This article is the second of a two-part series reporting on a population-based study intended to use an eHealth system to examine the feasibility of reaching underserved women with breast cancer (Gustafson, McTavish et al., Reducing the digital divide for low-income women with breast cancer, 2004; Madison Center for Health Systems Research and Analysis, University of Wisconsin; Comprehensive Health Enhancement Support System [CHESS]) and determine how they use the system and what impact it had on them. Participants included women recently diagnosed with breast cancer whose income was at or below 250% of poverty level and were living in rural Wisconsin (n = 144; all Caucasian) or Detroit (n = 85; all African American). Because this was a population-based study all 229 participants received CHESS. A comparison group of patients (n = 51) with similar demographics was drawn from a separate recently completed randomized clinical trial. Use rates (e.g., frequency and length of use as well as type of use) as well as impact on several dimensions of quality of life and participation in health care are reported. Low-income subjects in this study logged on and spent more time on CHESS than more affluent women in a previous study. Urban African Americans used information and analysis services more and communication services less than rural Caucasians. When all low-income women from this study are combined and compared with a low-income control group from another study, the CHESS group was superior to that control group in 4 of 8 outcome variables at both statistically and practically significant levels (social support, negative emotions, participation in health care, and information competence). When African Americans and Caucasians are separated the control group's sample size becomes 30 and 21 thus reducing power. Statistical significance is retained, however, in all four outcomes for Caucasians and in two of four for African Americans. Practical significance is retained for all four outcomes. We conclude that an eHealth system like CHESS will be used extensively and have a positive impact on low-income women with breast cancer.

To compare the benefits of the Internet generally versus a focused system of services, 257 breast cancer patients were randomly assigned to a control group, access to the Internet with links to high-quality breast cancer sites, or access to an eHealth system (Comprehensive Health Enhancement Support System, CHESS) that integrated information, support, and decision and analysis tools. The intervention lasted 5 months, and self-report data on quality of life, health-care competence, and social support were collected at pretest and at 2-, 4-, and 9-month posttests. CHESS subjects logged on more overall than Internet subjects and accessed more health resources, but the latter used non health-related sites more. Subjects with access to the Internet alone experienced no better outcomes than controls at any of the 3 time points, compared to pretest levels. Subjects with CHESS experienced greater social support during the intervention period and had higher scores on all 3 outcomes at 9 months, 4 months after the intervention ended. CHESS subjects also scored higher than those with Internet access during the intervention period but not significantly after the intervention ended. Thus, CHESS (with one simple interface and integrated information, communication, and skills services) helped newly diagnosed breast cancer patients even after computers were removed. In contrast, patients received little benefit from Internet access, despite having links to a variety of high-quality sites.Breast cancer affects one in eight women and is the second leading cause of cancer death among women (American Cancer Society, 2007). Earlier detection and improved treatment are reducing mortality from this disease, but its impact on a woman's quality of life remains substantial (Bruckner, Yost, Cashey, Webster, & Cella, 2005). Beginning with diagnosis and continuing at least through the stresses of treatment, breast cancer patients typically NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript experience uncertainties, anxiety, novel and difficult decisions, physical pain, impairment of everyday life functioning, feelings of social isolation, difficulties adjusting and maintaining relationships, and so on (Gustafson, Taylor, Thompson, & Chesney, 1993;Mandelblatt, Figuerido, & Cullen, 2003). Or, in summary, both the initial diagnosis of breast cancer and the subsequent treatment adversely affect a woman's quality of life.Apart from medical treatment, a variety of resources can impact how well a woman deals with the disease. For example, mounting evidence suggests that information produces accurate disease-related expectations (Maly, Leake, & Silliman, 2004), improved health, and even increased longevity among breast cancer patients (Kiecolt-Glaser & Glaser, 1987). Patients satisfied with social support perceive their health more positively and report fewer physical symptoms (Sammarco, 2004). Thus, understanding how quality of life can be buffered against the stresses of breast cancer should allow us to develop and...

Vascularized iliac bone-grafting with use of the technique described in this study is not indicated for the treatment of osteonecrotic femoral heads with segmental collapse.

The carbonation reactions of polymeric organolithium compounds with high purity, gaseous carbon dioxide have been investigated in benzene and benzene/tetrahydrofuran (75/25) solutions. The polymers investigated were poly(styryl)lithium, poly(isoprenyl)lithium, and poly-(styrene-b-isopreny1)lithium. In benzene solution the products are a mixture of the carboxylic acid and the ketone (dimer). No tertiary alcohol product (trimer) was observed. In benzene/ tetrahydrofuran solution, the quantitative carboxylation of chain ends was observed.0025-1 16X/82/09