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J Flannery

Publications and source records attributed to J Flannery.

At least 37 records · Page 2Linked to original sources
PubMed1994

Time trend and the age-period-cohort effect on the incidence of histologic types of lung cancer in Connecticut, 1960-1989.

BACKGROUND: Recent epidemiologic studies have suggested changing patterns of lung cancer incidence by histologic type. The observed time trends have been attributed to a change in the rate of cigarette smoking, changes in exposure to new environmental carcinogens, and changes in the criteria for the histopathologic diagnosis of lung cancer. The current study was designed to examine the incidence patterns of lung cancer by histologic type in Connecticut and to use this information to project the future trend of the disease in this population. METHODS: This study was based on all the lung cancer cases reported to the Connecticut Tumor Registry between 1960 and 1989. On the basis of this data set, crude and age-adjusted incidence rates of lung cancer were calculated by histologic type for each sex. The age-specific incidence rates are presented by calendar year and cohort year of birth. A regression model was used to identify birth cohort, period, and age as determinants of the observed time trends. RESULTS: For the overall age-adjusted incidence rates, squamous cell carcinoma and small cell carcinoma have stabilized in men, whereas they are still increasing in women. The incidence of adenocarcinoma has been increasing in both men and women, but there has been a much sharper incidence among females since the mid-1970s. An examination of age-specific incidence rates by birth cohort and the results from age-period-cohort modeling indicate that incidences of all three major histologic types of lung cancer in the recent birth cohorts either have started decreasing (squamous cell carcinoma) or shown a clear reduction in the rate of increase (adenocarcinoma and small cell carcinoma). This study, however, did not indicate an increase of bronchoalveolar lung carcinoma, which was reported by other clinically based studies. CONCLUSION: While the overall age-adjusted incidence rates showed different incidence patterns for different histologic types of lung cancer, a decreasing or stabilized rate for all three major histologic types of lung cancer was observed in recent birth cohorts in both males and females. The observed incidence pattern is consistent with smoking trends over time including changes in smoking prevalence and the consumption of low tar and filter cigarettes. It is expected that if the current trend in tobacco smoking continues and if there are no major changes in other risk factors for lung cancer, a forthcoming stabilization or decrease in the rate of lung cancer incidence for all major histologic types (including adenocarcinoma) in both sexes in Connecticut could be anticipated.

Adenocarcinoma↗
PubMed1994

Time trends in the incidence of renal carcinoma: analysis of Connecticut Tumor Registry data, 1935-1989.

Recent trends in the incidence of renal cancer, stratified by histology, have not been reported. This study utilized data from the Connecticut Tumor Registry (CTR), the oldest population-based cancer registry in the United States, to establish time trends in the incidence of adenocarcinoma and transitional cell carcinoma of the kidney and urinary tract. All 10,209 incident cases of renal cancer reported to the CTR between 1935 and 1989 were analyzed. Regression modelling was employed to determine the effects of age, period, and birth cohort on incidence rates, and to project future trends. The incidence rate of adenocarcinoma increased in females from 0.7/100,000 in 1935-39, to 4.2/100,000 in 1985-89; and in males, from 1.6/100,000 in 1935-39, to 9.6/100,000 in 1985-89. The reported incidence of transitional cell carcinoma increased in males from 0.5/100,000 in 1950-54 to 2.8/100,000 in 1985-89, and in females from 0.2/100,000 to 1.1/100,000 over the same period. Regression modelling revealed that both net and recent drift, the sum of period and cohort slopes, were positive for adenocarcinoma in both sexes, largely due to a positive cohort effect. While the net drift for transitional cell carcinoma was positive, recent drift was negative in both sexes due primarily to a negative cohort effect. Incidence rates of adenocarcinoma are likely to rise in the immediate future, with the rate of rise in females possibly exceeding that in males. Incidence rates of transitional cell carcinoma will stabilize.

Adult↗
PubMed1994

No improvement in survival from melanoma diagnosed from 1973 to 1984.

BACKGROUND: While the incidence and mortality of melanoma has increased dramatically during the last few decades, survival rates, based on the case-fatality ratio, have apparently improved. Efforts at early detection have probably been effective in the discovery of lesions at a curable stage. However, the effects of lead-time bias need to be accounted for in order to understand the contribution of early detection to the increased incidence. This can best be done by appropriately controlling for depth of the tumour or a surrogate of depth, at diagnosis. METHODS: A survival analysis was conducted for 3197 Connecticut residents newly diagnosed with invasive melanoma between 1973 and 1984. Five prognostic variables were evaluated: sex, age at diagnosis, anatomical site, histological type, and year of diagnosis. RESULTS: As expected, women and the young had better survival than men and the elderly. Melanomas located on the trunk had poorer prognosis than those on other sites. The survival experience by histological type was significantly different; lentigo maligna melanoma and superficial spreading melanoma had the best survival and nodular melanomas the poorest, while 'other' and unclassifiable melanomas had intermediate survival. When survival by period of diagnosis was controlled by other variables, which included surrogates for disease stage, there was no improvement in survival over time. CONCLUSION: These data do not imply that early diagnosis and treatment are ineffective; rather, that within stages of disease, survival improvements did not occur during the period 1973-1984.

Adolescent↗
PubMed1993

The time trend and age-period-cohort effects on incidence of adenocarcinoma of the stomach in Connecticut from 1955-1989.

BACKGROUND: Adenocarcinoma of the gastric cardia has been be increasing in Connecticut, and the risk factors responsible for the increasing incidence are unknown. This study examined the incidence pattern of adenocarcinoma of the gastric cardia and distal stomach in Connecticut during the past decades and identified components of birth cohort, period, and age as determinants of the observed time trends by regression modeling. METHODS: This study was based on all histologically confirmed incident cases of gastric adenocarcinoma reported to the Connecticut Tumor Registry between 1955 and 1989. Stomach cancers were grouped into cancers of the gastric cardia, distal stomach, or unknown/unspecified subsite. Age-adjusted incidence rates were calculated by the direct method standardized to the 1970 United States population. A regression model was used to identify birth cohort, period, and age as determinants of the observed time trends. RESULTS: The results indicated that the incidence rate of adenocarcinoma of the cardia is increasing, particularly in white males, whereas adenocarcinoma of the distal stomach is now decreasing in both sexes in Connecticut. Regression modeling suggests that the increase of adenocarcinoma of the cardia may be explained partly by a birth cohort phenomenon. CONCLUSION: There is little information regarding the risk factors that might be responsible for the observed increasing trend for adenocarcinoma of the cardia, although smoking, alcohol intake, retinol intake, and hiatal hernia have been associated with an increased risk of adenocarcinoma of the cardia or gastric cancer. Considering the different epidemiologic features of adenocarcinoma of the cardia and distal stomach, future analytic studies should separate cancer of the gastric cardia and cancer of the distal stomach in searching for etiologic factors.

Adenocarcinoma↗
PubMed1993

Case report: transcatheter renal embolization to effect renal ablation in recurrent PUJ obstruction in a patient with haemophilia.

We present a case of embolic ablation of a kidney with recurrent infected hydronephrosis in a patient for whom surgical resection was considered undesirable. The hydronephrosis recurred after embolization using gelfoam/steel coils but after a second embolization using lipiodol/absolute alcohol (50/50), the patient has remained asymptomatic. More than one embolization procedure may be necessary to effect renal ablation. Careful evaluation is necessary to determine whether ablation has been achieved. We recommend lipiodol/absolute alcohol as the embolic agent of choice.

Adult↗
PubMed1992

Epidemiology of non-Hodgkin lymphoma in Connecticut. 1935-1988.

BACKGROUND: During the past decades, there have been reports of increases in the incidence and mortality rates due to non-Hodgkin lymphoma (NHL) in many parts of the world. The risk factors responsible for the increasing incidence are largely unknown. This study provided an overview of the incidence pattern of NHL in Connecticut and generated hypotheses for additional investigation. METHODS: This study was based on all the NHL cases reported to the Connecticut Tumor Registry (CTR) between 1935 and 1988. Crude, age-adjusted, and age-specific incidence rates of NHL were calculated for each sex. Age-adjusted incidence rates were calculated by the direct method standardized to the 1970 United States standard million population. The data are presented by calendar year and cohort year of birth to examine the secular trends and birth cohort effects. Racial information was not coded before 1957 and is of uncertain validity until the early 1970s; therefore, racial analysis was restricted to 1970-1988. Analyses by histologic subtypes and by anatomic sites were restricted to the last 3 decades (1960-1988) because more accurate classification systems were used during this time. RESULTS: A total of 11,326 newly diagnosed cases of NHL were included in the study. Of them, 5866 (52%) were diagnosed in men and 5460 (48%) were diagnosed in women. The study results indicated that the incidence rate of NHL has been increasing during the past decades for men and women, whites and blacks, nodular NHL and diffuse NHL, disease originating from lymph nodes and disease originating from other sites, and in all age groups, especially the older age groups. Birth cohort examination did not show any indication of a decline or levelling off in incidence rates among recent birth cohorts. Age-specific incidence rates in both sexes suggested that the rates increase with age, with a sharp increase beginning at 50 years of age and peaking at 80 years of age. Men had a 30% higher incidence rate than women, and whites had approximately 1.5 times the age-adjusted incidence rate of blacks. CONCLUSIONS: The results indicated that the incidence rate of NHL has been increasing in Connecticut during the past decades and is likely to continue to rise in the coming years. Analytical epidemiologic studies are needed to examine the risk factors that might account for the increase in NHL.

Adult↗
PubMed1992

Time trend and age-period-cohort effects on incidence of esophageal cancer in Connecticut, 1935-89.

The purpose of this study was to examine the incidence pattern of esophageal cancer in Connecticut (USA) during the past decades, and to identify components of birth cohort, period, and and age as determinants of the observed time trends by regression modelling. This study is based on all of the esophageal cancer cases reported to the Connecticut Tumor Registry between 1935 and 1989. A total of 6,310 incident cases were included. Results indicate that among males, the overall age-adjusted incidence rate of esophageal cancer increased after 1935 and peaked between 1955 and 1959. Since then, incidence rates have been relatively stable. Among females, the overall esophageal cancer rate has not changed markedly since 1935. Analysis by histologic type indicates that the incidence rate of squamous cell carcinoma has been declining in this population; adenocarcinoma, however, showed a continuous increase. A fivefold increase among males and a threefold increase among females were observed for adenocarcinoma of the esophagus between 1970 and 1989. If cancers of the esophagus and gastric cardia are considered together, the incidence rate of adenocarcinoma exceeds that of squamous cell carcinoma among males during 1985-89. The observed increasing trend for adenocarcinoma of the esophagus is mainly from cancers arising in the lower third of the esophagus and primarily among Whites, especially White males. The results from regression modeling indicate that both period and birth cohort may have contributed to the observed increasing trend, and adenocarcinoma of the esophagus is likely to increase continuously in this population in the coming years.

Adenocarcinoma↗
PubMed1992

Race, stage of disease, and survival with cervical cancer.

Significant disparities in survival with cervical cancer were observed according to social and disease characteristics of 3711 patients from Connecticut from 1984 through 1988. Women with advanced disease were 25 times more likely to die during a 4-year follow-up than those diagnosed with carcinoma in situ. Elevated risk of death was also noted for blacks (OR = 1.73; 95% CI = 1.2-2.5) and for women diagnosed after the age of 52 years (OR = 33.4; 95% CI = 16.5-69.9). Persons living in census tracts with large proportions of high school graduates or with high median incomes experienced decreased risk (OR = 0.66; 95% CI = 0.45-0.98 and OR = 0.65; 95% CI = 0.44-0.95, respectively). Multivariate logistic regression analysis found the effects of stage of disease on vital status to be reduced by approximately 50% when adjusted for other factors, reflecting the sizable effect of a woman's background on those variables. Nonwhite and older women were at significantly greater risk of being diagnosed with invasive disease.

Adult↗
PubMed1991

FAMLI-RESCUE: a family assessment tool for use by neuroscience nurses in the acute care setting.

Family function information is essential to providing holistic nursing care, assessing specific areas of family dysfunction and assisting the client in adaptation to stress using family or external resources. This article presents an assessment tool developed by the author for collection and evaluation of family data in a simple format that can be used by neuroscience nurses caring for the ill or injured family member in the acute care setting. Theoretical rationale is presented along with a description of the instrument and its application. Based on assessment data, the health care plan is developed by nurses using expertise from health team members where appropriate.

Adaptation, Psychological↗
PubMed1990

Guilt: a crisis within a crisis.

Resolution of the crisis created by a catastrophic neurologic event can be obstructed by the patient's or family's feelings of guilt. This article describes the stages of guilt and manifestations that can be assessed by the nurse. The need for the nurse to assess personal values and responses is discussed. Barriers that may exist in the nurse/patient/family situation and hinder guilt resolution are also listed along with specific interventions to resolve guilt--the crisis within a crisis. Two case studies are included to demonstrate nurse and family interaction in a guilt crisis.

Adaptation, Psychological↗
PubMed1984

Increased prevalence of polycythemia vera in parents of patients on polycythemia vera study group protocols.

An investigation of relatives of 652 patients entered on studies of the Polycythemia Vera Study Group yielded five documented cases of the disease among the parents of patients. When compared with expected values based on the Connecticut Tumor Registry and other population studies a significant increase was found in the lifetime incidence of polycythemia vera in parents of these patients.

Adult↗
PubMed1981

Malignant melanoma of the skin occurring during pregnancy.

The clinical course of melanoma of the skin diagnosed during pregnancy was compared with a control population of women with melanoma that occurred during the childbearing years, as recorded by the Connecticut Tumor Registry. The survival at three and five years for the 12 patients whose melanoma developed during pregnancy was significantly worse than for 175 nonpregnant controls (five-year survival 55% for pregnant women compared with 83% for nonpregnant women, P less than 0.05). Melanoma during pregnancy tended to occur more often on the trunk, a prognostically poor site, and at more advanced stage of disease than in nonpregnant women. However, when pregnant patients were matched to random, nonpregnant case-controls by age, anatomic site of primary lesion, and stage at diagnosis, three- and five-year survivals were not different. The number of pregnant women observed among this group of women was not substantially higher than expected, when estimated from Connecticut live birth rates: 13.3 pregnancies were expected and 12 pregnant women were actually observed. However, an unknown number of pregnancies end in abortion, making more exact estimates impossible. Melanoma occurring during pregnancy usually carries a poor prognosis, but once the disease is diagnosed, the course is not worse than expected considering stage of disease and primary site.

Adult↗