***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Rates of malignant melanoma are rising , with those people with sun-sensitive skin most at risk . Health education interventions are needed to help people protect themselves by detecting early signs of melanoma and by protecting their skin from sunburn . This study aim ed to evaluate the impact of an interactive multimedia intervention " Skinsafe " on patients ' knowledge about melanoma and on their skin protective behaviors . METHODS In this cluster-r and omized , controlled trial conducted in Nottinghamshire , UK , doctors and nurses in 5 family practice s prescribed Skinsafe to patients with higher risk skin characteristics .  Measures of melanoma knowledge , perceived risk of melanoma and reported skin protective behaviors were obtained at baseline and at 6-month follow-up from 259 patients receiving the intervention and 330 patients with higher risk skin characteristics in 5 matched control practice s. RESULTS AND DISCUSSION Participants had low levels of melanoma knowledge at baseline . At follow-up , the intervention group had higher knowledge scores than control ( 3.71 vs. 3.03 , P < or = 0.001 ) , reported more protective skin behaviors ( 5.36 vs. 5.06 , P = 0.007 ) and were more likely to report mole checking ( odds ratio 1.67 , 95 % CI 1.04 to 2.70 , P = 0.035 ) . The Skinsafe intervention was evaluated positively by patients and could be used to support melanoma health education within clinical setting OBJECTIVES This study assessed whether the Learn , Share & Live breast cancer education program result ed in favorable , replicable , and sustainable outcomes . METHODS The program was implemented at index ( year 1 ) and replication ( year 2 ) sites . Baseline interviews ( year 1 ; n = 240 ) and 2 follow-up telephone interviews ( years 2 and 3 ; n = 337 and 323 ) were used to assess postintervention changes . RESULTS From baseline to year 2 , mammography adherence and stage of adoption improved at the index site relative to the replication site . Knowledge scores and percentages of respondents reporting that a friend had spoken with them about mammography improved significantly . Improvements were sustained through year 3 ( 2 years postintervention ) . In year 3 , replication participants showed improvements in regard to knowledge and perceived mammography benefits , and there was a trend toward increased adherence . Site differences in postintervention adherence may have stemmed from respective choices of follow-up activities . CONCLUSIONS The study outcomes affirm the impact of Learn , Share & Live , indicating a replicated and sustained program effect . Future studies should continue longer follow-up and explore the importance of providing mammography opportunities along with education Objective : We aim ed to develop and vali date a measurement tool to assess cancer awareness in the general population : the cancer awareness measure ( CAM ) . Methods : Items assessing awareness of cancer warning signs , risk factors , incidence , screening programmes and attitudes towards help seeking were extracted from the literature or generated by expert groups . To determine reliability , the CAM was administered to a university participant panel ( n=148 ) , with a sub- sample ( n=94 ) completing it again 2 weeks later . To establish construct validity ,  CAM  scores of cancer experts ( n=12 ) were compared with those of non-medical academics ( n=21 ) . Finally , university students ( n=49 ) were r and omly assigned to read either a cancer information leaflet or a leaflet with control information before completing the measure , to ensure the CAM was sensitive to change . Results : Cognitive interviewing indicated that the CAM was being interpreted as intended . Internal reliability ( Cronbach 's α=0.77 ) and test – retest reliability ( r=0.81 ) were high . Scores for cancer experts were significantly higher than those for non-medical academics ( t(31)=6.8 , P<0.001 ) . CAM scores were higher among students who received an intervention leaflet than the control leaflet ( t(47)=4.8 , P<0.001 ) . Conclusions : These studies show the psychometric properties of the CAM and support its validity as a measure of cancer awareness in the general population BACKGROUND The objective was to determine the impact of a multimedia device offering information about malignant melanoma on public knowledge , attitudes , and behaviors . METHODS Two municipalities in Sweden , Dalby and S S and by , were chosen . The population of Dalby was exposed to the multimedia program during 1994 - 97 , whereas the S S and by population was not . A question naire was sent to r and om sample s of the population s ( 10 % of those aged 20 - 59 years ) before ( 1994 , n = 373 and n = 409 , respectively ) and after the intervention ( 1996 , n = 375 and n = 418 , respectively ) . Response rates were 74 - 89 % . RESULTS The groups were well balanced at baseline . In both areas women scored higher both at baseline and in 1996 . Dalby women showed less fear of skin cancer in 1996 than in 1994 ( 2.13 vs 2.27 , p < 0.01 ) . This was not so in the controls . There was no major change in " sun behavior " in Dalby , whereas there was a negative change in S S and by . After the intervention Dalby men had more " knowledge " ( from 2.64 to 2.70 , p < 0.05 ) and a tendency to better " sun behavior " ( from 1.77 to 1.85 , p = 0.076 ) . There was no significant change over time in the S S and by men . CONCLUSIONS The multimedia program had a modest effect . The population in Dalby had more knowledge and changed its attitudes in a sun-protective direction . In the control area , the two-year follow-up sun behavior score was lower than at baseline . There was also significantly less fear of skin cancer after the intervention Is no evidence better than any evidence when controlled studies are unethical ? Rigorous evidence on the health effects of social interventions is scarce1 2 despite calls for more evidence from r and omised studies .3 One reason for the lack of such experimental research on social interventions may be the perception among research ers , policymakers , and others that r and omised design s belong to the biomedical world and that their application to social interventions is both unethical and simplistic.4 Applying experimental design s to social interventions may be problematic but is not always impossible and is a desirable alternative to uncontrolled experimentation.3 However , even when r and omised design s have been used to evaluate social interventions , opportunities to incorporate health measures have often been missed.5 For example , income supplementation is thought to be a key part of reducing health inequalities,6 but rigorous evidence to support this is lacking because most r and omised controlled trials of income supplementation have not included health measures .5 Current moves to increase uptake of benefits offer new opportunities to establish the effects of income supplements on health . In attempting to design such a study , however , we found that r and omised or other controlled trials were difficult to justify ethically , and our eventual design was rejected by funders . # # # # Box 1 Attendance allowance A pilot study carried out by one of us ( RH ) showed substantial health gains  among elderly people after receipt of attendance allowance . We therefore decided to pursue a full scale study of the health effects of income supplementation . Men over the age of 45 present with thicker , more advanced melanomas than younger people . A r and omised trial was conducted in this group to evaluate whether an educational brochure would increase knowledge about melanoma and the ability to recognise and discriminate between pigmented skin lesions .  Men in an industrial complex were allocated to an intervention group ( n = 110 ) and two control groups ( n = 96 and n = 108 ) . The intervention group was given two educational brochures about melanoma . Their effect on knowledge and ability to detect pigmented lesions was assessed by a question naire and a self-examination body chart given before the brochure , and at four weeks and three months after return of the brochure . The control groups did not receive any educational material , but control group 2 received the question naire and chart . At the end of the study all participants were examined for pigmented lesions by doctors , whose counts were compared with those of the participants . There was a significant ( 19.8 per cent ) increase in knowledge about melanoma in the intervention group ( but not in the control groups ) , except for discrimination of photos of benign and malignant lesions . The educational material did not improve the ability of those in the intervention group to recognise and count their pigmented lesions nor to discriminate between benign and malignant pigmented lesions . The increased knowledge about melanoma was retained for at least three months BACKGROUND Since it is widely accepted that the earlier cancer is detected , the better the chances of treatment and survival , people should be encouraged to create positive intentions toward early detection of several types of cancer , for instance , skin cancer , breast cancer , and colon cancer . This can be done by being alert to the warning signs of cancer and seeking help once a cancer symptom is detected . METHODS A r and omized controlled study ( n = 1,500 ) assessed the effects of computer-tailored information and general information on determinants and intentions to engage in early detection behaviors ( i.e. , passive detection and help seeking ) compared with those in a control group . Possible negative side effects , like increased chronic fear of cancer and more fatalistic attitudes toward cancer , were studied as well . RESULTS Shortly after the intervention , differences between the study groups were found in intention , several social psychological determinants , and knowledge . Six months after the intervention , there were still differences between the tailored information group and the control group in intentions toward help seeking . Neither of the interventions result ed in increased chronic fear nor more fatalistic attitudes toward cancer . CONCLUSIONS It is concluded that there were positive effects of the tailored intervention on determinants , passive detection , and help-seeking intentions in the short-term , but additional research is needed to assess ways of maintaining these effects in the long-term CONTEXT Although evidence -based guidelines recommend that physicians inform men about prostate cancer screening , the most efficient way to do this is not known . OBJECTIVE To evaluate whether a mailed educational pamphlet affected men 's knowledge about early detection of prostate cancer . DESIGN R and omized , controlled trial . SETTING Primary care clinic of the Minneapolis VA Medical Center . PATIENTS 342 men at least 50 years of age who responded to a mailed survey ( overall response rate , 68 % ) and did not report a history of prostate cancer . INTERVENTION " Early Prostate Cancer " pamphlet mailed to patients in the intervention group 1 week before their scheduled clinic appointments . OUTCOME MEASURES Patients ' responses to a survey mailed 1 week after their clinic appointments ; prostate-specific antigen ( PSA ) testing determined from electronic medical records . RESULTS Respondents were predominantly elderly white men ( mean age , 71 years ; 90 % white ) with chronic illnesses ( 48 % described their health as " fair " or " poor " ) . Men who received the educational pamphlet were better informed than men in the usual care group , as measured by correct responses to the following three questions about prostate cancer screening : the natural history of prostate cancer ( 32 % vs. 24 % ; P = 0.10 ) , whether treatment lengthens lives of men with early prostate cancer ( 56 % vs. 44 % ; P = 0.04 ) , and accuracy of PSA testing ( 46 % vs. 27 % ; P < 0.008 ) . The overall proportion of correctly answered questions was greater in the intervention group ( 45 % vs. 32 % ; P < 0.001 ) . Testing for PSA in the year after the index clinic appointments did not differ significantly between the intervention group and the usual care group ( 31 % vs. 37 % ; P > 0.2 ) . CONCLUSIONS Male veterans are poorly informed about the potential benefits and risks of prostate cancer screening . Although our mailed educational pamphlet enhanced knowledge only modestly , it was an inexpensive and easily implemented intervention Study aim was to determine the influence of a patient information leaflet ( PIL ) on mouth cancer to improve knowledge , reduce distress and increase intention to accept a mouth screen over a 2-month period . The design was a r and omised controlled trial . Two dental practice s in the northwest of Engl and participated . St and ardised multi-item scales of the three outcome measures were employed . The PIL was given to a r and omised intervention group of patients in waiting room . Single sheet question naire was completed by both groups of patients at baseline in waiting room ( immediately following leaflet administration in intervention arm of study ) . Repeat question naire completion at 8 weeks by all patients through postal system . Mann-Whitney U-tests comparing outcome variables between patients with and without access to the leaflet at baseline and 8 weeks were performed . Multiple logistic regression was used to predict re-reading of the leaflet at home . Useable replies were received from 317 patients ( 60 % response rate ) . All measures showed some benefit of immediate exposure to the leaflet at follow up . Older patients , less initial knowledge , and self-reported smoking positively predicted the re-reading of the leaflet . The introduction of a mouth cancer PIL into dental practice may help to inform patients about  oral cancer , moderate distress and encourage acceptance of an oral health screen As part of its strategy to identify cancer cases in a rural population , the cancer registry of Barshi , India , has developed a methodology which includes education of the population about likely symptoms of cancer , and motivation of symptomatic individuals to undergo medical investigation .  Patients with cervical cancer from the registry area who attended Barshi Cancer Hospital ( 84 % of the total ) showed a significant improvement in stage at diagnosis between 1988 - 1989 ( 38 % in stages I and II ) and 1990 - 1992 ( 51 % in stages I and II ) . 
    Output:
    
Results : We found some evidence that interventions delivered to individuals modestly increase cancer awareness in the short term and insufficient evidence that they promote early presentation .
We found limited evidence that public education campaigns reduce stage at presentation of breast cancer , malignant melanoma and retinoblastoma .
Conclusions : Interventions delivered to individuals may increase cancer awareness .
Interventions delivered to communities may promote cancer awareness and early presentation , although the evidence is limited