<p> Colorectal cancer is one of the most common cancers in the United States and confronting its challenges has remained a problem to the United States health sector, especially among outpatient clinics. Guided by health belief model, the purpose of this needs assessment was to identify patients age 50 and older in outpatient clinic located in a large metropolitan city in Texas who should receive information on the need for colorectal cancer screening based on their risk for developing colorectal cancer as outlined by American Cancer Society. A sample of 70 charts of patients age 50-75 years was randomly selected and audited using descriptive statistics. Among the patients aged 50-75 years attending the outpatient clinic, 25.7% were African Americans, 71.4% were Hispanic, and 2.9% were Caucasians; 42.9% were male and 57.1% were female. The rate of colorectal cancer screening was 12.9%, a rate that is lower than the rate for all Texans, which was 54.1% - 59.2%. CRC screening was ordered for 62.9% of all patients; 24.2% of clinic patients were identified as being at high risk for colorectal cancer. The low rate of screening may hamper early detection of colorectal cancer in outpatient clinics setting. It is recommended that the outpatient clinic develop intensive campaign to increase patient awareness about the need for and benefits of colorectal cancer screening, especially for those at high risk for developing colorectal cancer. The findings of this study may raise awareness on the chasm in quality of health care availability and provide insight on colorectal cancer and its prevention.</p>

<p> Prostate cancer is stimulated to grow in response to testosterone. Androgen deprivation therapy (ADT) leads to chemical castration and suppression of prostate cancer cell production. Testosterone levels less then 300ng/ml decreases bone mineral density and could result in osteoporosis. Studies have shown that during the first year of ADT, fracture risk, mainly in hips and spine increases about 50%. In men, 40% of hip fractures result in death. Exercise may reduce the risk of osteoporosis and thus contribute to the prevention of hip and other fractures. There is limited data regarding whether exercise is associated with a reduced risk of osteoporosis in men treated with ADT. </p><p> Purpose of this study was to evaluate the relationship between self-reported exercise and bone mineral density measured by dual-energy x-ray absorptiometry (DEXA) and 25 hydroxy vitamin D levels in prostate cancer patients receiving ADT. </p><p> A convenience sample of 96 men with prostate cancer treated with ADT for a minimum of nine months or longer and up to the time of inclusion in the study completed the Canadian Fitness Survey questionnaire to assess the amount and types of exercise performed. In addition, questions from a section of the NHANES survey about cigarette and alcohol use, history of non traumatic fracture, diseases causing fracture, and use of medication including calcium supplementation were asked. A serum vitamin D level and DEXA scan were completed within a specified time period based on length of time receiving ADT. Subjects were recruited from eight urology practices and one cancer center in Clark County, Nevada. </p><p> The relationships between total duration of exercise, intensity, frequency, bone density T-scores, and serum vitamin D were examined using correlation analysis, as was the relationship between specific types of exercise, measured the same way and bone density T-scores. Furthermore, regression analysis was used to examine for potential confounders. Confounders identified for this study include age, body mass index, cigarette smoking, alcohol use, history of non-traumatic fracture or disease causing fracture, and use of medication, including calcium supplementation. Regression analysis was conducted to determine if there was an independent association between exercise and bone mineral density and serum vitamin D. This study provides evidence associating exercise with reduced risk of osteoporosis in patients receiving ADT. </p><p> The second study looked at determinants of 25 OH vitamin D. We found that the only independent modifiable determinant was vitamin D supplementation of &ge;800 IU/day. Avoiding osteoporosis by increasing exercise in this group of patients is a practical measure that preventive care specialists could institute.</p>

Leiomyomata uteri, also know as uterine fibroids, are the most common tumors of the female reproductive tract. Although the majority of leiomyomata are asymptomatic, more than 30% of affected women suffer from one or more symptoms including abnormal uterine bleeding, anemia, pelvic pain, pelvic pressure, urinary problems and infertility. Our objective was to identify patient-, physician- and hospital-related factors that are associated with patterns of care for this condition. Two approaches were used to identify determinants of treatment among women with a primary diagnosis of leiomyoma. First, we used administrative data from the Massachusetts Health Data Consortium to identify determinants of hysterectomy in Massachusetts women over a two year period. Second, we conducted a chart review study of leiomyoma patients at Baystate Medical Center in Springfield, Massachusetts to identify determinants of treatment pattern during the same time period. Both sets of analyses identified factors associated with treatment decision. In the analysis of the Massachusetts Health Data Consortium data, significant determinants of hysterectomy included older age, White or Hispanic race, hospital location outside of Boston and hospital lacking specialized OB/GYN services. In the analysis using hospital records, we found that younger age; Black race, insurance through an HMO, more recent physician graduation, and nulliparity were significantly associated with a conservative treatment approach. Presence of symptoms including heavy bleeding and urinary problems were significantly associated with receiving no conservative treatment prior to hysterectomy. This pair of studies has clearly shown that a variety of clinical, patient, hospital and physician characteristics are important determinants of treatment in women with a primary diagnosis of leiomyoma. Future research should focus on examining the interrelationships of these various factors in determining patterns of care for various sub-sets of patients diagnosed with leiomyomata. New research efforts should be centered in large physician practice groups where longitudinal studies of patients can be used to assess the extent to which physician and patient attitudes and behaviors influence the decision making process with regard to this condition.