Objective: To analyze the survival rate of stomach cancer patients and its variation during different periods in Linzhou city, Henan Province, from 1988 to 2004, and evaluate the level of secondary prevention and diagnosis of stomach cancer in this area. Methods: All of the incidence and death records of stomach cancer from 1988 to 2004 were collected and matched from Linzhou Cancer Registry. The records that were identified as duplicate cases or had only death certificate (DCO) were excluded. The tumor cause eliminated life tables in this area were calculated and linked to the data of incidence and death of stomach cancer. FivE-year observed survival rates and fivE-year relative survival rates in three periods (1990-1994, 1995-1999, and 2000-2004) were calculated using period survival analysis mehod. The relative survival curves in the three periods were plotted. Results:The 5-year relative survival rate of stomach cancer was 26.66% during 1990-1994, 32.01% during 1995-1999, and 40.43% during 2000-2004 in Linzhou city. It showed a gradually increasing trend. The 5-year survival rates were higher in males than those in females. During 1990-1994 and 1995-1999, the 5-year survival rates of gastric cardia cancer were higher than those of non-cardia cancer. During 2000-2004 period, the 5-year survival rate of gastric cardia cancer was lower than that of non-cardia cancer. Conclusion: The survival rates of stomach cancer in Linzhou city are increasing gradually since 1990s in 20 century. It indicates that the levels of secondary prevention and clinical diagnosis and treatment on stomach cancer kept increasing in this area.

Objective:To understand knowledge, belief, practice level of insulin injection and influencing factors of behavior of clinical nurses in tertiary general hospitals, so as to provide the basis for formulating targeted training programs for insulin injection.Methods:Using the convenient sampling method, a total of 169 clinical nurses in the adult ward of a tertiary general hospital were selected as the research objects in May 2020. The self-made basic information questionnaire and Insulin Injection Knowledge, Belief and Practice Questionnaire were used for investigation. Binary Logistic regression analysis was used to investigate the influencing factors of insulin injection behavior of clinical nurses.Results:Among 169 clinical nurses, the awareness rate of guidelines was 82.84% (140/169) , 95.86% (162/169) of nurses had patient education experience, the incidence rate of insulin injection needle stab injury was 14.79% (25/169) , and 90.53% (153/169) of nurses had the need to receive insulin injection system training. The total scores of knowledge, belief and practice dimensions of the Insulin Injection Knowledge, Belief and Practice Questionnaire for clinical nurses were respectively 60.00 (45.00, 70.00) , 50.00 (49.00, 50.00) and 85.00 (82.00, 85.00) , and the total score of the questionnaire was 189.00 (178.50, 200.50) . The results of binary Logistic regression analysis showed that knowing the guidelines, receiving insulin injection operation training and insulin injection needle stick experience were the influencing factors of insulin injection behavior ( P<0.05) . Conclusions:Clinical nurses in tertiary general hospitals have a high level of insulin injection beliefs and behaviors and there are still deficiencies in insulin injection knowledge. In the training work related to clinical insulin injection, attention should be paid to strengthening and maintaining the belief and behavior of standardized insulin injection, emphasizing the safety of insulin injection, and combining with the technical guidelines and specifications of insulin injection, improving the knowledge reserve and application ability of insulin injection of clinical nurses.

Objective: To explore the psychological status and related factors in patients with precancerous of esophageal and gastric cardia in Linzhou of Henan. Methods: Clinical psycho-rating scale of Social Support Rating Scale (SSRS), Self-Rating Anxiety Scale (SAS, score ≥50 points with symptoms of anxiety) and Self-Rating Depression Scale (SDS, score ≥53 points with the symptoms of depression) were applied to survey life events and psychological status of subjects who aged 40-69 years old and participated in"The Early diagnosis and Early Treatment"program in Linzhou cancer hospital from July 2015 to Jan 2016. Patients with lower intraepithelial neoplasia or high-grade intraepithelial neoplasia were selected as precancerous lesions (n=118), and patients with normal grade were selected as healthy controls (n=210). Compare the differences of the scores between the two groups, and the logistic regression model was used to analyze the related factors of precancerous lesions and psychological status of the study subjects. Results: Precancerous lesions included esophageal (72 cases), gastric cardia (40 cases), esophageal and cardia dual source (6 cases); Precancerous lesions and healthy controls aged (57.17±7.71) and (53.12±7.99) years old, the difference was statistically significant (P<0.001). The anxiety and depression scale showed that the scores of SAS and SDS scores in the precancerous lesions were (37.18±10.01), (40.44±8.37) points, and (34.02±6.63), (38.49±8.73) points in control group, the difference was statistically significant (P=0.002, 0.032). While the social support total score (38.26±5.26), and subjective support score (24.08±3.83) and objective support score (7.50±1.89) in control group were all higher than those of precancerous group (36.80±6.18, 23.01±3.93, 6.93±1.57), and the difference were statistically significant (P=0.024, 0.016, 0.004). In addition, the Logistic analysis showed that subjects with low objective social support, subjective social support and anxiety symptoms were more likely to develop precancerous lesions, and the OR were 0.81, 0.72 and 1.05, respectively (P=0.028, 0.005, 0.009). Conclusion Social support, anxiety and depression status may be related to the occurrence and development of esophageal and gastric cardia precancerous lesions.

Objective: To evaluate effect of screening of esophageal cancer though comparing difference of survival level between screening and non-screening patients in Linzhou city. Methods: The records pathologically diagnosed as serious hyperplasia/carcinoma and esophageal cancer were drawn from database of first round screening in Linzhou city from 2005-2013 and were assigned to the screening group. The records of new esophageal cancer cases which diagnosed within 2 years before, screening from the same village aged from 40 to 69, were drawn from database of cancer registry in Linzhou city and were assigned to the non-screening group. Five or 10 year survival rate with 95%CI of patients with different malignant degree diseases in the screening group and the patients with esophageal cancer in the non-screening group was calculated respectively. The survival curves between the screening and non-screening group were compared by Log rank method. Results: All 26 908 persons were examined in first round screening in Linzhou city from 2005 to 2013. There were 374 persons with serious hyperplasia/carcinoma in situ, 157 persons with esophageal cancer (141 intramucosal carcinomas/submucosal cancers, 16 invasive cancers). The 5 year survival rate of serious hyperplasia/carcinoma, intramucosal carcinoma/submucosal cancer and invasive cancer were 95.0% (95%CI: 91.7%-97.0%) , 72.0% (95%CI: 62.7%-79.3%) and 41.7% (95%CI: 17.4%-64.6%) separately. The 5 year survival rate of esophageal cancer in screening and non-screening group were 68.7% (95%CI:59.9%-75.9%) and 40.8% (95%CI: 36.4%-45.2%). The 10 year survival rate of esophageal cancer in screening and non-screening group were 58.0% (95% CI: 44.6%-69.3%) and 34.3% (95% CI:29.1%-39.5%). The 5 or 10 year survival rate of esophageal cancer in the screening group were higher than that in the non-screening group in whatever sex or age. The survival distribution of the screening group was better than non-screening group (χ²=38.88, P<0.001). Conclusion More precancerous lesions and early esophageal cancer can be detected and patients' survival level was improved through organized esophageal cancer screening, which provided support to evaluate value of organized screening.

OBJECTIVETo estimate the cost-effectiveness of esophageal cancer endoscopic screening once-in-a-lifetime and to predict the optimal screening age for people in high-risk areas of rural China.

METHODSA Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long-term epidemiological effectiveness and cost-effectiveness were predicted by simulation of the model.

RESULTSCompared with the control group, strategies starting at 40, 45, 50 and 55 year-old had saved life-years of 629.51, 769.88, 738.98 and 533.21 years per 100 000 people, respectively, of which the strategy starting at 45 year-old saved the maximum life years. All strategies were cost-effective and starting at 40 year-old cost the most per life-year saved. Among all alternatives, strategies starting age at 45 year-old and 50 year-old were incremental cost-effective, and the incremental cost-effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively.

CONCLUSIONSThe strategy starting at 40 year-old implemented at present and other strategies were cost-effective in high-risk areas of rural China. However, the 45-year-old group is more aligned with the principle of cost-effectiveness. Considering the cost-effectiveness of different strategies and social economic status, 45 year-old is regarded as the optimal starting age of esophageal cancer once-in-a-lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year-old which could obtain better screening effects would be preferable in wealthy regions.

Adult ; Age Factors ; Case-Control Studies ; China ; Cost-Benefit Analysis ; Early Detection of Cancer ; Esophageal Neoplasms ; diagnosis ; Esophagoscopy ; economics ; Humans ; Markov Chains ; Middle Aged ; Rural Population

Objective To estimate the cost?effectiveness of esophageal cancer endoscopic screening once?in?a?lifetime and to predict the optimal screening age for people in high?risk areas of rural China. Methods A Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long?term epidemiological effectiveness and cost?effectiveness were predicted by simulation of the model. Results Compared with the control group, strategies starting at 40, 45, 50 and 55 year?old had saved life?years of 629. 51, 769. 88, 738.98 and 533. 21 years per 100 000 people, respectively, of which the strategy starting at 45 year?old saved the maximum life years. All strategies were cost?effective and starting at 40 year?old cost the most per life?year saved. Among all alternatives, strategies starting age at 45 year?old and 50 year?old were incremental cost?effective, and the incremental cost?effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively. Conclusions The strategy starting at 40 year?old implemented at present and other strategies were cost?effective in high?risk areas of rural China. However, the 45?year?old group is more aligned with the principle of cost?effectiveness. Considering the cost?effectiveness of different strategies and social economic status, 45 year?old is regarded as the optimal starting age of esophageal cancer once?in?a?lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year?old which could obtain better screening effects would be preferable in wealthy regions.

Objective To estimate the cost?effectiveness of esophageal cancer endoscopic screening once?in?a?lifetime and to predict the optimal screening age for people in high?risk areas of rural China. Methods A Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long?term epidemiological effectiveness and cost?effectiveness were predicted by simulation of the model. Results Compared with the control group, strategies starting at 40, 45, 50 and 55 year?old had saved life?years of 629. 51, 769. 88, 738.98 and 533. 21 years per 100 000 people, respectively, of which the strategy starting at 45 year?old saved the maximum life years. All strategies were cost?effective and starting at 40 year?old cost the most per life?year saved. Among all alternatives, strategies starting age at 45 year?old and 50 year?old were incremental cost?effective, and the incremental cost?effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively. Conclusions The strategy starting at 40 year?old implemented at present and other strategies were cost?effective in high?risk areas of rural China. However, the 45?year?old group is more aligned with the principle of cost?effectiveness. Considering the cost?effectiveness of different strategies and social economic status, 45 year?old is regarded as the optimal starting age of esophageal cancer once?in?a?lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year?old which could obtain better screening effects would be preferable in wealthy regions.