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The goal of this study was to assess the impact of infant-driven feeding (IDF) compared to traditional feeding protocols in promoting earlier successful feeding outcomes. We performed a cross-sectional analysis of infants admitted to a level three neonatal intensive care unit (NICU) over a 2-year period. We compared infants fed with the traditional protocol to those under the IDF protocol. Infants in the IDF group were younger at first feed (p

Objective Guidelines do not specify how cutoffs for high disease activity differ between the Disease Activity Score 28‐joint count indices DAS28–erythrocyte sedimentation rate (ESR) and DAS28–C‐reactive protein (CRP). Studies that compare DAS28‐CRP and DAS28‐ESR depend on data from clinical trials, registries, or practices with multiple providers. Existing studies use data from patients who received immunosuppressive therapy. This study compared the DAS28‐ESR and DAS28‐CRP values from immunosuppressive treatment–naïve patients in a single physician practice. Methods A retrospective electronic medical chart review was conducted for new diagnoses of rheumatoid arthritis (RA; International Classification of Diseases [ICD]‐9 714), based on the American College of Rheumatology/European League against Rheumatology 2010 RA classification criteria. The number of patients with high disease activity (>5.1) was compared using ESR and CRP data to calculate the proportion of discordance. A receiver operator curve and Youden index was used to calculate the DAS28‐CRP high disease activity cutoff estimation that corresponds with DAS28‐ESR of more than 5.1. Results There were 171 patients included in this study. The baseline mean DAS28‐ESR was higher than the baseline mean DAS‐28 CRP: 5.1 ± 1.2 versus 4.1 ± 1.0 (P < 0.001); 48.5% of patients met criteria for high disease activity (score >5.1) compared with only 14.6% when measured by DAS28‐CRP. Discordance was 33.9%. κ coefficient was only .307. Receiver operator curve and Youden index analysis suggested that the cutoff point for high disease activity of DAS28‐CRP greater than 4.1, which corresponds to DAS28‐ESR greater than 5.1. Similarly, DAS28‐ESR posttreatment scores were significantly higher than DAS28‐CRP. When measured by DAS28‐ESR, patients in remission had higher scores as measured by DAS28‐ESR (1.81) than DAS28‐CRP (1.45). Conclusion There is a difference between DAS28‐ESR and DAS28‐CRP, even when calculated for immunosuppressive treatment–naïve patients. DAS28‐CRP is significantly lower than DAS28‐ESR.

Background The ACR/EULAR recommendations endorse the use of glucocorticoids (GCs) for rheumatoid arthritis (RA) patients’ flares and as a bridge to a DMARD. However, the recommendation of low dose short-term monotherapy with (GCs) remains open to the discretion of the clinician. The aim of this study was to assess whether a short-term use of low dose prednisone monotherapy was effective in inducing remission in newly diagnosed RA patients. Methods A retrospective analysis of patients newly diagnosed with RA at a Community Health Center in North Dakota was performed based on the ACR/EULAR RA classification criteria. Demographic and clinical data were abstracted from patients’ medical charts. Patients treated with (< 10 mg/day) of prednisone up to 6 months were included. Response to prednisone was analyzed according to pre- and post-treatment DAS28-ESR score and EULAR response criteria. Results Data on 201 patients were analyzed. The mean prednisone dose was 8 mg/day (range: 5–10; SD = 1.2) and the mean treatment duration was 42.2 days (12–177; 16.9). Disease severity significantly improved from baseline to follow-up for: tender joint count (8.6 ± 4.8 vs. 1.5 ± 3.3; P P P P Conclusion Short-term use of low dose prednisone monotherapy induced disease remission and improved clinical severity of RA in the majority of newly diagnosed patients.

Purpose: Long-distance travel in underserved, rural areas could delay treatment of rhegmatogenous retinal detachment (RRD). The purpose of this study was to determine whether patients living remotely experienced a delay in treatment, presented with more-advanced RRD, or had worse visual acuity (VA) outcomes than patients living locally. Methods: A retrospective consecutive case series is presented of patients undergoing RRD repair by pars plana vitrectomy or scleral buckle from August 2011 to September 2014 in Minot, North Dakota, USA. Exclusion criteria were RRD cases presenting with concurrent vitreoretinal disease. Results: Of the 143 total patients, 45 lived locally, 5.2±1.6 miles (8.4±2.6 km), and 98 lived remotely, 122.8±69 miles (197.6±111 km). Duration of symptoms was 14.0±30.2 days for local and 19.2±37.5 days for remote patients ( P = .42). Time from referring provider exam to vitreoretinal surgeon exam was similar for local and remote patients, 1.5±2.9 vs 1.5±2.8 days ( P = .97). The fovea was detached in 51.1% of local and 53.6% of remote patients ( P = .78). Mean clock-hours of RRD were similar in local and remote patients, 5.2±2.3 vs 5.5±2.6 hours ( P = .51). Proliferative vitreoretinopathy was present in 6.7% of local vs 14.4% of remote patients ( P = .19). Time from vitreoretinal surgeon exam to surgical repair was similar for local and remote patients, 1.8±3.4 vs 1.8±3.8 days ( P = .70). The mean logMAR VA change at 6 months was similar in local and remote patients, –0.54±.7 vs –0.52±.8 ( P = .91). Reoperation was required in 4.4% of local vs 6.1% of remote patients ( P = .69). Conclusions: Patients traveling long distances for management of RRD did not experience a significant delay in treatment, present with more-advanced RRD, or have worse VA outcomes than patients who lived locally. Patients with RRD living in remote rural areas can have similar outcomes to patients living locally when referred and treated urgently.

The ACR/EULAR recommendations endorse the use of glucocorticoids (GCs) for rheumatoid arthritis (RA) patients' flares and as a bridge to a DMARD. However, the recommendation of low dose short-term monotherapy with (GCs) remains open to the discretion of the clinician. The aim of this study was to assess whether a short-term use of low dose prednisone monotherapy was effective in inducing remission in newly diagnosed RA patients.A retrospective analysis of patients newly diagnosed with RA at a Community Health Center in North Dakota was performed based on the ACR/EULAR RA classification criteria. Demographic and clinical data were abstracted from patients' medical charts. Patients treated with (10 mg/day) of prednisone up to 6 months were included. Response to prednisone was analyzed according to pre- and post-treatment DAS28-ESR score and EULAR response criteria.Data on 201 patients were analyzed. The mean prednisone dose was 8 mg/day (range: 5-10; SD = 1.2) and the mean treatment duration was 42.2 days (12-177; 16.9). Disease severity significantly improved from baseline to follow-up for: tender joint count (8.6 ± 4.8 vs. 1.5 ± 3.3; P 0.001), swollen joint count (6.2 ± 5.0 vs. 1.4 ± 3.0; P 0.001), and visual analog pain score (4.8 ± 2.6 vs. 2.1 ± 2.5; P 0.001). DAS28-ESR disease severity significantly improved from baseline to follow-up: (5.1 ± 1.2 vs. 2.7 ± 1.3; P 0.001). Per EULAR response criteria, 69.7% of patients showed good response to treatment and 20.4% showed moderate response. 54.2% of patients reached remission.Short-term use of low dose prednisone monotherapy induced disease remission and improved clinical severity of RA in the majority of newly diagnosed patients.

The aim of this study was to examine the trends and risk factors of antibiotic treatment for skin and soft tissue infections (SSTIs), in the United States.We conducted a retrospective analysis of SSTIs visits utilizing the 2011-2016 National Ambulatory Medical Care Survey.There were over 43 million visits for SSTIs in the US. We found no association between antibiotic treatment and gender, age, race, insurance, region, and metropolitan statistical area. Methicillin-resistantThis study found that providers more frequently utilize antibiotics with MRSA coverage for SSTIs. Antibiotic class chosen was associated with region, with MRSA coverage antibiotics more likely to be prescribed in the South. Additionally, individuals receiving antibiotics with MSSA coverage were older than those receiving antibiotics with MRSA coverage.

Background Antibiotic stewardship programs have been a major focus in recent years to curtail antibiotic resistance. The purpose of this study was to evaluate antibiotic utilization for acute respiratory tract infections (ARTI) in the Emergency Department (ED) setting. Material and methods A retrospective analysis of adult ARTI visits to EDs utilizing 2011–2017 National Hospital Ambulatory Medical Care Survey- Emergency Department (NHAMCS-ED) datasets was conducted. Included were all visits of adults (≥18 years) diagnosed with ARTI. Antibiotics were determined based upon NHAMCS-ED use of the Multum Lexicon Drug Database coding system. All significance tests were two-sided, P-value Results A total of 4632 unweighted ED visits, which represented more than 28 million US ED visits from 2011 to 2017, with 57.2% receiving a prescription for antibiotics. Antibiotic prescriptions for ARTI significantly declined from 65.8% in 2011 to 54.3% in 2017 (P = 0.046). Among all visits, patients were more likely to receive an antibiotic if they were over age 45 (33.0% vs 27.6%, P = 0.005), male (36.7% vs. 32.3%, P = 0.039), and presenting in a non-MSA ED (21.4% vs. 14.5%, P = 0.002). No association was found between antibiotic prescription and race (P = 0.076) insurance (P = 0.488), CBC (P = 0.148), x-ray (P = 0.278), and blood cultures (P = 0.182). Conclusion We found a significant reduction in the utilization of antibiotics among adult ARTI visits to U.S. EDs from 2011 to 2017. This is an improvement from previous studies which showed no change, suggesting that antimicrobial stewardship efforts may be impacting overall antibiotic use and should continue to be practiced.

The goal of this study was to assess the impact of infant-driven feeding (IDF) compared to traditional feeding protocols in promoting earlier successful feeding outcomes.We performed a cross-sectional analysis of infants admitted to a level three neonatal intensive care unit (NICU) over a 2-year period. We compared infants fed with the traditional protocol to those under the IDF protocol.Infants in the IDF group were younger at first feed (p 0.001). There was no difference in age at nasogastric (NG) tube removal or at discharge, length of stay, or percentage breastfeeding at discharge. There were no differences in outcomes within two subgroups born at35 and32 weeks gestation, respectively.The IDF program led to earlier initiation of oral feeding. However, this did not lead to earlier NG tube removal or discharge, a shorter length of stay, or increase in the rates of breastfeeding.

Objective: Endometriosis is a chronic, painful disease that can be disabling. There is a scarcity of research on the clinical management and outcomes of endometriosis in American Indian (AI) women. The aim of this study was to determine whether there are discrepancies between AI and White women in symptoms at presentation, initial diagnosis methods, clinical management, and long-term outcomes of endometriosis, in a rural state. Materials and methods: This retrospective study described and compared the clinical management and long-term outcomes of AI and White women diagnosed with endometriosis. All statistical tests were two-tailed with p-value < .05 considered to be significant. Results: 110 women diagnosed with endometriosis were included in the study, with 50% (n = 55) AI and 50% (n = 55) White. White women were more likely to have private insurance (80% vs. 42%; p < 0.001). AI women were more likely than White women to report abdominal pain at diagnosis (20.3% vs. 9%; p = 0.010), and be diagnosed with mild endometriosis symptoms at the initial visit, (44.4% vs. 10%; p = 0.051). White women were more likely to report a reduction or cessation of pain compared to AI women (63.3% vs. 34%; p = 0.004). Conclusion: We found the majority of women continue to report pain long after endometriosis diagnosis. AI women were less likely to report a reduction or cessation of pain. Future research should investigate why pain is more persistent in AI women.

Objective: The evaluation of racial disparities in access to and use of infertility services in the U.S. has been documented. The aims of this study were to: 1) investigate racial differences in length of time women report attempting to become pregnant until seeking medical help; and 2) determine the predictors of seeking medical help to achieve pregnancy. Materials and methods: The National Survey of Family Growth 2011-2015 was used to analyze the duration women attempted to get pregnant among those who sought medical help. Results: 563 women reported seeking medical help to achieve pregnancy. The majority 422 (81%) were white. Multiple linear regression showed that age (β = .93; p = .00), having less than high school education (β = 14.64; p = .01), and higher body mass index (β = .59; p = .00) are significantly associated with an increased length of time for seeking medical help to get pregnant. Religions other than Catholic or Protestant (β = -8.63; p = .04) is significantly associated with a decreased length of time for seeking medical help to get pregnant. Race was not associated with a significant difference in the length of time attempting to become pregnant (β = -1.80; p = .44). Conclusion: Age, education attainment, religious affiliation, and body mass index are significantly associated with the length of time pursuing pregnancy. Once women have utilized medical resources, racial differences in the length of time pursuing pregnancy are not apparent.

Objective: The evaluation of racial disparities in access to and use of infertility services in the U.S. has been documented. The aims of this study were to: 1) investigate racial differences in length of time women report attempting to become pregnant until seeking medical help; and 2) determine the predictors of seeking medical help to achieve pregnancy. Materials and methods: The National Survey of Family Growth 2011-2015 was used to analyze the duration women attempted to get pregnant among those who sought medical help. Results: 563 women reported seeking medical help to achieve pregnancy. The majority 422 (81%) were white. Multiple linear regression showed that age (β = .93; p = .00), having less than high school education (β = 14.64; p = .01), and higher body mass index (β = .59; p = .00) are significantly associated with an increased length of time for seeking medical help to get pregnant. Religions other than Catholic or Protestant (β = -8.63; p = .04) is significantly associated with a decreased length of time for seeking medical help to get pregnant. Race was not associated with a significant difference in the length of time attempting to become pregnant (β = -1.80; p = .44). Conclusion: Age, education attainment, religious affiliation, and body mass index are significantly associated with the length of time pursuing pregnancy. Once women have utilized medical resources, racial differences in the length of time pursuing pregnancy are not apparent

Introduction: Minimal research has been conducted on the prescribing patterns of emergency room physicians. The opioid epidemic is a well-known public health crisis and increased knowledge of providers’ tendencies to prescribe opioids over other analgesia may help to update guidelines, improve patient safety, and lower the amount of opioid diversion and death from overdose. The purpose of this study was to determine the association between patient visit demographics and prescribed opiate analgesics. Methods: We conducted a retrospective study analyzing adult patient visits that were seen in the emergency setting for acute pain including chest pain, back pain, abdominal pain, headache, face/tooth/ear, or musculoskeletal pain, utilizing the 2011-2016 National Hospital Ambulatory Medical Care Survey Emergency Department Patient Record dataset. We analyzed the relationship between various patient visit characteristics and whether opiate analgesics were given or prescribed. Results: Our study included 73,983 visits for pain, representing an estimated 407 million weighted visits over the study period. We found that those who received opiates were more likely to be female, 62.9% vs. 60.2% and more likely to be white, 74.2% vs. 71.3 %. Furthermore, visits that received opiates were more likely to be younger, have private insurance, and be in increased pain (all P-values = 0.000). Conclusion: We found that certain patient visit characteristics - including being female, white, younger, and private insurance - were given opiates more in the emergency department. Females have been found to report more pain, the elderly have special considerations regarding pain medications (including the risk of delirium and drug-drug interactions), while insurance status may be confounded by age (Medicare being a large portion of government insurance). However, explanations for differences in prescription rates by race could not be easily discerned.

Background: Evidence suggests that cancer patients with increased travel burden to treatment centers may have limited treatment options. Purpose: To investigate the association between travel distance to a treatment facility and initial treatment choice among young men with low-risk prostate cancer in a rural state. Methods: A retrospective medical charts review was conducted of young men (65 years or younger) newly diagnosed with low-risk prostate cancer from January 1, 2005 through December 31, 2014 who were treated with either active surveillance, radical prostatectomy, or brachytherapy at either of the two major hospital systems in Bismarck, ND, USA. Results: Information on a random sample of 242 patients was studied. The majority of patients (66%) received radical prostatectomy. Patients who received radical prostatectomy were significantly younger (p-value 0.001). PSA at diagnosis, clinical stage, and Gleason score were not associated with treatment choice (p-value = 0.06; p-value = 0.1794; and p-value = 1.00; respectively). Adjusting for age at diagnosis, PSA at diagnosis, and treatment facility, treatment choice was not associated with travel distance (p-value = 0.309). Patients treated at St. Alexius facility were more likely to undergo radical prostatectomy than Sanford health patients (p-value Conclusions: We found no association between travel distance and treatment choice for low-risk prostate cancer. Treatment choice was associated with institution which may suggest institutional bias in patterns of care.

Pre-eclampsia (PE) shares a number of proposed pathophysiologic mechanisms related to those implicated in cardiovascular disease (CVD), such as endothelial dysfunction, inflammation, insulin resistance, and impaired renal regulation. PE has also been associated with subsequent hypertension, CVD, and related mortality in later life.At follow-up, the four most recent blood pressures, body mass index (BMI), and use of hypertensive medications were recorded from clinic visits of 130 PE cases and 289 normal pregnancies. Student's t test, Chi-square testing, multivariate linear, and logistic regression were used in analysis.Follow-up measurements occurred a mean of 13.11 years post PE pregnancy. Multivariate linear regression showed a significant and independent association between current systolic blood pressure and previous history of PE (β = 4.47, p = 0.04), while adjusting for age, BMI, and blood pressure from 1 year prior to and up to the 20th week of gestation. A similarly adjusted multivariate logistic regression model found an odds ratio of 3.43, 95% CI 1.83-6.43, p = 0.001 for subsequent hypertension. Logistic regression analysis of the quartile with follow-up of less than 7.19 years also shows independent association of prior PE with subsequent hypertension.PE appears to confer risk of subsequent hypertension on this cohort of American Indian women within as little as 8 years. This risk is independent of additional risk factors such as increased age, BMI, and blood pressure prior to 20 weeks of gestation. There is evidence of increased risk among those with more severe PE.

Background and Objectives: Preeclampsia (PE) is a pregnancy-specific disorder that affects 2-8% of all pregnancies and as many as 60,000 annual maternal mortalities globally. A number of proposed pathophysiologic mechanisms relate to similar factors implicated in cardiovascular disease, such as endothelial dysfunction, inflammation, insulin resistance and impaired renal regulation. Pre-eclampsia has been associated with subsequent hypertension, cardiovascular disease and related mortality in later life. Methods: The 3 most recent blood pressures, body mass index (BMI) and use of hypertensive medications were recorded from electronic medical records of routine clinic visits for 130 cases and 289 controls previously identified and carefully characterized for a study of the etiology and complications of PE. Comparison between case and control groups was made using the student t test for continuous variables and chi-square testing for discrete variables. Linear regression analysis was used to evaluate the effects of risk factors on subsequent systolic and diastolic blood pressure (SBP and DBP respectively). Results: Follow-up measurements occurred a mean of 13.11 years (range 3.6 to 36.7 years) post PE pregnancy. Cases were of similar age (35.9 vs 36.1 years, p=0.82); but with significantly higher BMI (34.1 vs 31.6, p Discussion and Conclusions: PE appears to confer risk of subsequent hypertension on American Indian women after a period of at least 13 years. This risk is independent of additional risk factors such as increased BMI and age. The risk is apparent soon after the affected pregnancy and there are undoubtedly cases where the hypertension of PE fails to resolve post partum.

High levels of serum cholesterol have been proposed to increase the risk of prostate cancer but the epidemiologic evidence is limited. We conducted a hospital-based case–control study in Fargo, ND, USA, to examine the association between hypercholesterolemia and prostate cancer. Cases were men with incident, histologically confirmed prostate cancer. Controls were men without clinical cancer who were seen at the same hospital for an annual physical exam. Demographic and clinical data were abstracted from patients’ medical charts. From a patient population aged 50 to 74 years old, we obtained data on 312 White cases and 319 White controls. Hypercholesterolemia was defined as total cholesterol greater than 5.17 (mmol/l). Univariate logistic regression showed a significant association between hypercholesterolemia and prostate cancer (odds ratio (OR) = 1.64, 95% confidence interval (CI): 1.19–2.27). This association changed only slightly after adjustment for age, family history of prostate cancer, body mass index, type 2 diabetes, smoking, and multivitamin use (OR = 1.58, 95% CI: 1.11–2.24). A significant association was found between low HDL and prostate cancer (OR = 1.57, 95% CI: 1.04–2.36). High LDL was associated with a 60% increased risk for prostate cancer (OR = 1.60, 95% CI: 1.09–2.34). Compared to never smokers, current smokers had an 84% increased risk for prostate cancer (OR = 1.84, 95% CI: 1.09–3.13). This study adds to recent evidence that hypercholesterolemia may increase the risk of prostate cancer in white men.

Diametric analysis is the standard approach utilized for tumor measurement on medical imaging. However, the availability of newer more sophisticated techniques may prove advantageous. An evaluation of diameter, area, and volume was performed on 64 different lung lesions by three trained users. These calculations were obtained using a free DICOM viewer and standardized measuring procedures. Measurement variability was then studied using relative standard deviation (RSD) and intraclass correlation. Volumetric measurements were shown to be more precise than diametric. With minimal RSD and variance between different users, volumetric analysis was demonstrated as a reliable measurement technique. Additionally, the diameters were used to calculate an estimated area and volume; thereafter the estimated area and volume were compared against the actual measured values. The results in this study showed independence of the estimated and actual values. Estimated area deviated an average of 43.5% from the actual measured, and volume deviated 88.03%. The range of this variance was widely scattered and without trend. These results suggest that diametric measurements cannot be reliably correlated to actual tumor size. Access to appropriate software capable of producing volume measurements has improved drastically and shows great potential in the clinical assessment of tumors. Its applicability merits further consideration.

BACKGROUND AND OBJECTIVE: To compare treatment of exudative age-related macular degeneration (AMD) with bevacizumab versus aflibercept in terms of central retinal thickness (CRT) and best corrected visual acuity (BCVA). PATIENTS AND METHODS: A retrospective cohort study examining changes in CRT and BCVA over 12 months of follow-up in 111 patients treated with bevacizumab and 91 treated with aflibercept for exudative AMD. RESULTS: Treatment with bevacizumab and aflibercept reduced CRT from baseline to 12 months. Aflibercept significantly reduced the mean change from baseline CRT at 12 months compared to bevacizumab. However, mean CRT at 12 months was not significantly different after aflibercept versus bevacizumab (271.6 ± 74.0 μm vs 257.9 ± 48.5 μm). BCVA was significantly better at 6 months in the aflibercept group. At baseline, 18.5% of bevacizumab and 26.4% of aflibercept patients had BCVA better than 20/40. At 12 months, 34.8% of bevacizumab and 38.9% of aflibercept patients had BCVA better than 20/40. CONCLUSION: CRT decreased and BCVA improved after treatment with bevacizumab and aflibercept for exudative AMD. [ Ophthalmic Surg Lasers Imaging Retina . 2014;45:275–281.]

Introduction: Se condhand smoking (passive smoking) is associated with many negative health effects, primarily respiratory and cardiovascular diseases. Approximately, 46,000 deaths from cardiovascular disease are associated with secondhand smoke exposure annually in the United States, which is roughly 150 deaths in North Dakota. Studies show that passage of smokefree laws at the community level can reduce the incidence of heart attack. Methods: We co nducted a retrospective review of electronic medical records of patients admitted for heart attacks 4 months prior (April 15, 2010 through August 14, 2010) to implementation of the smoke-free ordinance and 4 months following (August 15, 2010 through December 14, 2010) implementation of the comprehensive smoke-free ordinance in Grand Forks, ND, United States. Results: We f ound an association between the heart attack rate and implementation of the comprehensive smoke-free law. The heart attack rate prior to the ban was 0.5% (83/16,702) compared with 0.3% (63/18,513) after the ban (p = .023). Thus, the rate of heart attacks decreased 30.6% and number of heart attack admissions decreased 24.1%, from 83 to 63, after implementation of a comprehensive smoke-free law. Conclusions: We f ound an implementation of the comprehensive smoke-free law was associated with a decrease in the heart attack rate. The heart attack rate decreased 30.6%. Our finding was similar to previous community level smoke-free law implementation studies and notable for the change going from a partial smoke-free law to a comprehensive smokefree law.

Laboratory data suggest an association between statins and risk of brain metastasis (BM) in patients diagnosed with lung cancer. Our retrospective cohort included 252 patients diagnosed with lung cancer and 55 (22%) patients subsequently developed BM. The risk of BM was significantly higher in younger patients (p < .0007). The multivariable Cox model did not show a significant association between statin use and BM from lung cancer (Hazard-Ratio (HR) = 1.20, 95% confidence interval (CI): 0.68–2.13). Future studies should focus on late stage NSCLC and examine the incidence of BM among statin users at the time of death.

Epidemiological data on the association between statin use and risk of breast cancer among overweight or obese postmenopausal women who have never used hormone therapy (HT) is limited.A hospital-based case-control study was conducted in Fargo, ND, USA. Cases were overweight or obese, postmenopausal White women without a history of HT use who were newly diagnosed with breast cancer. Controls were White women without clinical cancer who were seen at the same hospital for an annual physical examination.From a patient population aged 55 to 81 years old, data were obtained on 95 cases and 94 controls. Overall, there was no association between the use of statins and breast cancer risk odds ratio (OR)=1.3 (95% confidence interval (CI) 0.7-2.5). However, risk varied by hormone receptor status. Compared to non-users, obese women who used hydrophobic statins had an elevated risk of progesterone receptor-negative (PR(-)) breast cancer OR=4.0 (95% CI 1.2-13.8), but not of tumors with other hormone receptor profiles. The risk for breast cancer was also significantly increased among overweight women who used hydrophobic statins for less than or equal to 4 years OR=4.1 (95% CI 1.2-14.4).This observational study found an increased risk of breast cancer related to duration of statins use and PR(-) among postmenopausal women.

Reports of an association between primary hyperparathyroidism in women and risk of breast cancer suggest an etiologic role for high serum calcium. However, data on the association between serum calcium levels and breast cancer in women without clinical hyperparathyroidism are limited. We conducted a hospital-based case–control study among postmenopausal women in Fargo, ND. Cases were women aged 65 and older with newly diagnosed, histologically confirmed breast cancer. Controls were aged 65 and older without clinical cancer who were seen at the same hospital. We obtained data on 190 white cases and 172 white controls. Primary hyperparathyroidism (an abnormally high calcium level confirmed by an abnormally high serum PTH) was found in 3/190 cases and in 0/172 controls (p = 0.25). After excluding the women with primary hyperparathyroidism, the mean calcium levels among cases was 9.6 mg/dL (range, 7.5–11.0, SD = 0.47) vs. 9.4 mg/dL (7.7–10.5, 0.43) among the controls (p

We conducted a retrospective review of medical charts of patients, aged 18 to 59 years old, who underwent either a total knee replacement (TKR) or total hip replacement (THR) from January 2002 to December 2004. Of the 204 study subjects, 52% had a TKR while 48% had a THR. Obesity was significantly associated with the need for a TKR or THR when comparing the study group to adults of similar age in the general population (P< 0.0001). Seventy-two percent (146) of the study group was obese and 21% (42) overweight (BMI 25.0 to 29.9 kg/m2) compared to only 26% (596) obese and 34% (732) overweight in the general population. Patients undergoing a TKR were significantly more likely to be obese (BMI>30 kg/m2) than those having a THR, 83% (89) compared to 59% (57) (P< .0006). Our findings support those previously observed in the elderly population. Primary and secondary prevention programs aimed at reducing obesity are strongly recommended.

The purpose of this study was to assess the accuracy of estimated blood loss (EBL) as a reliable predictor of actual blood loss during orthopedic procedures. Between 1999 and 2002, 198 orthopedic cases were reviewed. A retrospective review compiled preoperative and postoperative demographic and laboratory data from the surgical patients. Estimated blood loss data was-collected from the perioperative and anesthesia reports. Statistical nalysis of EBL vs. change in hemoglobin yielded a correlation e6efficient of 0.189 and a p value of 0.008. We used multiple linear regression to obtain a model to predict change in hemoglobin based on EBL and the intravenous fluids received. The model is as follows: predicted change in hemoglobin = 1.001 x estimated blood loss (in liters) + 0.441 x intravenous fluids received (in liters) + 2.334. The study population included 198 patients, 126 males and 72 females, who met our inclusion criteria. The mean age was 68.1 years (range: SD 12.5), induding 126 males (64%) and 72 females (37%). The mean amount of perioperative intravenous fluids given was 1,732 mL (SD: 773). The mean surgical time was 64.8 minutes (SD: 23.1). The mean preoperative hematocrit and hemoglobin levels were 40.9 g/dL (SD: 4.3) and 13.9 g/dL (SD: 1.6), respectively. The mean postoperative hematocrit and hemoglobin levels were 32.0 g/dL (SD: 6.0) and 10.7 g/dL (SD: 1.6), respectively. The mean difference of preoperative hemoglobin vs. postoperative hemoglobin was 3.3 g/dL (SD 2.1). In this retrospective study, clinical estimation of blood loss was closely correlated with actual change in perioperative hemoglobin. Accurately predicting the postoperative hemoglobin level may prevent many unnecessary blood transfusions and related complications.

The prevention of skin cancer relies not only on the knowledge of the risks of ultraviolet rays, but also on the appropriate measures to minimize solar exposure. We conducted a questionnaire-based survey among a rural population to evaluate perceptions regarding (i) sun-related behaviors, (ii) measures taken to protect themselves, and (iii) self-skin assessment knowledge. Questions included data on patients’ knowledge of deleterious effects of sun exposure, their habits and perceptions about adequate protection, their knowledge of a suspicious cutaneous lesion, and if a physician had spoken to them about the risks of ultraviolet/solar exposure. One hundred and six adults (38 males and 68 females) seen in a primary care clinic were enrolled in our study. Of these, only 38.7% of our patients were concerned about their risk of cutaneous malignancies. On analysis of the sun-protection variables, we found an increased use of tanning beds among women and an increased use of hats in men. Interestingly, we also found that only 18% of respondents used sunscreen when anticipating sun exposure. With suspicious skin lesions, color of the lesion appeared to be the most concerning factor for the subjects, with increasing size being the second most likely factor of concern. Only 11.3% of respondents had a physician-performed skin assessment and only 19.8% performed self-skin assessments at least yearly. There seems to be a lack of appropriate knowledge regarding precancerous and cancerous skin lesions among rural communities. Increased patient education is urgently necessary in rural populations to decrease the growing incidence of cutaneous malignancies.

The objective of this study was to compare rates of infant sleeping position and other risk factors for sudden infant death syndrome from 1991 before the “Back to Sleep” campaign to rates in 1998 after the campaign. We used a cross-sectional risk factor prevalence study of risk factors for the years 1991 and 1998. In North Dakota the prevalence rates of prone sleeping declined 72% for American Indian infants and 62% for Caucasian infants. We were unable to identify a corresponding decline in SIDS in North Dakota for this time period. The relationship between sleeping position and SIDS may be more complex in rural and frontier settings and in American Indian populations than in urban and majority populations. The generalizability of this study is limited by the rural setting and small sample size. Longer term surveillance and additional reports from sites with pre “Back to Sleep” data as a baseline for both SIDS rates and sleeping position will be important to clarify the rate of prone sleeping position and SIDS.

Purpose: The purpose of this study was to investigate the association between travel distance to a comprehensive cancer center on initial stage of breast cancer diagnosis, treatment, and survival. Women with breast cancer living in rural locations in the Midwest may be at an increased risk by having to travel longer distances, often in inclement weather, to receive screening and treatment. Methods: A hospital-based retrospective chart review was conducted of women (n=260) diagnosed with incident breast cancer from January 1, 2007 through December 31, 2007 and receiving treatment at a comprehensive cancer center in Fargo, ND. The women resided predominantly from southeastern North Dakota and southwestern Minnesota. Women aged 29-94 years were included in the study. Women were excluded if they were non-white or had a prior cancer history. Demographic and clinical data recorded included: age at diagnosis, zip code, diagnosis, stage of disease at diagnosis, radiation, surgery, mortality and history of previous cancer. Travel distance was categorized as follows: 0-60 miles. Stage at diagnosis was categorized as Early (0-2) and Late (3-4). Surgery was categorized as breast-conserving surgery and mastectomy. SPSS 20.0 for Windows was used to perform analysis. Chi-square test was used and Mantel-Haenszel test for linear association was used to compare distance category to stage and treatment. ANOVA was used to compare age. A P value Results: The mean age at diagnosis was 60 years (range 29-94). The 5-year survival rate was 95.5%. There were 38.1% (n=99) women residing within 15 miles of the cancer center, 12.6% (33) between 15-44 miles, 21.5% (56) between 45-59 miles, and 27.7% (72) greater than 60 miles. The distribution of staging was 17.1% (42) stage 0, 46.9% (115) stage 1, 25.3% (62) stage 2, 7.8% (19) stage 3, and 2.9% (7) stage 4. Surgical resection was performed on 98% (255) of women, with 59.2% (151) receiving breast-conserving surgery, and 40.3% (104) receiving mastectomy. Radiotherapy was performed on 61.5% (160) women. A linear trend association was found between travel distance and stage of diagnosis (p=0.03). The further the distance the more likely women were to have a later stage of diagnosis. Similarly, linear trend association was found between travel distance and surgery type (p=0.005). The further the distance the more likely women were to have a mastectomy. No association was found between travel distance and age of diagnosis, receipt of radiotherapy, or 5-year survival. Conclusion: This study indicates that women with increased travel distances are more likely to have a later stage at diagnosis and mastectomy at surgery. Improvements in access to cancer treatment may be necessary for women in rural areas. Citation Format: Krishan Jethwa, Brooke Settergren, Brittany Berg, James Beal. Association between travel distance to a comprehensive cancer center and breast cancer stage, treatment, and outcomes in a rural state. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B15.