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J Carstensen

Publications and source records attributed to J Carstensen.

At least 55 records · Page 3Linked to original sources
PubMed1994

Space-time clustering in insulin-dependent diabetes mellitus (IDDM) in south-east Sweden.

Using the method developed by Knox, space-time clustering was analysed in all 584 cases of insulin-dependent diabetes mellitus (IDDM) diagnosed between 1977-1990 and below the age of 16 from four paediatric departments in south-east Sweden. The catchment areas of these clinics form a contiguous geographical area of 26,445 km2 with a total of 165,784 children aged 0-15 years. The annual incidence for the study period was 25.2 per 100,000 children aged 0-15 years with a statistically significant incidence variation between the years; highest incidence in 1983 (39.2) and lowest in 1977 and 1989 (18.9 and 20.7 respectively). In the analysis, 30 different combinations of critical cutoff values were used to define closeness in space and time of pairs of cases. Statistically significant results were seen for several combinations with the highest significance obtained for the cutoff values of 15 km and 7 months, respectively. This space-time clustering tended to be specially pronounced during the period with the highest incidence of IDDM, 1981-1985. Our results indicate that space-time clustering exists in IDDM. These findings may support the hypothesis that infectious agents (possibly viral) give rise to a portion of IDDM.

Adolescent↗
PubMed1994

Testing a modified Swedish version of the Rush Medicus Nursing Process Quality Monitoring Instrument in short-term care.

A modified Swedish version of the Rush Medicus Nursing Process Quality Monitoring Instrument (RMI-MSV) has been tested within surgical, medical and orthopedic units in a county hospital. Three units, one from each area, were randomized as experimental (E) units and three units as control (C) units. Two measurements, comprising 20 patients and five registered nurses in each unit, were carried out with an interval of 6 months. All the E units received feedback on the first measurement and one unit received special intervention concerning the main objective dealing with documentation. The E units tended to show greater improvements than the C units concerning most of the six main objectives included in the instrument. However, the objective dealing with documentation was the only one presenting a statistically significant greater improvement in E units compared with C units (p = 0.045). The effects obtained supported the evidence for validity of the RMI-MSV. The RMI-MSV was found to be sensitive to changes and appropriate for quality assessment. Further research is needed to develop non-situation-related factors which influence the quality of nursing care.

Adolescent↗
PubMed1994

DNA ploidy and S-phase fraction in primary melanomas and their regional metastases.

Flow cytometric analysis of DNA ploidy and S-phase fraction was performed on the primary melanomas and the first metastases from 55 melanoma patients with regional lymph node metastases or in transit metastases. The frequency of aneuploidy was significantly higher in metastases than in the primary tumour (p = 0.009), suggesting a higher growth potential in melanoma metastases than in the primary tumours. In 18 patients with reliable S-phase determinations from both primary tumour and metastasis there was no significant difference in mean S-phase fraction between primary melanomas and metastases. Skin metastases localized in dermis and subcutis had a significantly (p = 0.012) higher mean S-phase fraction than lymph node metastases.

Adult↗
PubMed1994

Pregnancy related sickness absence in a Swedish county, 1985-87.

Sickness absence during pregnancy has increased in Sweden as well as in other countries. STUDY OBJECTIVE--The study aimed to describe pregnancy related sickness absence and its increase from 1985-87; to consider if the increase were parallel to an increase in sickness absence for all diagnoses or could be explained by a higher birth rate; and to compare different ways of presenting sickness absence data. DESIGN--The data from a prospective incidence study of all new sick leave spells exceeding seven days in 1985-87 were related to the population at risk through relevant data from different registers. SETTING--The county of Ostergötland, Sweden (about 400,000 inhabitants). PARTICIPANTS--Subjects were approximately 70,000 sick leave-insured women aged 16-44 years, of whom some 15,000 had sickness absences > seven days. Some 4600 women gave birth in 1985, approximately 1300 of whom were listed as having pregnancy related diagnoses. MAIN RESULTS--The number of women with sick leave associated with pregnancy related diagnoses increased by 24% (95% confidence interval (CI) 15, 33%) during the period. This diagnosis group was one of the very few with an increasing number of people listed as sick. The corresponding increase for all diagnoses in women aged 16-44 years was < 1% (95% CI 1, 3%). The increase in the number of women who gave birth was 9% (95% CI 5, 13%). The sick leave rate associated with pregnancy related disorders increased by 14% (95% CI 7, 21%) in 1985-87, while that in all women aged 16-44 years increased by 3% (95% 1, 5%). (p < 0.0001). The number of sick leave days associated with pregnancy related disorders increased by 49% (p < 0.0001) in the period--twice the equivalent increase (p < 0.0001) in the total number of sick leave days for all diagnoses taken together. The sick leave rate and duration, like the increase in these variables, varied with age. Different ways of presenting the length of absence proved complementary to each other. CONCLUSIONS--After correcting for changes in the overall sick leave rate and in the birth rate, there is still an 11% increase in the sick leave rate associated with pregnancy related disorders that needs to be explained. Medical factors cannot explain this increase but changes in attitudes and practice in relation to sickness insurance among pregnant women and their doctors merit further study.

Adolescent↗
PubMed1994

Evaluation of the effect on breast cancer mortality of population based mammography screening programmes.

OBJECTIVE: To evaluate, by analysis of breast cancer mortality data from all the 26 Swedish counties for the years 1971 to 1990, whether the effect of the introduction of mammography screening in Sweden can be assessed by observation from existing mortality data. METHODS: A Poisson regression model was used to study whether a decrease in breast cancer mortality among women aged 50-74 years was associated with the extent of mammography screening in different counties and periods. RESULTS: In regions where mammography screening had been introduced, breast cancer mortality tended to be decreased, on average, compared with regions without screening. If a 10 year time lag between the start of screening and its full effect on mortality is assumed then the estimated reduction in breast cancer mortality associated with introduction of screening was 19% with a 95% confidence interval ranging from -3% to 37%. CONCLUSIONS: The results suggest that the effect of mammography screening may be studied using existing routine mortality data and appropriate statistical modelling. This way of assessing the outcome of the screening is valuable when continuously monitoring a screening programme that has become a public health routine.

Age Factors↗
PubMed1994

A population-based survey of ovarian malignancies in the southeast health care region of Sweden 1984-1987.

All 426 patients with ovarian malignancies registered in the population-based Tumor Registry of the Southeast region of Sweden during 1984 to 1987 were analyzed by survey of the hospital records and population registry data. After comparison with other population-based materials, it seems that the overall survival figures have improved in ovarian cancer. Excluding patients diagnosed at autopsy a 5-year corrected survival of 43% was recorded. Among patients aged under 45 years the corrected 5-year survival was 72%. In a Cox's regression analysis age and stage were significant predictors of cancer death while histology (epithelial vs. non-epithelial), although significant in the univariate analysis, did not add prognostic information in the multivariate model. The relative cancer death rate was 6.4 for patients aged over 74 years compared with those aged under 45 (p < 0.0001), and 13.8 for FIGO stage IV compared to stage I (p < 0.0001). For patients with advanced stage tumors (FIGO stage III or IV) postoperative residual tumor, stage, and age were independent prognostic factors in a multivariate analysis. The corrected cancer death rate was 2.0 for patients with > 1 cm relative to < or = 1 cm postoperative residual tumor nodule(s) (p < 0.0001).

Adolescent↗
PubMed1994

DNA content and S-phase fraction in male breast carcinomas.

Eighty-five male breast carcinomas limited to the breast, diagnosed between 1958 and 1967 in Sweden, were investigated by flow cytometry using paraffin-embedded tissue. DNA ploidy and S-phase fraction (SPF) were studied in relation to lymph node status, tumour size and malignancy grade, and with respect to clinical outcome. Median age at diagnosis was 65.5 years. Median survival time related to breast cancer was 78.7 months, and 37 patients died from the disease. Forty-nine (57.6%) carcinomas were aneuploid or had multiple stemlines. Median SPF was 8.9% for all tumours, for diploid and tetraploid (euploid) together 6.6%, and for aneuploid tumours 14.3% (p < 0.001). Ploidy was significantly related to the tumour size (p = 0.03), but no significant correlations with node status or malignancy grade were observed. In univariate survival analysis, node status, tumour size and malignancy grade predicted breast cancer mortality significantly. In a multivariate Cox's model, only node status and tumour size were independent prognostic factors. In contrast to females with breast cancer, ploidy and SPF had no significant relation to prognosis in males. This lack of predictive value of DNA analysis needs further evaluation. Studies based on extended materials are necessary to further investigated the role of DNA analysis as a predictor of outcome in male breast cancer patients.

Analysis of Variance↗
PubMed1994

DNA index and S-phase in primary brain tumors. A comparison between fresh and deparaffinized specimens studied by flow cytometry.

Forty-nine primary intracranial tumors (33 astrocytomas, eight acoustic schwannomas, five oligodendrogliomas, and three miscellaneous tumors) were studied by flow cytometry. Each tumor specimen was divided into two portions: one was studied as an unfixed suspension stained with propidium iodide and the other after formalin fixation and paraffin embedding. The 50-microns sections from the paraffin blocks were deparaffinized, rehydrated, and enzymatically disintegrated, and the cells in suspension were stained with propidium iodide. Flow cytometry of the two portions showed a significant correlation between fresh and fixed specimens regarding the S-phase (r = 0.87) and a very close correlation fo the deoxyribonucleic acid (DNA) index (r = 0.95). When the 33 astrocytomas were analyzed separately, similar results were obtained (r = 0.86 for S-phase and r = 0.93 for DNA index, respectively). This study demonstrated a high correlation between fresh and fixed specimens for DNA ploidy and S-phase both in primary intracranial tumors in general and also in the selected subgroup of astrocytomas.

Adolescent↗
PubMed1993

Treatment results and prognostic factors in a population-based study of epithelial ovarian cancer.

The Swedish Tumor Registries are population based. Three hundred eighty-four patients with epithelial ovarian cancer registered in the Tumor Registry of the Southeast Health Care Region during the years 1984 to 1987 were reviewed; 332 patients were eligible for survival analysis. The protocol treatment during this period included primary surgery aimed at tumor reduction followed by combination chemotherapy (anthracyclin + cis-platinum, AP) in FIGO stages IC-IV. All patients treated otherwise were registered as prescribed nonprotocol treatment. An overall corrected 5-year survival of 40% was recorded. However, only 166/325 of the patients (51%) were actually prescribed protocol treatment as defined above. The 5-year survival was 49% for patients prescribed protocol treatment compared to 33% for those prescribed nonprotocol treatment (P < 0.0001). Stages III-IV patients prescribed protocol treatment had 23% 5-year survival compared to 11% for patients prescribed nonprotocol treatment (P < 0.0001). The impact of cis-platinum-based combination chemotherapy was thus not as pronounced as expected from clinical studies since many patients were not considered to be in a good enough general condition to receive cis-platinum. Multivariate Cox analysis of 223 cases showed that age (P < 0.0001), stage (P = 0.0002), grade of differentiation (P = 0.006), and postoperative residual tumor (P = 0.007) were independent prognostic factors. A prognostic index was developed which divided the patients into different risk groups. It was shown that high-risk patients identified by this index were mainly found in the group prescribed nonprotocol treatment and that the prognostic index could not be used to identify patients with a low probability of response among patients prescribed protocol treatment.

Adult↗
PubMed1993

Continuous versus intermittent prednimustine treatment of non-Hodgkin's lymphoma.

Seventy-eight patients with advanced non-Hodgkin's lymphomas were randomized for treatment with prednimustine (Sterecyt) in two different schedules: either receiving continuous treatment at a dosage of 60 mg daily, or intermittent two-week courses with 200 mg daily for five days. The aim of the study was to compare efficacy and side effects of the two different schedules. Forty patients received continuous, and 38 patients intermittent treatment. Objective response was achieved in 66% of 71 evaluable patients, equally distributed between the two treatment arms. The 10-year survival rate was 20% (SE = 6%; continuous treatment) and 11% (SE = 5%; intermittent treatment), respectively (logrank p = 0.26). Median time to response, duration of response and time to progression showed no significant difference between the treatment groups. Median time on treatment was longer for patients treated continuously, probably due to more easily performed dose adjustments in such patients. There was a significant decrease of the white blood cell counts in patients who received prednimustine continuously compared with those treated according to the intermittent schedule (p = 0.02). No significant differences were found regarding the thrombocyte levels. The response rate was closely related to haematological toxicity (p = 0.01). Our results suggest that prednimustine in non-Hodgkin's lymphomas has similar effectiveness both in daily treatment and in a two-weekly intermittent schedule. Continuously given treatment may be easier to govern and, thereby, allow for higher treatment intensity. With respect to toxicity, daily doses of approximately 30-40 mg in previously untreated patients may be recommended.

Adult↗
PubMed1993

Serum beta-lipoprotein, serum cholesterol and Quetelet's index as predictors for survival of breast cancer patients.

We studied the survival of breast cancer patients in relation to serum cholesterol level, serum beta-lipoprotein level (BLP) and being overweight among women having breast cancer diagnosed during a follow-up period of 20 years. A cohort of 46,570 women attended a general health screening including examination of serum lipid levels, height and weight during 1963-1965. Of these, 1170 women developing breast cancer; 196 were below the age of 50 and 974 were above 50 years of age. 66 of the younger women, and 341 of the older women were reported to have died of breast cancer. A correlation was found between high serum BLP and decreased survival of breast cancer patients < 50 years of age. For women > or = 60 years of age, BLP was positively correlated to breast cancer survival. No correlation was found between serum cholesterol level and breast cancer survival in any age group. Increasing obesity was statistically significantly correlated to decreased survival with breast cancer. The latter findings were in accordance with other studies which have shown being overweight as a risk factor for breast cancer. As for the relationships between ischaemic heart disease and serum lipid levels, in studies of cancer risks in relation to serum cholesterol level, the different fractions of cholesterol seem to be of importance.

Age Factors↗
PubMed1993

DNA ploidy and S-phase in primary malignant melanoma as prognostic factors for stage III disease.

In 82 patients with stage III malignant melanoma, the primary tumours were investigated by DNA flow cytometry. The tumours were classified as DNA diploid (n = 36), tetraploid (n = 11) and aneuploid (n = 35). By univariate analysis a significant correlation with post-recurrence survival was found for time to first metastasis, DNA-ploidy and S-phase fraction. By multivariate analysis, significant prognostic variables were found to be the time to first metastasis (P = 0.006), and ploidy (P = 0.011). Patients with diploid melanomas and a long recurrence-free interval had a median post-recurrence survival time of 45 months compared to 18 months in patients with DNA aneuploid tumours and an early recurrence. The S-phase could be estimated in 47 primary melanomas and was found to be a significant prognostic variable (P = 0.017). The median survival was 45 months for patients with melanomas with a S-phase fraction below 5%, and 19 months for melanomas with S-phase above 10%. The prognostic value of the S-phase remained significant even after adjustment for recurrence-free interval and DNA ploidy.

Aged↗
PubMed1993

S-phase fraction is a prognostic factor in stage I breast carcinoma.

PURPOSE AND METHODS: The prognostic significance of cell proliferation, estimated as cytometric S-phase fraction (SPF), was investigated in node-negative breast cancer patients with small tumors (T1, NO). The 219 stage I patients originated from two series and were diagnosed either from 1978 to 1981 or from 1981 to 1985. The tumors were analyzed for estrogen receptors (ERs) by isoelectric focusing and for cellular DNA content by static cytofluorometry or flow cytometry. RESULTS: A high SPF correlated with the absence of ERs and abnormal DNA content, and was less often found in tumors smaller than 11 mm compared with those with a diameter between 11 and 20 mm. Among the variables age, tumor size, DNA ploidy, ER status, and SPF, only SPF showed a significant association with distant recurrence and breast cancer survival in systemically untreated patients. The relative recurrence rate for patients with an SPF of 10% or greater was three times that for patients with lower SPFs. Estimated 8-year breast cancer survival rates for the same groups were 72% and 91%, respectively. CONCLUSION: This study suggests that cytometric SPF has prognostic significance in stage I breast carcinoma.

Analysis of Variance↗
PubMed1992

Relationships of DNA ploidy, S-phase fraction and hormone receptor status to tumor stage in breast cancers detected by population screening. The South-East Sweden Breast Cancer Group.

Cellular DNA content was analyzed by flow cytometry and estrogen and progesterone receptors by an immuno-biochemical method (EIA) in a consecutive series of 807 frozen breast-cancer samples. Before the beginning of the study, a mammography screening program had been introduced in the region where the tumors were diagnosed. Forty percent of the tumors were judged as DNA diploid, of which 86% were ER-positive. The proportion of ER-positive tumors among non-diploids was significantly lower, or 73% (p less than 0.001). S-phase fraction (SPF) was estimated in 691 cases (86%), with an overall mean of 8.4%. DNA ploidy as well as ER and PR status were independently related to SPF. Unlike the results obtained in most older series, the biological variables correlated significantly with tumor staging factors such as lymph-node status and tumor size. Patients with nodal involvement, especially those with 4 positive nodes or more, more often had tumors which were receptor-negative, DNA aneuploid and of high S-phase rate. Large tumor size was significantly related to lower frequencies of receptor positivity and strongly related to DNA aneuploidy and high S-phase fraction. Multiple linear regression analysis showed that these relationships were mainly due to the associations of SPF with the other variables. S-phase fraction was the only independent factor predicting nodal status, while DNA ploidy in addition to SPF was associated with tumor size. In fact, DNA ploidy (p less than 0.001), ER and PR status (p less than 0.001, p = 0.002), nodal status (p = 0.04) and tumor size (p less than 0.001) were all independently related to SPF.

Breast Neoplasms↗
PubMed1992

Flow cytometric analysis of uterine sarcoma: ploidy and S-phase rate as prognostic indicators.

Flow cytometry of various gynecological tumors has shown that aneuploid tumors and a high S-phase rate carry a prognosis worse than that of diploid tumors or tumors with a low S-phase. The aim of this study is to investigate the prognostic importance of DNA ploidy and S-phase rate in relation to mitotic count, tumor stage, tumor grade, and histology in 37 patients with uterine sarcoma stages I-IV (FIGO). Flow cytometry was performed on archival paraffin-embedded tumor tissue and the histologic specimens were reviewed by a single pathologist. Nineteen (51%) of the tumors were classified as DNA aneuploid. The S-phase fraction (SPF) was determined in 33 cases. The mean SPF (+/- SD) was 15.0% (+/- 9.5%). The mean SPF was three times higher in aneuploid tumors than in diploid cases. Both the proportion of aneuploid tumors and the mean SPF were significantly higher in later stage tumors, more poorly differentiated tumors, and tumors with a higher mitotic index. No significant differences were seen between histologic types with respect to the two cytometric variables. The 5-year cancer survival rate was only 11% in aneuploid cases compared with 59% in diploid cases (log rank, P = 0.0002). There was a significantly worse prognosis in cases with a higher SPF (P = 0.0009) and in case with a higher mitotic index (P = 0.0016). In the multivariate survival analysis using the Cox proportional hazards model, DNA ploidy showed a significant prognostic value (P = 0.046) even when adjusted for stage, grade, and mitotic index. When adjusted for stage and grade only, SPF showed significant additional prognostic value.

Adult↗
PubMed1992

Significance of S-phase fraction and hormone receptor content in the management of young breast cancer patients.

Tumours from 336 breast cancer patients under the age of 50 were analysed for hormone receptor content and by DNA flow cytometry. Sixty-six percent of the tumours were positive for estrogen receptors (ER), 60% were progesterone receptor (PR) positive and 42% showed DNA diploid profiles. DNA hypodiploid tumours were relatively frequent (7%), especially in patients aged 40 years or less (11%). S-phase fraction (SPF), with a mean of 10%, correlated significantly with receptor status, DNA ploidy, lymph node status, tumour size and age. With a median follow-up period of 34 months, the distant recurrence-free interval was independently predicted by lymph node status, tumour size, SPF and PR content. Amongst the 212 patients who had not received adjuvant systemic treatment, receptor status was, in addition to lymph node status and SPF, independently related to distant recurrence rate. A high SPF identified a subgroup with high recurrence rate, comprising approximately one third of the node-negative patients. Similarly, the one third of node-positive patients who had PR-positive tumours with a low S-phase fraction formed a subgroup with low recurrence rate. We conclude that hormone receptor assays and DNA flow cytometry should be useful tools in the management of breast cancer patients less than 50 years of age.

Adult↗