What Do Women Know About Breast Density? Results From a Population Survey of Virginia Women.

PURPOSE: Breast density reduces the sensitivity of mammography and is a moderate independent risk factor for breast cancer. Virginia is one of 24 states that currently require notification of patients when they have dense breasts. However, little is known about what women in the general population know about breast density. This survey study assessed knowledge about breast density and about its impact on mammography and breast cancer risk. METHODS: A random sample of 1024 Virginia women between ages 35 and 70 years without breast cancer, reached by landline and cell phone, who completed a 24-minute interview. Bivariate and multivariate analysis was performed. RESULTS: Thirty-six percent of respondents had been informed about their breast density. These women were more likely to be familiar with the term "breast density." Seventy-five percent of respondents reported being either somewhat or very familiar with risk factors for breast cancer, but <1% spontaneously listed breast density as a risk factor. About half of women who had a mammogram in the last year were aware of their breast density. Overall, only one in five women were aware that density reduces the sensitivity of mammography and only one in eight were aware that density increases breast cancer risk. Very few respondents (5.3%) were able to correctly answer three density knowledge questions. Lower-education, African-American, and Jewish women were less knowledgeable about breast density. CONCLUSIONS: Although women are becoming aware of the term "breast density," they may not understand its relationship to cancer detection on mammography and, especially, its relationship to breast cancer risk.

Injury, disability and access to care in Rwanda: results of a nationwide cross-sectional population study.

BACKGROUND: Disparities in access to quality injury care are a growing concern worldwide, with over 90 % of global injury-related morbidity and mortality occurring in low-income countries. We describe the use of a survey tool that evaluates the prevalence of surgical conditions at the population level, with a focus on the burden of traumatic injuries, subsequent disabilities, and barriers to injury care in Rwanda. METHODS: The Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate surgical consultation or intervention. Questions are structured anatomically and designed around a representative spectrum of surgical conditions. Households in Rwanda were sampled using two-stage cluster sampling, and interviews were conducted over a one-month period in 52 villages nationwide, with representation of all 30 administrative districts. Injury-related results were descriptively analyzed and population-weighted by age and gender. RESULTS: A total of 1,627 households (3,175 individuals) were sampled; 1,185 lifetime injury-related surgical conditions were reported, with 38 % resulting in some form of perceived disability. Of the population, 27.4 % had ever had a serious injury-related condition, with 2.8 % having an injury-related condition at the time of interview. Over 30 % of household deaths in the previous year may have been surgically treatable, but only 4 % were injury-related. CONCLUSIONS: Determining accurate injury and disability burden is crucial to health system planning in low-income countries. SOSAS is a useful survey for determining injury epidemiology at the community level, which can in turn help to plan prevention efforts and optimize provision of care.

Relationship of adverse events and support to RN burnout.

Registered nurse (RN) "second victims" are RNs who are harmed from their involvement in medical errors. This study used the conceptual model nurse experience of medical errors and found a relationship between RN involvement in preventable adverse events and 2 domains of burnout: emotional exhaustion (P = .009) and depersonalization (P = .030). Support to RNs involved in preventable adverse events was inversely related to RN emotional exhaustion (P < .001) and depersonalization (P = .003) and positively related to personal accomplishment (P = .002).

Estimating pediatric surgical need in developing countries: a household survey in Rwanda.

PURPOSE: Surgical services for children are often absent in resource-limited settings. Identifying the prevalence of surgical disease at the community level is important for developing evidence-based pediatric surgical services and training. We hypothesize that the untreated surgical conditions in the pediatric population are largely uncharacterized and that such burden is significant and poorly understood. Furthermore, no such data exist at the population level to describe this population. METHODS: We conducted a nationwide cross-sectional cluster-based population survey to estimate the magnitude of surgical disease in Rwanda. Conducted as a verbal questionnaire, questions included representative congenital, acquired, malignant and injury-related conditions. Pediatric responses were analyzed using descriptive statistics and univariate analysis. RESULTS: A total of 1626 households (3175 individuals) were sampled with a 99% response rate; 51.1% of all individuals surveyed were younger than age 18. An estimated 50.5% of the total current surgical need occurs in children. Of all Rwandan children, 6.3% (95% CI 5.4%-7.4%), an estimated 341,164 individuals, were identified to have a potentially treatable surgical condition at the time of the interview. The geographic distribution of surgical conditions significantly differed between adults and children (p<0.001). CONCLUSIONS: The results emphasize the magnitude of the pediatric surgery need as well as the need for improved education and resources. This may be useful in developing a collaborative local training program.

Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda.

BACKGROUND: Operative disease is estimated to contribute to 11% of the global burden of disease, but no studies have correlated this figure to operative burden at the community level. We describe a survey tool that evaluates population-based prevalence of operative conditions and its first full-country implementation in Rwanda. METHODS: The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate an operative consultation or intervention. Household surveys in Rwanda were conducted in October 2011 in 52 clusters nationwide. Data were population-weighted and analyzed with the use of descriptive statistics. RESULTS: A total of 1626 households (3175 individuals) were sampled with a 99% response rate. 41.2% (95% confidence interval [95 CI%] 38.8-43.6%) of the population has had at least one operative condition during their lifetime, 14.8% (95% CI 13.3-16.5%) had an operative condition during the previous 12 months, and 6.4% (95% CI 5.6-7.3%) of the population were determined to have a current operative condition. A total of 55.3% of the current operative need was found in female respondents and 40.3% in children younger than 15 years of age. A total of 32.9% of household deaths in the previous year may have been related to operative conditions, and 55.0% of responding households lacked funds for transport to the nearest hospital providing general practitioner operative services. CONCLUSION: The SOSAS survey tool provides important insight into the burden of operative disease in the community. Our results show a high need for operative care, which has important implications for the global operative community as well as for local health system strengthening in Rwanda.

Pilot testing of a population-based surgical survey tool in Sierra Leone.

BACKGROUND: The prevalence of surgical diseases in low income countries is thought to be very large, but to date no population-based survey has documented the need. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a survey tool programmed for use with iPads to measure the prevalence of surgical conditions. METHODS: To assess the appropriateness and utility of SOSAS, a pilot test was undertaken in Sierra Leone. Local medical students were trained in sampling, interviewing, and SOSAS specifics. Five clusters of 10 households were randomly selected and 100 individuals were interviewed. Problems with the tool, iPad use, and respondent answers were collected. Daily debriefings with the enumerators aimed to identify problems and ways for improvement. RESULTS: Administering SOSAS via iPads was found to be easy and facilitated data entry. Quick analysis of the data allowed for rapid feedback. Although the survey has 450 possible data entry points, by using conditional formatting, the enumerators were able to collect household demographics and interview two randomly selected household members in an average of 25 min. The survey methodology was acceptable, with a response rate of 96%. Five major sections were amended after the pilot. DISCUSSION: Pilot testing of SOSAS showed that a population-based survey measuring the prevalence of surgical disease could be undertaken in a low income country. It is recommended that SOSAS be used with a larger sample size to calculate the prevalence of surgical disease in low income countries.

Human papillomavirus vaccination recommendation may be linked to reimbursement: a survey of Virginia family practitioners and gynecologists.

OBJECTIVE: Concerns have been raised about gynecologists as vaccinators. This survey evaluated use of the human papillomavirus (HPV) vaccine, attitudes, and barriers among gynecologists and family practitioners for differences between the 2 specialties. DESIGN: A cross-sectional survey was conducted using a 50-item, self-administered questionnaire mailed to participants. SETTING: The study was conducted in Virginia through the University of Virginia Center for Survey Research. PARTICIPANTS: The questionnaire was mailed to 500 family practitioners and 500 gynecologists. INTERVENTIONS: The questionnaire asked provider and practice demographics, vaccine practices, knowledge, HPV vaccine attitudes, and barriers to vaccination. MAIN OUTCOME MEASURES: We compared gynecologists to family practitioners for the outcome of offering HPV vaccination. Logistic regression was performed to determine factors associated with providers choosing to offer and recommend the HPV vaccine. RESULTS: After exclusion of ineligible physicians, 385 of 790 doctors responded (48.7%). Seventy percent of family practitioners and 73.5% of gynecologists currently offer the HPV vaccine. There were no significant differences in demographics or practice patterns between the specialties. The most frequent barrier to vaccination reported by both groups was reimbursement. In multivariate logistic regression, inadequate reimbursement was negatively associated with offering the HPV vaccine (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.15-1.1) and with recommending the vaccine to patients (OR 0.45; 95% CI 0.26-0.76). Experience treating HPV- related disease was positively associated with offering the HPV vaccine (OR 2.3; 95% CI 1.1-4.8). CONCLUSIONS: Gynecologists are providing HPV vaccination at rates similar to family practitioners. Reimbursement concerns may negatively have an impact on doctors' recommendation of the HPV vaccine.

Year 2000 Oncology Nursing Society Research Priorities Survey.

PURPOSE/OBJECTIVES: To determine the Oncology Nursing Society's (ONS's) research priorities for 2001-2005 for oncology nursing across the entire scope of cancer care, including prevention, detection, treatment, and palliative care. DESIGN: A cross-sectional, mailed survey. SAMPLE: Stratified by the general member group (i.e., a random sample of 1,850 ONS members) and researcher group (i.e., census of 150 ONS researchers). 788 responded for an overall response rate of 39%. MAIN RESARCH VARIABLES: 113 topics that were identified from the 1994 ONS Research Priority Survey questionnaire and earlier ONS Research Priority Surveys, with the addition of 20 new items to existing questionnaire categories and one new category area: health services research. FINDINGS: Top 20 research priorities were distributed across six of eight questionnaire categories, and the number of top 20 priorities within categories differs. Compared to the 1994 survey, 9 topics were common to both top 20 lists; 8 were new to the top 20, and 11 dropped out of the top 20. When the researcher group and adjusted total sample group top 20 priority ratings were compared, nine topics were common to both groups. CONCLUSIONS: Examining research priorities affords different perspectives to guide practice, education, research, management, and administration. IMPLICATIONS FOR NURSING: ONS Research Priority Survey results provide an important foundation for developing future research across the entire scope of oncology nursing.