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To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.01675.x Byline: Mary A. M. Rogers (*[dagger]), Lona Mody ([double dagger]s.), Samuel R. Kaufman (*[dagger]), Brant E. Fries ([parallel]s.#), Laurence F. McMahon (*[dagger]), Sanjay Saint (*[dagger]**) Keywords: urinary catheterization; nursing homes Abstract: OBJECTIVES: To assess use of urinary collection devices (external, intermittent, and indwelling catheters; pads or briefs) and examine predictors of indwelling catheters in skilled nursing facilities (SNFs). DESIGN: Retrospective cohort study. SETTING: SNFs in California, Florida, Michigan, New York, and Texas. PARTICIPANTS: All patients admitted to SNFs in 2003 who remained there for 1 year (N=57,302). MEASUREMENTS: Characteristics of patients who used different collection strategies (indwelling, intermittent, and external catheterization; pads or briefs) and predictors of indwelling urinary catheterization from the Nursing Home Minimum Data Set using multinomial logistic regression. RESULTS: The prevalence of indwelling catheterization was 12.6% at admission and 4.5% at the annual assessment (P CONCLUSION: Coinciding with federal regulations, urinary catheterization was lower than has been reported previously and declined over time. Further reduction should be targeted at the evaluation of skin problems, appropriateness of multiple medications, and alternative measures in patients with diabetes mellitus, obesity, deep vein thrombosis, and communication problems. Author Affiliation: (*)General Medicine ([double dagger])Geriatric Medicine, Department of Internal Medicine ([parallel])Institute of Gerontology, School of Medicine (#)School of Public Health, University of Michigan, Ann Arbor, Michigan ([dagger])Patient Safety Enhancement Program, Veterans Affairs Medical Center and University of Michigan Health System, Ann Arbor, Michigan (s.)Geriatric Research, Education, and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (**)Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Health Services Research and Development Center of Excellence, Ann Arbor, Michigan Article note: Address correspondence to Mary A.M. Rogers, PhD, Department of Internal Medicine, University of Michigan, 300 North Ingalls, Suite 7E07, Ann Arbor, MI 48109-0429. E-mail: maryroge@umich.edu

A study on the extent of usage of skilled care by elderly patients who have undergone coronary artery bypass grafting is presented.

Background: Estrogen exposure is a major risk factor for breast cancer. Increased estrogen responsiveness of breast epithelium may enhance this effect. We examined the relationship between breast cancer diagnosis and 1) the presence and absence of estrogen receptor expression in benign breast epithelium, 2) the level of expression and 3) its variation during the menstrual cycle, and 4) other established risk factors, e.g., age, age at menarche, parity, and family history. Methods: We measured estrogen receptor expression (as % of positive cells) by immunohistochemistry in normal breast epithelium from 376 women undergoing diagnostic or therapeutic breast surgery. Data on established risk factors were collected prior to surgery and those on menstrual cycle dates at the time of surgery. Logistic regression was used to assess risks (odds ratios [ORs]). Results: The crude OR for breast cancer in women with estrogen receptorpositive breast epithelium versus those without was 3.16 (95% confidence interval [CI] = 1.89-5.28), with an OR of 2.49 (95% CI = 1.25-4.96) for premenopausal and an OR of 3.32 (95% CI = 1.43-7.68) for postmenopausal women. The ORs remained high and statistically significant after controlling for age and other breast cancer risk factors. The level of estrogen receptor expression was higher in patients with breast cancer than in control subjects and it was related to breast cancer risk in postmenopausal women (P trend [is less than] .005). Expression declined as expected in premenopausal control subjects as the menstrual cycle progressed but rose in breast cancer patients (P trend [is less than] .015). Conclusions: The overexpression of estrogen receptors in normal breast epithelium may augment estrogen sensitivity and hence the risk of breast cancer. [J Natl Cancer Inst 1997;89:37-42]