Colorectal and anal neoplasms following liver transplantation.

OBJECTIVE: Liver transplantation (LT) is the treatment of choice for end-stage liver disease. The required immunosuppression increases the risk for developing malignancies. Some viruses play a crucial role. Data on neoplasms of the colon, rectum and anus in LT are limited. METHOD: A retrospective evaluation of the incidence and clinical course of colorectal and anal malignancies and colonic polyps in a series of 467 consecutive LTs in 402 individuals between 1998 and 2001 was performed. Standard immunosuppression included Tacrolimus, Mycophenolic acid and steroids. RESULTS: During a median follow up of 5.2 years, three colon adenocarcinomas, one EBV associated cecal posttransplant lymphoproliferative tumour and two HPV associated anal tumours were identified. Pre-LT colonoscopy was performed in 161 patients (40%), and of 153 evaluable individuals, 53 (34.9%) had polyps. Colonoscopy was performed in 186 patients (46.3%) median 14.8 (range 0.2-77.8) months post-LT and 55 (29.3%) had polyps. Post-LT adenomatous polyps were detected in 47.3% of patients with pre-LT polyps vs 6.7% of patients without pre-LT polyps (P < 0.001). Patients with alcoholic liver disease had a significantly higher rate of adenoma formation (50.0% vs 11.1%, P < 0.001). No patient died from colorectal/anal malignancy. CONCLUSION: The incidence of metachronous and new polyp formation in our study is similar to people who are not immunocompromised, but subgroups are at increased risk. Viral-associated malignancies, including post-transplant lymphoproliferative disorders and anal cancer, are important entities in the LT population suggesting that complete screening of the colon, rectum and anus including pre-LT and post-LT colonoscopy should be utilized.

A telephone needs assessment for potential high utilizers.

BACKGROUND AND OBJECTIVES: We conducted a telephone needs assessment of patients at risk for high utilization of health services to determine the type of intervention that might be most responsive to their needs. METHODS: Family practice patients who were classified as at high risk based on self-reported health-related quality of life (HRQOL), age, and gender received a structured telephone interview to ask about their health problems, difficulties with their health care, and types of help programs that might be useful to them. RESULTS: Of 867 adult patients randomly selected as eligible for the study, 352 completed the Duke Health Profile to measure HRQOL, 122 were classified at risk for high utilization, and 104 were interviewed by telephone. Patient-reported health problems were similar to provider-reported problems. High-risk patients reported difficulties receiving help from the clinic on issues of communication and logistics (43.9%), limitations of clinic facilities and services (26.3%), and financial concerns (26.3%). Of the highest risk patients, 45.8% expressed willingness to participate in help programs conducted over the telephone. CONCLUSIONS: Many high-risk patients might benefit from participation in a telephone intervention program. A future study is needed to measure the effectiveness of such a program to improve utilization of health services.

Attitudes toward smoking and family-based health promotion among rural mothers and other primary caregivers who smoke.

The family milieu provides a potential context for integrating smoking cessation and prevention activities to complement school-based efforts. In this study, surveys were mailed to caregivers of elementary school children to assess demographics, smoking characteristics and attitudes, and receptivity to and preferred format for health promotion programs. Fifty-three percent (n = 276) of 501 caregivers responded. Among smokers, most did not want their children to smoke, and they wanted to quit themselves; 91% considered it important to involve their children in their smoking cessation attempts; and 70% expressed willingness to participate in health promotion for the entire family. Written materials either mailed home or brought home from school were the preferred program formats. These findings suggest the feasibility of a program in which adults and children work together at home on smoking cessation and prevention activities that might increase the effectiveness of school-based smoking prevention messages.