal cancer through hyperinsulinemia, the association of sugar intake and colorectal adenoma, a precursor lesion to most colorectal cancer, is poorly understood, particularly in Asian populations. We undertook a cross‐sectional study in a Japanese population to investigate the association between dietary sugar intake and the prevalence of colorectal adenoma. Study subjects were selected from participants who underwent magnifying colonoscopy with dye spraying as part of a cancer screening program and who responded to a self‐administered questionnaire before the colonoscopy. A total of 738 cases with colorectal adenoma and 697 controls were enrolled. Dietary intakes of glucose, fructose, galactose, sucrose, maltose, lactose, and total sugars (sum of these six mono‐ or disaccharides) were calculated from a food frequency questionnaire, and divided into quartiles based on the distribution among controls. Odds ratios and 95% confidence intervals of colorectal adenoma were estimated using unconditional logistic regression models, with adjustment for potential confounding factors. Total sugar intake was not significantly associated with the prevalence of colorectal adenoma (odds ratio for the highest intake group compared to reference group = 1.18; 95% confidence interval, 0.81‐1.73; P for trend = .34). Furthermore, no statistically significant positive associations were observed for any of the six mono‐ or disaccharides. Findings were similar on additional analyses by site, size, and number of adenomas. Our findings do not support an association between high sugar intake and increased odds ratios of colorectal adenoma. In this case‐control study in a Japanese population, dietary intakes of sugars were calculated from a food frequency questionnaire and odds ratios and 95% confidence intervals of colorectal adenoma according to sugar intake were estimated using logistic regression models. We found that sugar intake was not significantly associated with the prevalence of colorectal adenoma. Furthermore, no statistically significant positive associations were observed for any of the six mono‐ or disaccharides.

Background Monitoring sexual health of young Australian women is a major research priority since introduction of the federally funded HPV vaccination programme, plus screening programmes for chlamydia. Social networking sites (SNS), commonly used by young people, present an opportunity for innovative recruitment modalities. We assessed young women’s knowledge and experience of chlamydia, HPV, HPV vaccines and cervical cytology (Pap smears) utilising Facebook Method This was part of a feasibility study assessing use of Facebook to recruit subjects for a larger prospective health study, the Young Female Health Initiative (YFHI). Women 16 to 25 years, from Victoria, Australia were eligible to participate. An advertisement was placed on Facebook for 6 months and visible to a random sample of eligible women. Women clicking on the advertisement were redirected to our website, then contacted and asked to complete a survey at the YFHI study centre, or the questionnaire online. The survey contained demographic questions, plus sexual health questions. Results We enrolled 426 respondents, of whom 278 completed the survey (50% study centre, 50% online). Respondents’ socioeconomic and geographical distribution (urban, regional, rural) were representative of the target population; those > 18 years were more likely to enrol than 16–17 year olds (p < 0.05). Overall, 76% had been sexually active, median age of coitarche was 16.9 years [CI 16.6–17.2], 63% had heard of HPV: of these, 73% knew HPV is sexually acquired and 94% that it causes cancer. 78% had heard of chlamydia: those who were sexually active were more likely to know of chlamydia than were virgins (p < 0.01), while 63% knew it could cause chronic pelvic pain, and 86% that it could cause infertility. This recruitment method also was cost-effective ($USD 20 per compliant participant). Conclusions SNS is an effective recruitment strategy to engage young women in sexual health research