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Search Results: 1 - 10 of 1330 matches for " Mikael Hartman "
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Is there an optimal environment in which to learn clinical anatomy? One man’s view  [PDF]
Eng-Tat Ang, Peter Abrahams, Seow Choon Sheong, Mikael Hartman
Forensic Medicine and Anatomy Research (FMAR) , 2014, DOI: 10.4236/fmar.2014.21004
Abstract: Learning anatomy is essential in medical schools, and even more so for budding surgeons. Much has been discussed regarding the updated curriculum, and whether the pedagogies should be based upon cadaveric, and/or multimedia, or hybrid approaches. Much debate has also been centered on who is best qualified to teach. While all these are important, the setting is also critically important for the medical students and surgical trainees. Therefore the overarching issue is whether all these activities should be held in the dissection room, the operating theatre or the classical “Theatrum Anatomicum” ? What are the key experiential learning differences in picking up anatomical knowledge in the various venues listed above? This paper will provide some insights for teachers and students of human anatomy, and some ideas for the future planners and developers of anatomy learning centers internationally.
A constant risk for familial breast cancer? A population-based family study
Kamila Czene, Marie Reilly, Per Hall, Mikael Hartman
Breast Cancer Research , 2009, DOI: 10.1186/bcr2260
Abstract: We analyzed a Swedish population-based cohort with complete family links and calculated incidence rates of breast cancer in mothers of 48,259 daughters diagnosed with breast cancer.The risk for breast cancer in mothers of breast cancer patients is elevated relative to the background population at all ages. Mothers have an overall incidence of 0.34%/year at ages older than a daughter's age at diagnosis. This rate is not affected to any large extent by the daughter's age at diagnosis. A constant incidence rate of 0.40%/year from age 35 years onward is seen in mothers of breast cancer patients diagnosed before 35 years of age. For mothers of daughters diagnosed at age 35 to 44 years the incidence pattern is less clear, with the rate being stable for approximately 20 years after the daughter's age at diagnosis and rising thereafter. Older age at a daughter's diagnosis (≥ 45 years) appears to confer an age-dependent increase in incidence in the mother.Incidence of familial breast cancer in first-degree relatives may increase to a high and constant level by a predetermined age that is specific to each family. This phenomenon appears inconsistent with accepted theories of malignant transformation.Studies of familial aggregation of breast cancer identify a family history of breast cancer as one of the strongest risk factors for the disease [1,2]. Familial risks for female breast cancer have been the subject of numerous epidemiological studies [3-7]. A study that re-analyzed 52 epidemiological studies of familial breast cancer presented summary risk ratios of 1.80 and 2.93 for one and two affected first-degree relatives, respectively [8].Young age at onset of disease within a family has long been regarded as a particularly strong risk factor for breast cancer [9-11]. Several studies have investigated the familial risk for breast cancer in relation to both the proband's age at diagnosis and the age of the person at risk [3,12]. The results are similar, regardless of whether s
Is Genetic Background Important in Lung Cancer Survival?
Linda S. Lindstr?m, Per Hall, Mikael Hartman, Fredrik Wiklund, Kamila Czene
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0005588
Abstract: Background In lung cancer, a patient's survival is poor with a wide variation in survival within the stage of disease. The aim of this study was to investigate the familial concordance in lung cancer survival by means of analyses of pairs with different degrees of familial relationships. Methods Our population-based Swedish family database included three million families and over 58 100 lung cancer patients. We modelled the proband (parent, sibling, spouse) survival utilizing a multivariate proportional hazard (Cox) model adjusting for possible confounders of survival. Subsequently, the survival in proband's relative (child, sibling, spouse) was analysed with a Cox model. Findings By use of Cox modelling with 5 years follow-up, we noted a decreased hazard ratio for death in children with good parental survival (Hazard Ratio [HR] = 0.71, 95% CI = 0.51 to 0.99), compared to those with poor parental survival. Also for siblings, a very strong protective effect was seen (HR = 0.14, 95% CI = 0.030 to 0.65). Finally, in spouses no correlation in survival was found. Interpretation Our findings suggest that genetic factors are important in lung cancer survival. In a clinical setting, information on prognosis in a relative may be vital in foreseeing the survival in an individual newly diagnosed with lung cancer. Future molecular studies enhancing the understanding of the underlying mechanisms and pathways are needed.
Is breast cancer prognosis inherited?
Mikael Hartman, Linda Lindstr?m, Paul W Dickman, Hans-Olov Adami, Per Hall, Kamila Czene
Breast Cancer Research , 2007, DOI: 10.1186/bcr1737
Abstract: We carried out a population-based cohort study in Sweden based on the nationwide Multi-Generation Register. Among all women with breast cancer diagnosed from 1961 to 2001, 2,787 mother-daughter pairs and 831 sister pairs with breast cancer were identified; we achieved complete follow-up and classified 5-year breast cancer-specific prognosis among proband (mother or oldest sister) into tertiles as poor, intermediary, or good. We used Kaplan-Meier estimates of survival proportions and Cox models to calculate relative risks of dying from breast cancer within 5 years depending on the proband's outcome.The 5-year survival proportion among daughters whose mothers died within 5 years was 87% compared to 91% if the mother was alive (p = 0.03). Among sisters, the corresponding proportions were 70% and 88%, respectively (p = 0.001). After adjustment for potential confounders, daughters and sisters of a proband with poor prognosis had a 60% higher 5-year breast cancer mortality compared to those of a proband with good prognosis (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.2 to 2.2; p for trend 0.002). This association was slightly stronger among sisters (HR, 1.8; 95% CI, 1.0 to 3.4) than among daughters (HR, 1.6; 95% CI, 1.1 to 2.3).Breast cancer prognosis of a woman predicts the survival in her first-degree relatives with breast cancer. Our novel findings suggest that breast cancer prognosis might be inherited.Breast cancer, the most common female malignancy, has an important genetic contribution estimated to 25% to 28% [1,2]. Mutations in high-penetrant genes such as BRCA1 (breast cancer 1, early onset) and BRCA2 account for only a small proportion of this hereditary component, suggesting an important but yet-to-be-detected role for low-penetrant single nucleotide polymorphisms. Overall, the prognosis of women with a family history of breast cancer has been reported as similar or worse compared to women without a family history [3-6]. A relatively poor outcome ha
Demographic and Spatial Predictors of Anemia in Women of Reproductive Age in Timor-Leste: Implications for Health Program Prioritization
Andrew A. Lover, Mikael Hartman, Kee Seng Chia, David L. Heymann
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0091252
Abstract: Anemia is a significant risk factor for poor health outcomes for both the mother and neonate; however, the determinants of anemia in many epidemiological settings are poorly understood. Using a subset of a nationally representative cluster survey (2010 Demographic and Health Survey) in combination with other non-contemporaneous survey data, the epidemiology of anemia among women of reproductive age in Timor-Leste has been explored. Logistic regression was used to identify risk factors, population-level impacts were estimated as population attributable fractions and spatial analytics were used to identify regions of highest risk. The DHS survey found that ~21% of adult women in Timor-Leste are anemic (49,053; 95% CI: 37,095 to 61,035), with hemoglobin <12.0 g/dL. In this population, the main risk factors (adjusted odds ratio; 95% CI) are: currently abstaining from sex for any reason (2.25; 1.50 to 3.38); illiteracy (2.04; 1.49 to 2.80); giving birth within the previous year (1.80; 1.29 to 2.51); consumption of fruits/vegetables low in vitamin A (1.57; 1.13 to 2.20); and the district-level confirmed malaria incidence (1.31; 1.15 to 1.49). A review of prior soil-transmitted helminth surveys in Timor-Leste indicates low-to-moderate prevalence with generally low egg counts, suggesting a limited impact on anemia in this setting, although comprehensive survey data are lacking. Examination of the population-level effects highlights the impacts of both recent births and malaria on anemia, with more limited impacts from diet; the evidence does not suggest a large contribution from geohelminths within Timor-Leste. These patterns are divergent from some other settings in the Asia-Pacific region and highlight the need for further focused research. Targeting high-burden districts and by increasing access to pre/postnatal care, raising literacy levels, increasing access to family planning, and improving malaria control should be prioritized to maximize inherently limited health budgets in reaching these populations.
SILC for SILC: Single Institution Learning Curve for Single-Incision Laparoscopic Cholecystectomy
Chee Wei Tay,Liang Shen,Mikael Hartman,Shridhar Ganpathi Iyer,Krishnakumar Madhavan,Stephen Kin Yong Chang
Minimally Invasive Surgery , 2013, DOI: 10.1155/2013/381628
Abstract: Objectives. We report the single-incision laparoscopic cholecystectomy (SILC) learning experience of 2 hepatobiliary surgeons and the factors that could influence the learning curve of SILC. Methods. Patients who underwent SILC by Surgeons A and B were studied retrospectively. Operating time, conversion rate, reason for conversion, identity of first assistants, and their experience with previous laparoscopic cholecystectomy (LC) were analysed. CUSUM analysis is used to identify learning curve. Results. Hundred and nineteen SILC cases were performed by Surgeons A and B, respectively. Eight cases required additional port. In CUSUM analysis, most conversion occurred during the first 19 cases. Operating time was significantly lower (62.5 versus 90.6?min, P = 0.04) after the learning curve has been overcome. Operating time decreases as the experience increases, especially Surgeon B. Most conversions are due to adhesion at Calot’s triangle. Acute cholecystitis, patients’ BMI, and previous surgery do not seem to influence conversion rate. Mean operating times of cases assisted by first assistant with and without LC experience were 48 and 74 minutes, respectively (P = 0.004). Conclusion. Nineteen cases are needed to overcome the learning curve of SILC. Team work, assistant with CLC experience, and appropriate equipment and technique are the important factors in performing SILC. 1. Introduction Single-incision laparoscopic cholecystectomy (SILC) has been increasingly performed for benign gallbladder disease over the last few years with comparable operative results with conventional 4-port laparoscopic cholecystectomy (CLC). With results from randomized controlled trials (RCTs) [1–5] and series of publications [6–9] showing that SILC is equally safe, with no obvious additional scar and potentially have less postoperative pain and earlier return to daily activity [5], more surgeons are embarking on learning the technique. As SILC is a new approach to gallbladder disease, many aspects of this new technique have not been studied in detail. Most surgeons embarking on this technique are concerned with its learning curve, conversions, and potential longer operating time. To date, very limited work has been done to look into this important issue and few publications have looked into learning curve of SILC from conversion point of view. To perform SILC safely and successfully, there may be changes in surgical technique, need of new equipment, and modifications in the role of assistant. In this study, we report an SILC learning experience of a tertiary university hospital
Estrogen Receptor Status in Relation to Risk of Contralateral Breast Cancer–A Population-Based Cohort Study
Maria E. C. Sandberg, Per Hall, Mikael Hartman, Anna L. V. Johansson, Sandra Eloranta, Alexander Ploner, Kamila Czene
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046535
Abstract: Background It is unclear whether estrogen receptor (ER)-status of first primary breast cancer is associated with risk of metachronous (non-simultaneous) contralateral breast cancer (CBC), and to what extent endocrine therapy affects this association. Methods We studied the effect of ER-status of the first cancer on the risk of CBC overall, and for different ER-subtypes of CBC, using a large, population-based cohort. The cohort consisted of all women diagnosed with breast cancer in the Stockholm region 1976–2005; 25715 patients, of whom 940 suffered CBC. The relative risk was analyzed mainly using standardized incidence ratios (SIR). Results Women with breast cancer had a doubled risk of CBC compared to the risk of breast cancer in the general female population (SIR: 2.22 [2.08–2.36]), for women with a previous ER-positive cancer: SIR = 2.30 (95% CI:2.11–2.50) and for women with a previous ER-negative cancer: SIR = 2.17 (95% CI:1.82–2.55). The relative risk of ER-positive and ER-negative CBC was very similar for women with ER-positive first cancer (SIR = 2.02 [95%CI: 1.80–2.27] and SIR = 1.89 [95%CI: 1.46–2.41] respectively) while for patients with ER-negative first cancer the relative risk was significantly different (SIR = 1.27 [95% CI:0.94–1.68] for ER-positive CBC and SIR = 4.96 [95%CI:3.67–6.56] for ER-negative CBC). Patients with ER-positive first cancer who received hormone therapy still had a significantly higher risk of CBC than the risk of breast cancer for the general female population (SIR = 1.74 [95% CI:1.47–2.03]). Conclusion The risk of CBC for a breast cancer patient is increased to about two-fold, compared to the risk of breast cancer in the general female population. This excess risk decreases, but does not disappear, with adjuvant endocrine therapy. Patients with ER-positive first cancers have an increased risk for CBC of both ER subtypes, while patients with ER-negative first cancer have a specifically increased risk of ER-negative CBC.
Generic Substitution Effects on Firm Level Market Shares in the Finnish Beta Blocker Market 1997Q1-2007Q4  [PDF]
Mikael Linden
Modern Economy (ME) , 2013, DOI: 10.4236/me.2013.412092

The firm level market structure of the Finnish beta blocker market in the period from 1997Q1 to 2007Q4 is analyzed with data analysis and with panel data regression methods. Four different market concentration measures are used. Although drug prices have decreased in response to the competition-enhancing generic substitution system which started on the 1st of March 2003, the firms’ observed market shares in the market have not decreased uniformly in the all market dimensions. At the drug substitution group level, policy change has led to more equal group share distributions both for the nominal sales shares and quantity sales shares compared to the pre-policy period. At the whole market level, nominal firm sales shares of the largest firms have increased during the policy era but quantity sales shares have declined. The results imply that the dominant firms’ nominal sale shares are augmented with firm-specific drug price setting power. The results challenge the European Union (EU) drug policy targeted to increase competition in the drug markets.


Do Gender Differences in Undergraduate Engineering Orientations Persist when Major is Controlled?
Harriet Hartman,Moshe Hartman
International Journal of Gender, Science and Technology , 2009,
Abstract: The question posed in this paper is how persistent are gender differences in engineering orientation and achievement, once we control for engineering discipline, cohort, and year in the program. The data come from a multi-year survey of engineering students at a mid-Atlantic public university, which has four engineering disciplines: chemical, civil/environmental, electrical/computing,and mechanical, which vary by proportion of women in them. Using multivariate analysis, we control for gender, cohort, year in the program, and major in the analysis of differences in engineering self-confidence, satisfaction with the core course and interpersonal climate, engineering grades, expectations from the undergraduate degree and long-term commitment to a career in engineering.We then are able to isolate the significant gender differences and interaction effects that persist when these other factors are held constant. We find that gender clearly matters with respect to engineering grades, self-confidence, satisfaction with the core course, and commitment to the engineering career, even when major, year, and cohort (and grades, for all of the other dependent variables) are controlled. However, gender differences with regard to peer integration are insignificant; and there are few remaining gender differences with regard to expectations from an engineering degree. Suggestions for further research are proposed.
A comparative population-based study of prostate cancer incidence and mortality rates in Singapore, Sweden and Geneva, Switzerland from 1973 to 2006
Cynthia Chen, Nasheen Naidoo, Qian Yang, Mikael Hartman, Helena MariekeM Verkooijen, En Yun Loy, Christine Bouchardy, Kee Seng Chia, Sin Eng Chia
BMC Cancer , 2012, DOI: 10.1186/1471-2407-12-222
Abstract: Data from patients diagnosed with prostate cancer were extracted from national cancer registries in Singapore (n?=?5,172), Sweden (n?=?188,783) and Geneva (n?=?5,755) from 1973 to 2006. Trends of incidence and mortality were reported using the Poisson and negative binomial regression models. The age, period and birth-cohort were tested as predictors of incidence and mortality rates of prostate cancer.Incidence rates of prostate cancer increased over all time periods for all three populations. Based on the age-period-cohort analysis, older age and later period of diagnosis were associated with a higher incidence of prostate cancer, whereas older age and earlier period were associated with higher mortality rates for prostate cancer in all three countries.This study demonstrated an overall increase in incidence rates and decrease in mortality rates in Singapore, Sweden and Geneva. Both incidence and mortality rates were much lower in Singapore. The period effect is a stronger predictor of incidence and mortality of prostate cancer than the birth-cohort effect.
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