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Biomedical subjects

S A Joslyn

Publications and source records attributed to S A Joslyn.

6 recordsLinked to original sources
PubMed2000

Racial differences in breast carcinoma survival.

BACKGROUND: Survival after breast carcinoma diagnosis is significantly worse among African American women for reasons unknown. The purpose of this study was to update reports on the National Surveillance, Epidemiology, and End Results Program and to examine the effect of race on breast carcinoma survival. METHODS: Subjects were 135,424 women diagnosed with primary breast carcinoma between 1988-1995. Patient age, tumor stage at the time of diagnosis, hormone receptor status, tumor histology, menopausal status, and survival were compared by race category. RESULTS: African American women diagnosed with breast carcinoma (n = 11,159) had a significantly increased risk of death from breast carcinoma and from all cancers compared with white women (n = 124,265), independent of the effects of other predictor variables. African American women were significantly younger at the time of diagnosis, with approximately 33% of the population age </= 50 years, compared with slightly <25% of the white women belonging to that younger age group. African American women were significantly more likely to present with advanced stages of breast carcinoma and, within each stage category, had significantly poorer survival compared with white women. African American women were significantly less likely to have tumors positive for estrogen or progesterone receptors, as well as histologically confirmed lobular and tubular carcinomas, whereas they were more likely to have inflammatory, medullary, and papillary histology compared with white women. CONCLUSIONS: The results of the current study show that race is an independent predictor of survival from breast carcinoma. These findings are consistent with other large, population-based studies of racial differences in breast carcinoma survival and have been comported by studies of racial differences in the molecular biology of breast carcinoma, thus providing support for the epidemiologic credibility of the independence of the association.

Adult↗
PubMed1999

Radiation therapy and patient age in the survival from early-stage breast cancer.

PURPOSE: To analyze the use of radiation therapy following local excision of invasive localized breast cancer and subsequent survival by 5-year age category. METHODS: Data for 27, 399 women diagnosed with localized stage of breast cancer and treated with local excision surgery from 1983 through 1992 were collected and provided by the national Surveillance, Epidemiology, and End Results (SEER) program. Use of radiation therapy was analyzed by race, ethnic background, geographic location, and age at diagnosis. Survival for women treated with local excision plus radiation therapy was compared to that of women treated with local excision alone for each 5-year age category. RESULTS: Subjects in older age groups were significantly less likely (p < 0.001) to receive radiation following local excision compared to younger age groups. Statistically significant survival advantages were conferred on women receiving radiation therapy in each 5-year age category from age 35 to 84 years (ranging from p = 0.02 to p < 0.0001). CONCLUSION: While the use of radiation therapy following local excision of early-stage breast tumors drops significantly in older age groups, women aged 35-84 years receiving radiation therapy had significant reductions in mortality. These results did not appear to be influenced by the presence of mortal comorbid conditions. These results strongly suggest the need to consider carefully patient characteristics other than age in deciding the course of treatment for early-stage breast cancer.

Adult↗
PubMed1994

Case definition in survival studies of out-of-hospital cardiac arrest.

The purpose of this investigation was to determine problems with case definition and selection biases in studies of survival from out-of-hospital cardiac arrest, by comparing characteristics of subjects with cardiac arrest who entered the emergency medical services (EMS) system and those who did not enter the system. Data for 143 prehospital cardiac arrest patients in Johnson County, Iowa, were obtained from death certificates and EMS reports. Approximately one half of cardiac arrest patients entered the EMS system. Mean total number of causes of death listed on death certificates was significantly higher in subjects who did not enter the EMS system. Several factors, including age, sex, and number of causes of death listed on death certificates were significant univariate factors in whether a cardiac arrest victim entered the EMS system, but multivariate logistic regression indicated age by itself was the most significant factor. These results indicate there are possible initial biases determining who will enter the EMS system, which affects the generalizability of previous studies.

Age Factors↗
PubMed1993

Survival from out-of-hospital cardiac arrest: effects of patient age and presence of 911 Emergency Medical Services phone access.

The purpose of this investigation was to determine factors associated with survival from out-of-hospital cardiac arrest, including effects of 911 Emergency Medical Services telephone access and the age of patient. Subjects included 1,753 prehospital cardiac arrest patients in Iowa. Patient survival status and other variables were compared for patients with access to a 911 service with those who did not, and for different age categories, using univariate associations and multivariate logistic regression analysis. The presence of 911 telephone access was significantly associated with survival from out-of-hospital cardiac arrest (9.18% versus 5.35% survival for 911 versus no 911 groups, respectively). This association was partially the result of the significant association of 911 with decreased time from collapse to call for help, decreased time to cardiopulmonary resuscitation (CPR), and decreased time to first shock (if in ventricular fibrillation [VF]). Younger age was significantly associated with survival in univariate analyses (8.94% versus 6.26% survival for younger versus older age groups, respectively), but this was not an independent association, which is indicated by the lack of significance of age in the multivariate model.

Age Factors↗
PubMedDate not supplied

Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis.

BACKGROUND: The purpose of this study was to determine the accuracy of diagnosing group A beta-hemolytic streptococci (GABHS) with rapid antigen testing compared with throat culture methods commonly used. METHODS: Two separate studies were conducted. Initially, 182 patients with acute pharyngitis had both throat culture (sheep blood agar or Strep Select Agar) and rapid antigen detection screening tests (Directigen1-2-3 Group A Strep) performed. For the second study, a rapid antigen detection test (Directigen1-2-3 Group A Strep) was obtained from 614 patients. All subjects who screened negative (n = 469) received a throat culture. All subjects who screened positive (n = 145) were treated with antibiotics, and 31 of these patients received a throat culture. Statistical analyses included calculating sensitivity, specificity, positive and negative predictive values, and prevalence. RESULTS: For the initial 182 patients, the prevalence of GABHS was 12 percent. Sensitivity was 95.45 percent, specificity was 96.25 percent, positive predictive value was 77.78 percent, and negative predictive value was 99.35 percent. In the second group of subjects, four false-negatives were present (negative predictive value = 99.18 percent). CONCLUSIONS: Results of these pilot studies indicate that an extremely low percentage (< 1 percent) of subjects with GABHS escaped detection with our rapid screening test methods. These results conflict with results from previous investigations, which have reported relatively low specificity and sensitivity of rapid antigen detection tests when compared with throat cultures. Results from this study support treatment protocols based on a rapid screening test as a single diagnostic test.

Adolescent↗