Challenges of hepatitis C treatment in Native Americans in two North Dakota medical facilities.

INTRODUCTION: The prevalence of chronic liver disease (CLD) in the Aboriginal North American population is disproportionately higher than that of the non-indigenous population. Hepatitis C virus (HCV) is the second leading cause of CLD in American Indians or Alaska Natives (AIANs). This study described the experience of two teaching community medical centers in North Dakota in treating HCV infection among AIANs and compared treatment outcomes to a cohort of Caucasian patients. METHODS: The retrospective study described the characteristics and proportion of AIAN patients with HCV who received treatment. Documented reasons for not receiving treatment were analyzed. For those AIAN patients treated for HCV infection, responses to treatment, including rapid, early and sustained virological responses (SVRs), were compared with those of Caucasians. RESULTS: Only 22 (18%) of 124 AIANs with HCV infection received treatment. Common reasons for not receiving treatment include lack of access to specialists, concomitant or decompensated liver disease, alcohol and drug abuse and cost. There were no significant differences in the baseline characteristics and key predictors of SVR in AIANs compared to Caucasian controls. CONCLUSIONS: Most AIAN patients with HCV infection do not receive treatment despite comparable treatment response rates to Caucasians. Further population-based studies, addressing access to specialized hepatitis C treatment and public health concerns are warranted, as it is crucial to treat chronic HCV infection to decrease the burden of disease in the AIAN community.

Statins use and risk for brain metastasis from lung cancer.

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.

Obesity increases the likelihood of total joint replacement surgery among younger adults.

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/m(2)) 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/m(2)) 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.

Estimating the proportion of community-associated methicillin-resistant Staphylococcus aureus: two definitions used in the USA yield dramatically different estimates.

The objective of this retrospective study was to compare the prevalence of community-associated methicillin-resistant Staphylococcus aureus (CAMRSA) and healthcare-associated MRSA (HAMRSA) using healthcare risk factor exposure criteria with that obtained using Centers for Disease Control and Prevention (CDC) criteria. Cases were defined as CAMRSA or HAMRSA based on the general CDC guidelines for nosocomial infections, and then re-assessed with healthcare risk factor exposure criteria using a medical chart review. One hundred MRSA cases occurred at a mid-Western veterans affairs medical centre from November 2001 to November 2003. The proportion of these cases classified as CAMRSA differed dramatically when classified by healthcare risk factor exposure criteria (5%) compared with CDC nosocomial infection criteria (49%). Estimating the role of healthcare-related exposures and developing strategies to control MRSA can be markedly affected by the criteria used to determine CAMRSA and HAMRSA.

International variation in pancreatic cancer mortality for the period 1955-1998.

BACKGROUND: Pancreatic cancer is an important cause of cancer mortality in developed countries. This article examines time trends for pancreatic cancer mortality rates in 38 countries on five continents between 1955 and 1998. METHODS: We used the World Health Organization database on Age-Standardized World Population pancreatic cancer mortality rates by gender and fitted these data with linear regression models. This allowed us to (1) investigate the statistical significance of temporal trends; and (2) consider differences in trends among countries; and (3) predict future pancreatic cancer mortality rates. RESULTS: Over 44 years, pancreatic cancer mortality rates increased for females worldwide. Pancreatic cancer mortality rates for men increased in Southern Europe. In contrast, pancreatic cancer mortality rates for men in North America and Oceania increased until about 1975 and then decreased or remained stable. Our predictive models suggest that by 2005 the relative burden of pancreatic cancer mortality will have shifted away from Northern Europe and North America toward Southern Europe and Asia. CONCLUSIONS: Future research on pancreatic cancer should concentrate separately on the assessment of risk attributable to exposure to environmental factors, lifestyle factors, genetic determinates of pancreatic cancer, and the interactive influences of these factors on pancreatic cancer.