The art and science of cancer education and evaluation: toward facilitating improved patient outcomes.

Cancer education is a constantly evolving field, as science continues to advance both our understanding of cancer and its effects on patients, families, and communities. Moving discoveries to practice expeditiously is paramount to impacting cancer outcomes. The continuing education of cancer care professionals throughout their practice life is vital to facilitating the adoption of therapeutic innovations. Meanwhile, more general educational programs serve to keep cancer patients, their families, and the public informed of the latest findings in cancer research. The National Cancer Institute conducted an assessment of the current knowledge base for cancer education which involved two literature reviews, one of the general literature of the evaluation of medical and health education efforts, and the other of the preceding 5 years of the Journal of Cancer Education (JCE). These reviews explored a wide range of educational models and methodologies. In general, those that were most effective used multiple methodologies, interactive techniques, and multiple exposures over time. Less than one third of the articles in the JCE reported on a cancer education or communication product, and of these, only 70% had been evaluated for effectiveness. Recommendations to improve the evaluation of cancer education and the educational focus of the JCE are provided.

The effect of occupation and industry on the injury risks from demanding work schedules.

OBJECTIVE: Employees working in nonstandard shifts and long-hour schedules have an increased risk for job-related injuries and illnesses. This study estimates the extent of that risk among various occupations and industries. METHODS: Longitudinal data for 13 years among a sample of nearly 11,000 employees aged 22 to 43 was used to calculate the risk of injury by occupation and industry for six types of demanding work schedules. Cox proportional hazard regression analyses were used to estimate risks within specific occupational and industrial classifications. RESULTS: The greatest risks of job-related injury were among 1) construction workers in evening shifts, 2) professional, technical, and managerial personnel working overtime schedules, and 3) employees working overtime shifts in the business and repair services sectors. CONCLUSIONS: Injury prevention efforts should be targeted toward employees in specific industries and occupations who work certain long-hour and shift work schedules.

Associations between employees' work schedules and the vocational consequences of workplace injuries.

INTRODUCTION: This study examines the effect of long-hour work schedules and nonstandard shift work (e.g., night and evening shifts) on the ability of injured workers to maintain productive employment following a workplace injury. METHODS: Analyses were based on 13 years of data from the National Longitudinal Survey of Youth. Multivariate logistic regression analyses were performed with one of ten nonstandard schedules as the independent variable and a particular vocational consequences as the dependent variable. Vocational consequences included being unable to perform normal job duties, temporary job reassignment, working less than full time, filing a workers' compensation claim, and quitting or being fired because of the injury. Covariates in the regression model included age, gender, occupation, industry, and region. RESULTS: The most prominent effects of working a nonstandard schedule were a increased risk of being fired (OR = 1.81; 1.15-2.90 CI 95%), quitting (OR = 1.68; 1.20-2.36 CI 95%), or being unable to work full time (OR = 1.33; 1.08-1.64 CI 95%) following an injury, compared to injured workers in conventional schedules. Schedules involving overtime and long working hours generally had a greater impact on vocational consequences following a workplace injury than did schedules involving night, evening, and other nonstandard shift work. CONCLUSIONS: Occupational rehabilitation professionals need to consider the specific type of work schedule when developing effective return-to-work plans for injured workers. Special precautions need to be taken for workers returning to schedules that involve more than 12 h per day, 60 h per week, and long commutes.

Nonstandard shift schedules and the risk of job-related injuries.

OBJECTIVES: This study assessed the extent to which working various types of nonstandard shift schedules (eg, night and evening shifts) is associated with the risk of occupational injuries or illnesses. METHODS: Multivariate analyses were conducted using data from 13 years (1987 to 2000) of the National Longitudinal Survey of Youth (NLSY) encompassing 110 236 job records and over 82 000 person-years of work experience. Cox proportional hazard regression techniques were used to derive hazard ratios comparing the relative risk of suffering a work-related injury among people working night, evening, rotating, split, and irregular shifts to the risks for those working conventional day shifts, after adjustment for age, gender, occupation, industry, and region. Incidence rates were normalized using a common denominator of 100 person-years of "at-risk time" to obtain valid comparisons. RESULTS: All of the nonstandard shift schedules, except split shifts, were found to have a higher risk for occupational injuries and illnesses than conventional day shifts. After control for the selected covariates, the calculated hazard ratios were 1.43 for evening shifts [95% confidence interval (95% CI) 1.26-1.62], 1.36 for rotating shifts (95% CI 1.17-1.58), 1.30 for night shifts (95% CI 1.12-1.52), 1.15 for irregular shifts (1.03-1.30), and 1.06 for split shifts (0.71-1.58). CONCLUSIONS: These findings suggest that nonstandard shifts are not more risky merely because of the concentration of hazardous jobs in those types of schedules or because of underlying differences in the characteristics of employees working nonstandard shifts. The results point to the need to extend targeted injury prevention programs not only to people working night shifts, but also to those who work evenings.

Predictors of work-related injuries and illnesses: national survey findings.

This study used national survey data of working adults (aged 33-41) to identify factors associated with the occurrence of occupational injuries and illnesses. Data from the National Longitudinal Survey of Youth were used to compare selected employment and personal characteristics for respondents who reported experiencing a work-related injury or illness with those who did not. Multivariate analyses were performed to calculate nationally representative odds ratios reflecting the likelihood for specific individual attributes and job characteristics to be associated with the reporting of a work-related injury or illness, while controlling for relevant covariates. In this study the incidence of occupational injuries was related to several demographic factors, including low family income and rural residence, and several job characteristics, including working in a high-hazard occupation, job dissatisfaction, and exposure to six specific hazardous job activities: (1) performing lots of physical effort on the job, (2) lifting or carrying more than 10 lbs, (3) using stairs and inclines, (4) kneeling or crouching, (5) reaching, and (6) hearing special sounds. These results suggest targeted prevention strategies for decreasing the incidence of work-related injuries and illnesses, such as worker self-assessment of the total physical effort demanded by a job and periodic monitoring of workforce job satisfaction.

Validity and reproducibility of a physical activity questionnaire in women.

PURPOSE: To determine the validity and reproducibility of a self-administered physical activity questionnaire that assesses the frequency, intensity, and duration of recreational, household, and occupational activity in women. METHODS: The questionnaire was administered by mail twice to 131 participants 1 yr apart. During this interval, participants completed four 1-wk activity logs corresponding to different seasons throughout the year. RESULTS: The intraclass correlation coefficients used to measure reproducibility were 0.82 for total activity, 0.79 for moderate activity, 0.86 for vigorous activity, 0.80 for recreational activity, and 0.73 for household activity. The distribution of activity scores was similar between the questionnaires and the average of the four logs, indicating the participants' ability to incorporate seasonal variation into their recall on a questionnaire. The correlations between the questionnaire-based activity scores and log-based activity scores, indicating validity, were 0.26 for total activity, 0.15 for moderate activity, and 0.52 for vigorous activity. Women younger than age 50 tended to have higher validity scores than women aged 50 yr and older (r = 0.31 vs r = 0.19, respectively, for total activity). CONCLUSION: These data indicate that this physical activity questionnaire is reproducible and provides a useful measure of current activity, particularly vigorous activity, over a 1-yr period.

Reproducibility of a self-administered lifetime physical activity questionnaire among female college alumnae.

Recent epidemiologic evidence suggests that lifetime physical activity is an important factor in the development of many chronic diseases. The authors assessed the reproducibility of a self-administered physical activity questionnaire designed to assess the duration, frequency, and intensity of lifetime household and recreational activities. The study was conducted among 134 female college alumnae from two colleges in western Massachusetts who were aged 39-65 years in 1998. A modified version of the Historical Leisure Activity Questionnaire was used to assess physical activity over four prior age periods (menarche to 21 years and 22-34, 35-50, and 51-65 years). The questionnaire was administered to participants by mail twice 1 year apart. The intraclass correlation coefficients used to measure reproducibility were 0.82 for total lifetime physical activity, 0.80 for lifetime moderate-intensity activities, 0.86 for lifetime vigorous-intensity activities, 0.87 for lifetime recreational activities, and 0.78 for lifetime household activities. Correlations were 0.73 for total activity during the earliest prior age period (menarche to 21 years), 0.70 for ages 22-34 years, 0.78 for ages 35-50 years, and 0.83 for ages 51-65 years. These data indicate that this physical activity questionnaire is reproducible and provides a useful measure of average lifetime activity.