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- Abe, O, et al.
(författare)
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Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials
- 2005
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Ingår i: The Lancet. - 1474-547X. ; 365:9472, s. 1687-1717
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Tidskriftsartikel (refereegranskat)abstract
- Background Quinquennial overviews (1985-2000) of the randomised trials in early breast cancer have assessed the 5-year and 10-year effects of various systemic adjuvant therapies on breast cancer recurrence and survival. Here, we report the 10-year and 15-year effects. Methods Collaborative meta-analyses were undertaken of 194 unconfounded randomised trials of adjuvant chemotherapy or hormonal therapy that began by 1995. Many trials involved CMF (cyclophosphamide, methotrexate, fluorouracil), anthracycline-based combinations such as FAC (fluorouracil, doxombicin, cyclophosphamide) or FEC (fluorouracil, epirubicin, cyclophosphamide), tamoxifen, or ovarian suppression: none involved taxanes, trastuzumab, raloxifene, or modem aromatase inhibitors. Findings Allocation to about 6 months of anthracycline-based polychemotherapy (eg, with FAC or FEC) reduces the annual breast cancer death rate by about 38% (SE 5) for women younger than 50 years of age when diagnosed and by about 20% (SE 4) for those of age 50-69 years when diagnosed, largely irrespective of the use of tamoxifen and of oestrogen receptor (ER) status, nodal status, or other tumour characteristics. Such regimens are significantly (2p=0 . 0001 for recurrence, 2p<0 . 00001 for breast cancer mortality) more effective than CMF chemotherapy. Few women of age 70 years or older entered these chemotherapy trials. For ER-positive disease only, allocation to about 5 years of adjuvant tamoxifen reduces the annual breast cancer death rate by 31% (SE 3), largely irrespective of the use of chemotherapy and of age (<50, 50-69, &GE; 70 years), progesterone receptor status, or other tumour characteristics. 5 years is significantly (2p<0 . 00001 for recurrence, 2p=0 . 01 for breast cancer mortality) more effective than just 1-2 years of tamoxifen. For ER-positive tumours, the annual breast cancer mortality rates are similar during years 0-4 and 5-14, as are the proportional reductions in them by 5 years of tamoxifen, so the cumulative reduction in mortality is more than twice as big at 15 years as at 5 years after diagnosis. These results combine six meta-analyses: anthracycline-based versus no chemotherapy (8000 women); CMF-based versus no chemotherapy (14 000); anthracycline-based versus CMF-based chemotherapy (14 000); about 5 years of tamoxifen versus none (15 000); about 1-2 years of tamoxifen versus none (33 000); and about 5 years versus 1-2 years of tamoxifen (18 000). Finally, allocation to ovarian ablation or suppression (8000 women) also significantly reduces breast cancer mortality, but appears to do so only in the absence of other systemic treatments. For middle-aged women with ER-positive disease (the commonest type of breast cancer), the breast cancer mortality rate throughout the next 15 years would be approximately halved by 6 months of anthracycline-based chemotherapy (with a combination such as FAC or FEC) followed by 5 years of adjuvant tamoxifen. For, if mortality reductions of 38% (age <50 years) and 20% (age 50-69 years) from such chemotherapy were followed by a further reduction of 31% from tamoxifen in the risks that remain, the final mortality reductions would be 57% and 45%, respectively (and, the trial results could well have been somewhat stronger if there had been full compliance with the allocated treatments). Overall survival would be comparably improved, since these treatments have relatively small effects on mortality from the aggregate of all other causes. Interpretation Some of the widely practicable adjuvant drug treatments that were being tested in the 1980s, which substantially reduced 5-year recurrence rates (but had somewhat less effect on 5-year mortality rates), also substantially reduce 15-year mortality rates. Further improvements in long-term survival could well be available from newer drugs, or better use of older drugs.
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- Olsson, C, et al.
(författare)
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A Gender Perspective on Sick Leave Among Young Adults - Barriers and Resources for Return to Work as Experienced by Young Employees and Managers: A Protocol for a Qualitative Study
- 2021
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Ingår i: INTERNATIONAL JOURNAL OF QUALITATIVE METHODS. - : SAGE Publications. - 1609-4069. ; 20
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: About 20% of the working-age population in the average OECD country is suffering from a mental disorder. The prevalence rates are especially high among young adults and women. Young adults need to deal with challenges connected to growing up and entering the labour market, their young age often leaving them with little experience and a low level of preparedness for failure. Moreover, young women and men are confronted with gender norms and expectations that have been found to affect both sick leave and return to work. While managers have been shown to have a significant impact on the well-being of employees, few studies investigate the experiences of both employees and managers in relation to sick leave and return to work among youth. The aim of this study is to investigate perceived causes of sick leave owing to common mental disorders as well as barriers to and resources for return to work for young employees, from the perspectives of both employees and managers. Furthermore, differences and similarities in the patterns of experiences of women and men will be analyzed. Methods and analysis: This study has a qualitative research design. Data will consist of individual interviews with employees aged 19–29 and managers in female- and male-dominated occupations in a Swedish setting. The participants will be recruited using a purposive sampling strategy. The interviews will be analysed in two steps: firstly, a conventional content analysis will be conducted. Secondly, a gender analysis focusing social relations and gender order will be applied to interpret the data by examining differences and similarities in the patterns of experiences of women and men.
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- Schmidt, HT, et al.
(författare)
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Recoil-ion momentum distributions for transfer ionization in fast proton-He collisions
- 2005
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Ingår i: Physical Review A. Atomic, Molecular, and Optical Physics. - : American physical society. - 1050-2947 .- 1094-1622. ; 72:1
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Tidskriftsartikel (refereegranskat)abstract
- We present high-luminosity experimental investigations of the transfer ionization (TI:p+He -> H-0+He2++e(-)) process in collisions between fast protons and neutral helium atoms in the earlier inaccessibly high-energy range 1.4-5.8 MeV. The protons were stored in the heavy-ion storage and cooler ring CRYRING, where they intersected a narrow supersonic helium gas jet. We discuss the longitudinal recoil-ion momentum distribution, as measured by means of cold-target recoil-ion momentum spectroscopy and find that this distribution splits into two completely separated peaks at the high end of our energy range. These separate contributions are discussed in terms of the earlier proposed Thomas TI (TTI) and kinematic TI mechansims. The cross section of the TTI process is found to follow a sigma proportional to v(-b) dependence with b=10.78 +/- 0.27 in accordance with the expected v(-11) asymptotic behavior. Further, we discuss the probability for shake-off accompanying electron transfer and the relation of this TI mechanism to photodouble ionization. Finally the influence of the initial-state electron velocity distribution on the TTI process is discussed.
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- Torres-Rueda, S, et al.
(författare)
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Stark choices: exploring health sector costs of policy responses to COVID-19 in low-income and middle-income countries
- 2021
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Ingår i: BMJ global health. - : BMJ. - 2059-7908. ; 6:12
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Tidskriftsartikel (refereegranskat)abstract
- COVID-19 has altered health sector capacity in low-income and middle-income countries (LMICs). Cost data to inform evidence-based priority setting are urgently needed. Consequently, in this paper, we calculate the full economic health sector costs of COVID-19 clinical management in 79 LMICs under different epidemiological scenarios.MethodsWe used country-specific epidemiological projections from a dynamic transmission model to determine number of cases, hospitalisations and deaths over 1 year under four mitigation scenarios. We defined the health sector response for three base LMICs through guidelines and expert opinion. We calculated costs through local resource use and price data and extrapolated costs across 79 LMICs. Lastly, we compared cost estimates against gross domestic product (GDP) and total annual health expenditure in 76 LMICs.ResultsCOVID-19 clinical management costs vary greatly by country, ranging between <0.1%–12% of GDP and 0.4%–223% of total annual health expenditure (excluding out-of-pocket payments). Without mitigation policies, COVID-19 clinical management costs per capita range from US$43.39 to US$75.57; in 22 of 76 LMICs, these costs would surpass total annual health expenditure. In a scenario of stringent social distancing, costs per capita fall to US$1.10–US$1.32.ConclusionsWe present the first dataset of COVID-19 clinical management costs across LMICs. These costs can be used to inform decision-making on priority setting. Our results show that COVID-19 clinical management costs in LMICs are substantial, even in scenarios of moderate social distancing. Low-income countries are particularly vulnerable and some will struggle to cope with almost any epidemiological scenario. The choices facing LMICs are likely to remain stark and emergency financial support will be needed.
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