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PubMed2026

Evaluating A Patient-Led Health Literacy Program for People Living With Metastatic Breast Cancer.

IntroductionLow cancer health literacy undermines patients' ability to interpret complex information and participate in shared decision making, and is associated with worse outcomes. Evidence for effective health literacy interventions in metastatic breast cancer (MBC) remains limited. We evaluated a patient-led, virtual health literacy program designed to strengthen MBC-specific knowledge and self-efficacy.MethodsWe conducted a mixed-methods, pre-post evaluation across two program iterations (Fall 2023; Spring 2024) delivered by a national, patient-led-MBC organization, Project Life. The five-week synchronous course called Spinning Science covered breast cancer subtyping, genetic/genomic testing, clinical trials, circulating tumor DNA, and information literacy, with small-group activities and polling. Program participants were adults living with MBC. De-identified pre/post surveys assessed (1) self-efficacy for engaging in health decisions, and (2) knowledge using items adapted from the Cancer Health Literacy Test aligned to course content. Paired two-sample t-tests examined pre-post changes (α=0.05). Open-ended responses were analyzed thematically.ResultsFifty-four people with MBC were enrolled (cohort 1, n=17; cohort 2, n=37); 46 provided matched pre- and post-surveys (14 and 32, respectively). Agreement with "I don't know enough to make my own medical decisions" declined from 43% pre to 13% post (p<0.05), indicating improved self-efficacy. Baseline knowledge scores were high, and knowledge item gains were not statistically significant, consistent with ceiling effects. Post-program items showed >80% agreement for increased confidence in self-advocacy, improved health literacy, and sense of community. Qualitative feedback highlighted strengths like digestible content, approachable patient facilitators and flexible scheduling, as well as priorities for refinement such as continued access to materials, and more MBC-specific and numeracy content.ConclusionsA patient-developed, virtual health literacy program for people living with MBC showed meaningful improvements in self-efficacy, with actionable, participant-driven refinements between cohorts. This model offers a practical, scalable pathway for advancing self-efficacy within and beyond MBC.

Humans↗

PubMed2005

The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.

BACKGROUND: Randomized clinical trials have not yet demonstrated the mortality benefit of smoking cessation. OBJECTIVE: To assess the long-term effect on mortality of a randomly applied smoking cessation program. DESIGN: The Lung Health Study was a randomized clinical trial of smoking cessation. Special intervention participants received the smoking intervention program and were compared with usual care participants. Vital status was followed up to 14.5 years. SETTING: 10 clinical centers in the United States and Canada. PATIENTS: 5887 middle-aged volunteers with asymptomatic airway obstruction. MEASUREMENTS: All-cause mortality and mortality due to cardiovascular disease, lung cancer, and other respiratory disease. INTERVENTION: The intervention was a 10-week smoking cessation program that included a strong physician message and 12 group sessions using behavior modification and nicotine gum, plus either ipratropium or a placebo inhaler. RESULTS: At 5 years, 21.7% of special intervention participants had stopped smoking since study entry compared with 5.4% of usual care participants. After up to 14.5 years of follow-up, 731 patients died: 33% of lung cancer, 22% of cardiovascular disease, 7.8% of respiratory disease other than cancer, and 2.3% of unknown causes. All-cause mortality was significantly lower in the special intervention group than in the usual care group (8.83 per 1000 person-years vs. 10.38 per 1000 person-years; P = 0.03). The hazard ratio for mortality in the usual care group compared with the special intervention group was 1.18 (95% CI, 1.02 to 1.37). Differences in death rates for both lung cancer and cardiovascular disease were greater when death rates were analyzed by smoking habit. LIMITATIONS: Results apply only to individuals with airway obstruction. CONCLUSION: Smoking cessation intervention programs can have a substantial effect on subsequent mortality, even when successful in a minority of participants.

Behavior Therapy↗

PubMed2000

Sources of health insurance and characteristics of the uninsured: analysis of the March 2000 Current Population Survey.

This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the characteristics most closely related to an individual's health insurance status. Based on EBRI estimates from the March 2000 Current Population Survey (CPS), it represents 1999 data--the most recent available. In 1999, for the first time since at least 1987, the percentage of Americans with health insurance increased: 82.5 percent of nonelderly Americans (under age 65) were covered by some form of health insurance, up from 81.6 percent in 1998. The percentage of nonelderly Americans without health insurance coverage declined from 18.4 percent in 1998 to 17.5 percent in 1999. The main reason for the decline in the number of uninsured Americans is the strong economy and low unemployment. Between 1998 and 1999, the percentage of nonelderly Americans covered by employment-based health insurance increased from 64.9 percent to 65.8 percent, continuing a longer-term trend that started between 1993 and 1994. In 1999, 34.1 million Americans received health insurance from public programs, and an additional 15.8 million purchased it directly from an insurer. Twenty-five million Americans participated in the Medicaid program, and 6.5 million received their health insurance through the Tricare and CHAMPVA programs and other government programs designed to provide coverage for retired military members and their families. Despite expansions in the State Children's Health Insurance Program (S-CHIP), public health insurance coverage did not increase overall between 1998 and 1999. The percentage of nonelderly Americans covered by Medicaid and other government-sponsored health insurance coverage did not change between 1998 and 1999, though some children benefited from expansions in government-funded programs. The percentage of children in families just above the poverty level without health insurance coverage declined dramatically, from 27.2 percent uninsured in 1998 to 19.7 percent uninsured in 1999. Some of the decline can be attributed to expansions in Medicaid and S-CHIP, but it appears that expansions in employment-based health insurance and individually purchased coverage had an even larger effect than expansion of S-CHIP. Even though the number and percentage of uninsured declined substantially between 1998 and 1999, more than 42 million Americans remain uninsured. As long as the economy is strong and unemployment is low, employment-based health insurance coverage will expand and the uninsured will decline gradually. If the economy continues to soften or comes close to a recession, the number of uninsured would easily and quickly start to increase again as unemployment rises. Should a severe downturn in the economy occur, causing the uninsured to represent 25 percent of the nonelderly population, 63 million Americans would be uninsured.

Adolescent↗

PubMed1976

Life style and nutrient intake in the elderly.

The life styles of the elderly population under study indicate that they had positive attitudes toward health in general and toward food and eating, Their food habits and beliefs were free from faddism, they were willing to try new foods and to change at least some of their food habits, and they had a good appetite for meals. Meal patterns and choice of foods, snacks, and food likes were toward foods of high nutritive value. They had comparatively few food dislikes, and the majority ate three meals a day. Many of the participants in this study had nutrient intakes of less than two-thirds the 1974 RDA'S. Food choices, meal patterns, and beliefs about food suggest that economic factors strongly influenced dietary adequacy and limited the food choices and size of servings. Black females appear to be the most disadvantaged group. All of these findings are a strong indicator of the need for group feeding programs for the elderly. Such meal programs should provide at least one-third of the daily nutrient needs, and should be pleasurable experiences using foods appropriate to the food habits and beliefs of the specific groups, their locale, and their cultural-economic backgrounds. These programs should also be accompanied by realistic nutrition education programs designed to provide guidance in buying and using foods of highest nutritive value within their resources. The need for such programs becomes increasingly urgent because of today's rapidly increasing food prices.

Black or African American↗

PubMedDate not supplied

Characteristics of critical care nursing internship programs.

Development of programs to prepare new graduate nurses to work in critical care units has been a priority for nurse educators for many years. Despite the presence of many such internship programs, little data are available about the characteristics of such programs. Results of this study suggest that the development of internship programs designed to prepare new graduate nurses in critical care nursing continues to be a priority. The standards used by these programs are individualized and are often reflective of the unique needs of the institution. Costs of these programs are quite high. Recommendations for future directions based upon the results of the study are offered.

Clinical Clerkship↗

PubMed1989

The nurse's role in cancer rehabilitation. Review of the literature.

Rehabilitative nursing is an integral part of all phases of patient-centered care. The role of the nurse in addressing rehabilitation issues for cancer patients is one of teaching, counseling, and coordination. Nurses have made significant contributions to educational programs available to cancer patients and their families. The program structure, content, and setting are as varied as the potential patient. Site-specific support programs, as well as programs that identify and support positive coping behaviors, have been developed by nurses. In their efforts to maximize resource allocation in a variety of settings, nurses have developed roles and programs that promote the process of rehabilitation. This review of nursing literature provides a source for nurses wishing to continue designing programs that enhance rehabilitation.

Adaptation, Psychological↗

PubMed1987

Care givers in the workplace: employer support for employees with elderly and chronically disabled dependents.

With increasing demands for dependent care, and more women in the work force, employees may be required to balance work and care giving responsibilities. The New York Business Group on Health survey examines the role of business and industry concerning this issue: employer awareness about problems of employees responsible for the care of elderly or chronically disabled dependent family members, and company programs and policies to deal with employee care giver problems. Findings from this exploratory study of 69 companies in the greater New York area indicate that approximately half are aware of care giver needs, and many have identified employee problems in the workplace (lateness, absenteeism, etc). Few have programs designed specifically for care givers. However, larger companies and those with a predominantly female work force have more policies and programs that can accommodate care giver needs. Various strategies currently being tried by companies to support care givers are described.

Aged↗

PubMed1985

Control of Isospora suis-induced coccidiosis on a swine farm.

Results of a program designed to control neonatal porcine coccidiosis on a total confinement, farrow-to-finish swine farm are reported. The control program consisted of washing, phenol disinfection, and steam cleaning of farrowing houses and treatment of sows with amprolium HCl before and after farrowing. Before initiation of the control program, 88.9% of the sows examined in the farrowing house were negative for coccidian oocysts, 9.9% were positive for Eimeria spp, and 1.2% were positive for Isospora suis. Most pigs nursing on sows before initiation of the control program had diarrhea at 5 to 10 days of age, which led to dehydration and weight loss. Morbidity was high, and mortality was moderate. Composite fecal samples from these litters were all positive (100%) for I suis. After initiation of the control program, 99.6% of the sows examined in the farrowing house were negative for coccidian oocysts and 0.4% were positive for Eimeria spp. Clinical signs of coccidiosis were rarely present in nursing pigs examined after the control program was initiated; however, I suis was still present in 19.8% of the composite fecal samples from pigs examined. An association between oocyst production in sows and I suis infections in pigs was not found in the present study. Oocysts of Eimeria spp were not found in the feces from the pigs.

Amprolium↗

PubMed1979

Aminoglycoside serum assays restricted through a pharmacy program.

A pharmacy program designed to reduce the inappropriate use of aminoglycoside serum assays is described, and the results of an evaluation of the program are reported. If the clinical status of the patient for whom an assay is ordered does not correspond to the indications for the test, a pharmacist calculates predicted aminoglycoside serum levels based on renal function and discourages the physician from having the test performed. If the indications for a test are met, the pharmacist checks for potential interactions. He specifies the exact times serum samples are to be collected, and he prepares a pharmacokinetic report for the physician based on the test results. During the 18-month evaluation, 67 tests were ordered for 53 patients. Three tests were not performed based on pharmacist advice. Five tests could not be evaluated. Of the remaining 59 tests, 56 (95% were used appropriately; 54 of the appropriate decisions made (92%) were a result of the physician following the recommendations of the pharmacist. The program appears to prevent problems that occur when aminoglycoside serum assays are not restricted.

Aminoglycosides↗

PubMed1983

[Computer bank of amino acid sequences of protein hormones. Comparative analysis of the sequences in pro-opio-melanocortin, proenkephalin and prodynorphin: detection of phorphin--the 4th repeating peptide in prodynorphin].

Using a BESM-6 computer, a computer system for accumulation and comparative analysis of amino acid sequences (AS) of protein-peptide hormones and their precursors (the so-called computer bank of protein hormone AS) was developed. A Fortran-based program designed for construction of correspondence schemes of AS and their local similarity profiles was elaborated. In combination with the previous programs this system allows a rapid inclusion of the newly deciphered sequences into the corresponding homologous groups, thus complementing the correspondence scheme and specifying the evolution profiles. A comparative analysis of AS in proopiomelanocortin (POMC), proenkephalin (PENK) and prodynorphin (PDIN) revealed evolutionary-conservative and variable sites. The conservative sites of AS are active centers of the hormones. The leu-enkephalin analog, phorphin, the fourth repeating peptide of this precursor, was detected in prodynorphin, which, similar to beta-neo-endorphin, dynorphin and rimorphin may possess a biological activity. The similarity of the effector sites of the melanotropin sequence from POMC to the met-enkephalin sequence from PENK and leu-enkephalin sequence from PDIN as well as to gastrin and cholecystokinin was established. This may suggest that the hormone-receptor complexes in target organs of these hormones are also similar.

Amino Acid Sequence↗

PubMed1994

GREEN: a program package for docking studies in rational drug design.

A program package, GREEN, has been developed that enables docking studies between ligand molecules and a protein molecule. Based on the structure of the protein molecule, the physical and chemical environment of the ligand-binding site is expressed as three-dimensional grid-point data. The grid-point data are used for the real-time evaluation of the protein-ligand interaction energy, as well as for the graphical representation of the binding-site environment. The interactive docking operation is facilitated by various built-in functions, such as energy minimization, energy contribution analysis and logging of the manipulation trajectory. Interactive modeling functions are incorporated for designing new ligand molecules while considering the binding-site environment and the protein-ligand interaction. As an example of the application of GREEN, a docking study is presented on the complex between trypsin and a synthetic trypsin inhibitor. The program package will be useful for rational drug design, based on the 3D structure of the target protein.

Algorithms↗

PubMed1994

Implementing the Put Prevention into Practice program.

Put Prevention into Practice (PPIP) is a national program designed to improve the delivery of preventive care to patients by all primary care clinicians. It covers the full range of clinical preventive services, including immunizations, screening tests, chemoprophylaxis, and counseling interventions. The materials that comprise this program involve patients, office/clinic systems and staff, and clinicians, including nurse practitioners. The need for preventive care, the barriers to be overcome, the PPIP program, and a strategy for its implementation are delineated. Principles for successful implementation include: high level administrative support, ownership by all the players in the implementation process, a person designated to manage implementation, and an ongoing evaluation/auditing process that provides feedback to clinicians and others participating in the program.

Adult↗

PubMed2000

Improving patient outcomes by pooling resources (the Texas Heart Care Partnership experience).

The morbidity and mortality associated with cardiovascular disease presents an enormous humanistic and economic burden in the United States. In Texas, cardiovascular disease has been the leading cause of death since 1950. Risk-factor modification has been targeted in the secondary prevention of cardiovascular disease, including lipid management, smoking cessation, improved control of blood pressure, physical activity, weight management, the use of antiplatelet agents/anticoagulants, angiotensin-converting enzyme (ACE) inhibitors in congestive heart failure, beta blockers after myocardial infarction, and estrogen replacement therapy. The Heart Care Partnership (HCP) is a multifaceted interactive program designed to improve risk-factor management in the secondary prevention of cardiovascular disease through physician education, participation, and consensus development in addition to practice improvement processes and patient education. Development and implementation of the Texas HCP was a joint effort of the Texas Medical Association, the Texas Affiliate of the American Heart Association, and Merck & Co. This program helps hospitals improve the quality of care and outcomes for patients with heart disease. Program resources include educational workshops, quality improvement processes, and patient educational materials. HCP workshops address the treatment gap, define optimal care, and help define institution-specific plans for treating heart disease. Quality-improvement processes provide hospitals with baseline data and tools to improve and measure outcomes over time. The HCP workshops are provided as a combination of lectures, interactive discussions, and small group planning sessions designed to encourage audience participation. Upon completing the HCP program, participants are able to (1) describe the evidence-based medicine supporting secondary prevention of cardiovascular disease; (2) identify and prioritize cardiovascular disease risk factors for secondary prevention; (3) identify barriers to and solutions for implementing secondary prevention; and (4) develop site-based plans for cardiovascular risk-factor modification with definite time lines for implementation ("care maps"). The HCP's initial audit of medical practices indicates that Texas appears to share the same deficiencies in the secondary prevention of cardiovascular disease as the rest of the country. However, improvements can be demonstrated in both the hospital and physician office settings through the HCP. The HCP facilitated the cooperation of the medical community in the state of Texas to work together in a synchronized, communicative manner to decrease coronary events. This partnership represents a watershed event in the history of Texas medicine. It is the first time that such a statewide team approach to address a public health issue has been initiated. In the past, medical organizations within the state have had disparate goals and multiple strategies for achieving them.

Cardiology↗

PubMed2004

Human exposure monitoring and evaluation in the Arctic: the importance of understanding exposures to the development of public health policy.

Arctic indigenous peoples face significant challenges resulting from the contamination of Arctic air, water, and soil by persistent organic pollutants, heavy metals, and radionuclides. International cooperative efforts among governments and research institutions are under way to collect the information needed by environmental health scientists and public health officials to address environmental contamination in the Arctic. However, the climatic, political, and cultural conditions of the land and its native populations combine to present a unique set of scientific and logistic challenges to addressing this important public health issue. Public health officials have the responsibility to respect the cultural traditions of indigenous communities, while simultaneously designing strategies that will reduce their exposure to environmental contaminants and rates of disease and dysfunction. Researchers can better understand the link between environmental exposures and disease through monitoring programs for both the subsistence diets and health status of the indigenous populations. We suggest that the incorporation of community-based participatory research methods into programs designed to assess biomarkers of contaminant exposure in children and adults may be a valuable addition to ongoing and newly developed research programs. This approach could serve as a model for international environmental health initiatives, because it involves the participation of the local communities and seeks to builds trust between all stakeholders.

Adult↗

PubMed2005

Interventions to enhance adaptation to bereavement.

This paper reviews quantitative evaluations of the efficacy of intervention programs designed to reduce the pain and suffering associated with bereavement. After identifying the psychological and physical health impacts of bereavement and outlining the prevalence of detrimental outcomes, we conclude that a minority of bereaved persons experience severe and sometimes lasting consequences, whereas the majority manage to overcome their grief across the course of time. We detail criteria for establishing the efficacy of bereavement intervention and examine the impact of intervention according to these stringent criteria. We critically examine previous reviews and summarize their conclusions. Using a narrative review approach, we apply a public health framework to organize intervention programs into primary, secondary, and tertiary prevention strategies. A comprehensive, updated review of empirical studies in these categories leads to the following conclusions: Routine intervention for bereavement has not received support from quantitative evaluations of its effectiveness and is therefore not empirically based. Outreach strategies are not advised, and even provision of intervention for those who believe that they need it and who request it should be carefully evaluated. Intervention soon after bereavement may interfere with "natural" grieving processes. Intervention is more effective for those with more complicated forms of grief. Finally, a research agenda is outlined that includes the use of rigorous design and methodological principles in both intervention programs themselves and in studies evaluating their efficacy; systematic investigation of "risk factors"; and comparison of relative effectiveness of different intervention programs (i.e., what works for whom).

Adaptation, Psychological↗

PubMed1988

A computerized approach to discipline-specific bibliographies in the allied health sciences.

The traditional subject headings in Index Medicus and other standard indexes have frequently proved too broad for researchers in the allied health sciences. Therefore, the Physician Assistant Program at the University of Florida has developed a computerized bibliography program designed to expedite research by using a selected list of keywords as subject headings and subheadings tailored to the interests and concerns of the physician assistant profession. Each subject heading and subheading is translated into a numerical coding system that permits efficient data entry and rapid identification of items in the professional literature as well as reducing the incidence of operator error in data entry. The program can be used for review of the literature, curriculum design, identification of supplementary reading material for education courses, and identification of appropriate resources to enhance the study of the physician assistant profession. Through the development of discipline-specific keywords, the program can be tailored to the educational and research interests of any discipline in the allied health sciences or other educational fields.

Abstracting and Indexing↗

PubMed1998

Redesigning metabolic networks using mathematical programming

The design of new generation bioprocessing plants is increasingly dependent on the design of process-compatible microorganisms. The latter, whether through genetic or physiological manipulations, can be greatly assisted by metabolic engineering. An emerging powerful tool in metabolic engineering research is computer-assisted cell design using mathematical programming. In this work, the problem of optimizing cellular metabolic networks has been formulated as a Mixed Integer Nonlinear Programming (MINLP) model. The model can assist genetic engineers to identify which cellular enzymes should be modified, and the new levels of activity required to produce an optimal network. Results are presented from the tricarboxylic acid cycle in Dictyostelium discoideum. Copyright 1998 John Wiley & Sons, Inc.

Journal Article↗

PubMedDate not supplied

A multidisciplinary approach to chronic pain.

Chronic pain often is frustrating to nurses and patients, since many times it has not been responsive to traditional medical approaches. The purpose of this article is to discuss the chronic pain syndrome and the role of nursing within a multidisciplinary chronic pain rehabilitation program designed to return the patient to a functional lifestyle. The purpose and rationale for each treatment modality within the pain management program is described, although the treatment plans are individualized for every patient. Nurses play a crucial role, because they are the only professionals who are constantly available to the patient. Nurses collect data and continually assess the patient to develop comprehensive nursing care plans. In this intensive educational program, nurses also assist in teaching the patient positive health practices to control the pain. Further evaluations of these chronic pain rehabilitation programs are needed.

Analgesia↗