Midlife Study of the Louisville Twins: Connecting Cognitive Development to Biological and Cognitive Aging.

The Louisville Twin Study (LTS) began in 1958 and became a premier longitudinal twin study of cognitive development. The LTS continuously collected data from twins through 2000 after which the study closed indefinitely due to lack of funding. Now that the majority of the sample is age 40 or older (61.36%, N = 1770), the LTS childhood data can be linked to midlife cognitive functioning, among other physical, biological, social, and psychiatric outcomes. We report results from two pilot studies in anticipation of beginning the midlife phase of the LTS. The first pilot study was a participant tracking study, in which we showed that approximately 90% of the Louisville families randomly sampled (N = 203) for the study could be found. The second pilot study consisted of 40 in-person interviews in which twins completed cognitive, memory, biometric, and functional ability measures. The main purpose of the second study was to correlate midlife measures of cognitive functioning to a measure of biological age, which is an alternative index to chronological age that quantifies age as a function of the breakdown of structural and functional physiological systems, and then to relate both of these measures to twins' cognitive developmental trajectories. Midlife IQ was uncorrelated with biological age (- .01) while better scores on episodic memory more strongly correlated with lower biological age (- .19 to - .31). As expected, midlife IQ positively correlated with IQ measures collected throughout childhood and adolescence. Additionally, positive linear rates of change in FSIQ scores in childhood significantly correlated with biological age (- .68), physical functioning (.71), and functional ability (- .55), suggesting that cognitive development predicts lower biological age, better physical functioning, and better functional ability. In sum, the Louisville twins can be relocated to investigate whether and how early and midlife cognitive and physical health factors contribute to cognitive aging.

Exploring Perceptions of Shift Length: A State-Based Survey of Registered Nurses.

OBJECTIVE: The aim of this study was to explore clinical nurses' perspectives of shift length. BACKGROUND: Discussions about scheduling practices, work rotations, and shift length are pervasive among nurses and nursing leadership. However, the science surrounding nurse perceptions of longer shifts is limited. METHODS: A survey instrument was developed and distributed to nurses engaged in the state's professional association. RESULTS: Data from 190 clinical nurses were included. When working a 40-hour work week, 76.3% reported a preference for 10-hour shifts, whereas 83.5% preferred a 12-hour shift during a 36-hour week. Those who chose longer shifts perceived improved work life balance and better patient care. Those identifying 8-hour shifts also pointed to work life balance as benefit. CONCLUSIONS: The results capture the voice of the nurse regarding shift length. The preference for the 10-hour shift within the 40-hour work week is novel. These results may assist with efforts to initiate change, improve the work environment and enhance home life.

Mechanisms of Communicating Health Information Through Facebook: Implications for Consumer Health Information Technology Design.

BACKGROUND: Consumer health information technology (IT) solutions are designed to support patient health management and have the ability to facilitate patients' health information communication with their social networks. However, there is a need for consumer health IT solutions to align with patients' health management preferences for increased adoption of the technology. It may be possible to gain an understanding of patients' needs for consumer health IT supporting their health information communication with social networks by explicating how they have adopted and adapted social networking sites, such as Facebook, for this purpose. OBJECTIVE: Our aim was to characterize patients' use of all communication mechanisms within Facebook for health information communication to provide insight into how consumer health IT solutions may be better designed to meet patients' communication needs and preferences. METHODS: This study analyzed data about Facebook communication mechanisms use from a larger, three-phase, sequential, mixed-methods study. We report here on the results of the study's first phase: qualitative interviews (N=25). Participants were over 18, used Facebook, were residents or citizens of the United States, spoke English, and had a diagnosis consistent with type 2 diabetes. Participants were recruited through Facebook groups and pages. Participant interviews were conducted via Skype or telephone between July and September 2014. Data analysis was grounded in qualitative content analysis and the initial coding framework was informed by the findings of a previous study. RESULTS: Participants' rationales for the use or disuse of a particular Facebook mechanism to communicate health information reflected six broad themes: (1) characteristics and circumstances of the person, (2) characteristics and circumstances of the relationship, (3) structure and composition of the social network, (4) content of the information, (5) communication purpose, and (6) attributes of the technology. CONCLUSIONS: The results of this study showed that participants consider multiple factors when choosing a Facebook mechanism for health information communication. Factors included what information they intended to share, what they were trying to accomplish, attributes of technology, and attributes and communication practices of their social networks. There is a need for consumer health IT that allows for a range of choices to suit the intersectionality of participants' rationales. Technology that better meets patients' needs may lead to better self-management of health conditions, and therefore, improve overall health outcomes.

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.

Beyond traditional advertisements: leveraging Facebook's social structures for research recruitment.

BACKGROUND: Obtaining access to a demographically and geographically diverse sample for health-related research can be costly and time consuming. Previous studies have reported mixed results regarding the potential of using social media-based advertisements to overcome these challenges. OBJECTIVE: Our aim was to develop and assess the feasibility, benefits, and challenges of recruiting for research studies related to consumer health information technology (IT) by leveraging the social structures embedded in the social networking platform, Facebook. METHODS: Two recruitment strategies that involved direct communication with existing Facebook groups and pages were developed and implemented in two distinct populations. The first recruitment strategy involved posting a survey link directly to consenting groups and pages and was used to recruit Filipino-Americans to a study assessing the perceptions, use of, and preferences for consumer health IT. This study took place between August and December 2013. The second recruitment strategy targeted individuals with type 2 diabetes and involved creating a study-related Facebook group and asking administrators of other groups and pages to publicize our group to their members. Group members were then directly invited to participate in an online pre-study survey. This portion of a larger study to understand existing health management practices as a foundation for consumer health IT design took place between May and June 2014. In executing both recruitment strategies, efforts were made to establish trust and transparency. Recruitment rate, cost, content of interaction, and characteristics of the sample obtained were used to assess the recruitment methods. RESULTS: The two recruitment methods yielded 87 and 79 complete responses, respectively. The first recruitment method yielded a rate of study completion proportionate to that of the rate of posts made, whereas recruitment successes of the second recruitment method seemed to follow directly from the actions of a subset of administrators. Excluding personnel time, the first recruitment method resulted in no direct costs, and the second recruitment method resulted in a total direct cost of US $118.17. Messages, posts, and comments received using both recruitment strategies reflected ten themes, including appreciation, assistance, clarification, concerns, encouragement, health information, interest, promotion, solicitations, and support. Both recruitment methods produced mixed results regarding sample representativeness with respect to characteristics such as gender, race, and ethnicity. CONCLUSIONS: The results of the study demonstrate that leveraging the social structures of Facebook for health-related research was feasible for obtaining small samples appropriate for qualitative research but not for obtaining large samples needed for quantitative research. The content of interactions with members of the target population prompted ethical deliberations concerning suitable target communities and appropriate boundaries between researchers and participants. Widespread replication of this method would benefit from a broad discussion among researchers, social media users, social media companies, and experts in research ethics to address appropriate protocols for such interactions.

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.

Analysis of Social Mission Commitment at Dental, Medical, and Nursing Schools in the US.

Importance: The COVID-19 pandemic and calls for racial justice have highlighted the need for schools to promote social mission. Measuring social mission engagement and performance in health professions education may encourage institutional efforts to advance health equity and social justice commitments. Objective: To describe the current state of social mission commitment within dental, medical, and nursing schools in the US and to examine how social mission performance compares across school types. Design, Setting, and Participants: This cross-sectional survey study invited all US dental and medical schools and a subset of baccalaureate- and master's degree-conferring nursing schools to participate in a self-assessment to measure their school's social mission commitment from January 29 through October 9, 2019. The survey measured 79 indicators (with indicators defined as responses to specific scored questions that indicated the state or level of social mission commitment) across 18 areas in 6 domains of school functioning (educational program, community engagement, governance, diversity and inclusion, institutional culture and climate, and research) that have potential to enhance social mission engagement and performance. Individual health professions schools were the unit of analysis, and 689 dental, medical, and nursing schools were invited to participate. School deans and program directors were the primary target respondents because of their broad insight into their school's programs and policies and their ability to request data from various internal sources. Demographic information from respondents was not collected because multiple respondents from an institution could complete different sections of the survey. Main Outcomes and Measures: Survey responses were analyzed to create indicator scores, standardized area scores, and an overall social mission score for each school. Using descriptive analyses, frequency and contingency tables of specific indicators within each area were created, and schools were compared based on ownership status (private or public), Carnegie Classification of Institutions of Higher Education research classification group (doctoral university with very high research activity [R1], doctoral university with high [R2] or moderate [R3] research activity, baccalaureate or master's nursing college or university, or special focus institution), and discipline group (dental school, medical school granting doctor of osteopathic medicine [DO] degrees, medical school granting doctor of medicine [MD] degrees, nursing school granting baccalaureate-level degrees, or nursing school granting master's-level degrees). Results: Among 689 invited schools, 242 schools (35.1%) completed the self-assessment survey. Of those, 133 (55.0%) were nursing schools, 83 (34.3%) were medical schools, and 26 (10.7%) were dental schools. Response rates ranged from 133 of 420 invited nursing schools (31.7%) to 83 of 203 invited medical schools (40.9%). Most schools included social determinants of health in their curriculum in either required courses (233 of 242 schools [96.3%]) or elective courses (4 of 242 schools [1.7%]), but only 116 of 235 schools (49.4%) integrated social determinants of health across all years of study. Most schools also included health disparities in either their required courses (232 of 242 [95.9%]) or elective courses (6 of 242 [2.5%]); however, only 118 of 235 schools (50.2%) integrated health disparities across all years of study. In several areas of social mission, public schools performed better than private schools (eg, curriculum: mean [SE] standardized area score, 0.13 [0.07] points vs -0.14 [0.09] points, respectively), and R1 doctoral universities and special focus institutions performed better than R2 and R3 doctoral universities and baccalaureate and master's nursing colleges and universities (eg, extracurricular activities: mean [SE] standardized area score, 0.25 [0.09] points for R1 doctoral universities and 0.20 [0.12] points for special focus institutions vs -0.05 [0.12] points for R2 and R3 doctoral universities and - 0.30 [0.12] points for baccalaureate and master's nursing colleges and universities. Different areas of strength emerged for dental, medical, and nursing schools. For example, in the curriculum area, MD-granting medical schools had a mean (SE) standardized area score of 0.38 (0.08) points, which was significantly higher than the standardized area scores of dental schools (mean [SE], -0.21 [0.14] points), DO-granting medical schools (mean [SE], -0.22 [0.13] points), graduate nursing schools (mean [SE], -0.21 [0.19] points), and undergraduate nursing schools (mean [SE], -0.05 [0.10] points). Conclusions and Relevance: In this study, there was widespread interest from health professions educational leaders in understanding and enhancing social mission commitment. Future work may focus on identifying and promoting best practices using the framework described, providing schools with continued opportunities for self-assessment, and further validating the self-assessment survey.

[Formula: see text]Survey methods for neuropsychologists: A review of typical methodological pitfalls and suggested solutions.

Objective: Survey research has enjoyed an increase in popularity, in part due to the availability of user-friendly software programs for online survey development and deployment. Neuropsychologists often use this methodology to learn about common clinical practices and attitudes in the field or to assess outcomes for patients. This paper aims to provide an overview of sound methods and common problems in survey research, along with specific recommendations for neuropsychologists wishing to conduct their own surveys or judge the quality of survey research. We also discuss some recent challenges and changes in the field of survey methodology.Method: We provide a brief literature review on survey design and methodology, as well as a review of recent studies addressing current challenges such as sampling, measurement, and response rates.Results: We suggest best practices that should be implemented when designing, administering and reporting on neuropsychological survey-based research studies. We discuss two approaches to improve survey design, Total Survey Error and the Tailored Design Method.Conclusions: In spite of the current challenges in modern survey research, with lower response rates and the proliferation of internet surveys, survey research continues to be a valuable tool in neuropsychology. We offer a list of DO's and DON'T's to guide neuropsychologists planning to conduct surveys of their field.

[Formula: see text]Survey research in neuropsychology: A systematic review.

Objective: This systematic review paper summarizes the research in neuropsychology using survey methodology, tallies key design features of published survey studies, and evaluates the degree to which the survey methods are disclosed in these publications.Method: We conducted a systematic review of neuropsychological studies that used survey methodology using PRISMA guidelines. We rated 89 surveys on the American Association for Public Opinion Research (AAPOR) required disclosure items and quality indicators.Results: Following the AAPOR guidelines for survey disclosure and quality, we found only fair to good compliance with disclosure requirements, with the average article reporting 73% of the required elements of method. Rates of disclosure of required items went up after the year 2000 but then dropped back somewhat after 2010. We also found a decrease in survey response rates over time.Conclusions: Most of the surveys published concern practice patterns and trends in the field. Response rates have gone down, as is common in other surveys. There is room for improvement in disclosure practices in survey articles in neuropsychology. We provide a rubric for evaluating disclosure of methods, to guide researchers who want to use surveys in their neuropsychological research, as well as guide consumers of survey research.

Social Mission Metrics: Developing a Survey to Guide Health Professions Schools.

The social mission, which is focused on advancing social justice and health equity, has gained recognition as an important aspect of health professions education. However, there is currently no established method to measure a school's commitment to these activities. In this Perspective, the authors describe the development of a new tool to measure the social mission at dental, medical, and nursing schools across the United States, and they reflect on the implications of using this tool to deepen discussions around the social mission and strengthen progress toward health equity.From 2016 to 2019, the authors created and field tested the online social mission metrics survey for health professions schools to identify their level of engagement in social mission activities, track that level over time, and compare their progress with that of other schools. The survey measures a school's social mission values, programs, and activities across 6 domains and 18 activity areas. The authors also developed a scoring system based on stakeholder priorities, which they used to provide customized, confidential feedback to the schools that participated in the field tests.Going forward, the authors recommend that schools complete the survey every 3 to 5 years to track their social mission over time, and they plan to expand the survey process to additional dental, medical, and nursing schools as well as to schools in other health professions. The social mission metrics survey is meant to be a useful tool for improving the level and quality of social mission engagement at health professions schools, with the goal of improving the awareness, skills, and commitment of health professionals to health equity.

Tailored Educational Approaches for Consumer Health: A Model to Address Health Promotion in an Era of Personalized Medicine.

PURPOSE: To develop a model, based on market segmentation, to improve the quality and efficiency of health promotion materials and programs. DESIGN: Market segmentation to create segments (groups) based on a cross-sectional questionnaire measuring individual characteristics and preferences for health information. Educational and delivery recommendations developed for each group. SETTING: General population of adults in Virginia. PARTICIPANTS: Random sample of 1201 Virginia residents. Respondents are representative of the general population with the exception of older age. MEASURES: Multiple factors known to impact health promotion including health status, health system utilization, health literacy, Internet use, learning styles, and preferences. ANALYSIS: Cluster analysis and discriminate analysis to create and validate segments. Common sized means to compare factors across segments. RESULTS: Developed educational and delivery recommendations matched to the 8 distinct segments. For example, the "health challenged and hard to reach" are older, lower literacy, and not likely to seek out health information. Their educational and delivery recommendations include a sixth-grade reading level, delivery through a provider, and using a "push" strategy. CONCLUSION: This model addresses a need to improve the efficiency and quality of health promotion efforts in an era of personalized medicine. It demonstrates that there are distinct groups with clearly defined educational and delivery recommendations. Health promotion professionals can consider Tailored Educational Approaches for Consumer Health to develop and deliver tailored materials to encourage behavior change.

From loquacious to reticent: understanding patient health information communication to guide consumer health IT design.

BACKGROUND AND SIGNIFICANCE: It is increasingly recognized that some patients self-manage in the context of social networks rather than alone. Consumer health information technology (IT) designed to support socially embedded self-management must be responsive to patients' everyday communication practices. There is an opportunity to improve consumer health IT design by explicating how patients currently leverage social media to support health information communication. OBJECTIVE: The objective of this study was to determine types of health information communication patterns that typify Facebook users with chronic health conditions to guide consumer health IT design. MATERIALS AND METHODS: Seven hundred participants with type 2 diabetes were recruited through a commercial survey access panel. Cluster analysis was used to identify distinct approaches to health information communication both on and off Facebook. Analysis of variance (ANOVA) methods were used to identify demographic and behavioral differences among profiles. Secondary analysis of qualitative interviews ( n = 25) and analysis of open-ended survey questions were conducted to understand participant rationales for each profile. RESULTS: Our analysis yielded 7 distinct health information communication profiles. Five of 7 profiles had consistent patterns both on and off Facebook, while the remaining 2 demonstrated distinct practices, with no health information communication on Facebook but some off Facebook. One profile was distinct from all others in both health information communication practices and demographic composition. Rationales for following specific health information communication practices were categorized under 6 themes: altruism, instrumental support, social support, privacy and stigma, convenience, and Facebook knowledge. CONCLUSION: Facebook has been widely adopted for health information communication; This study demonstrates that Facebook has been widely adopted for health information communication. It also shows that the ways in which patients communicate health information on and off Facebook are diverse.

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.

When are clinical trials beneficial for study patients and future patients? A factorial vignette-based survey of institutional review board members.

OBJECTIVE: The ethicists believe that the goal of clinical research is to benefit future and not current (trial) patients. Many clinicians believe that the clinical trial enrolment offers best management for their patients. The objective of our study was to identify the situations when a clinical trial is beneficial for the patients enrolled in the trial and future patients. DESIGN: Factorial vignette-based cross-sectional survey via the internet. PARTICIPANTS: Institutional review board (IRB) members of the US Medical Schools. MAIN OUTCOME MEASURES: Each participant was invited to review 9 clinical vignettes related to (1) study approval and (2) the assessment if the study is designed to help future or current patients more. RESULTS: A total of 232 IRB members from 42 institutions participated. When considering approval of the trial, we found that uncertainty about treatment effects (OR=1.13; 95% CI 1.08 to 1.19) and requirement for continuation of standard therapy (OR=3.84; 95% CI 2.7 to 5.55) were the only statistically significant factors affecting IRB members' decisions to approve the study. The odds of IRB members approving a trial increased when a trial proposed to enrol patients with life-threatening versus chronic debilitating disease (OR=2.04; 95% CI 1.47 to 2.86). We also found that similar factors affected judgements related to the assessment whether the trial will benefit future or current patients more-(1) future patients: uncertainty (OR=1.27; 95% CI 1.18 to 1.37); continuation of standard treatment (OR=1.66; 95% CI 1.07 to 2.56); seriousness of condition (OR=1.78; 95% CI 1.15 to 2.28); (2) current patients: uncertainty (OR=1.54; 95% CI 1.4 to 1.7); continuation of standard therapy (OR=2.17; 95% CI 1.39 to 3.44). CONCLUSIONS: IRB members view the proposed studies to be beneficial for current patients and future patients if there is uncertainty regarding treatment effects and if studies do not require stopping the current treatment. This finding supports the design and use of pragmatic trials which may reduce therapeutic misconception and improve trial enrolment, speeding up therapeutic discoveries.

Those Responsible for Approving Research Studies Have Poor Knowledge of Research Study Design: a Knowledge Assessment of Institutional Review Board Members.

BACKGROUND: Institutional Review Board (IRB) members have a duty to protect the integrity of the research process, but little is known about their basic knowledge of clinical research study designs. METHODS: A nationwide sample of IRB members from major US research universities completed a web-based questionnaire consisting of 11 questions focusing on basic knowledge about clinical research study designs. It included questions about randomized controlled trials (RCTs) and other observational research study designs. Potential predictors (age, gender, educational attainment, type of IRB, current IRB membership, years of IRB service, clinical research experience, and self-identification as a scientist) of incorrect answers were evaluated using multivariate logistic regression models. RESULTS: 148 individuals from 36 universities participated. The majority of participants, 68.9% (102/148), were holding a medical or doctoral degree. Overall, only 26.5% (39/148) of participants achieved a perfect score of 11. On the six-question subset addressing RCTs, 46.6% (69/148) had a perfect score. Most individual questions, and the summary model of overall quiz score (perfect vs. not perfect), revealed no significant predictors - indicating that knowledge deficits were not limited to specific subgroups of IRB members. For the RCT knowledge score there was one significant predictor: compared with MDs, IRB members without a doctoral degree were three times as likely to answer at least one RCT question incorrectly (Odds Ratio: 3.00, 95% CI 1.10-8.20). However, even among MD IRB members, 34.1% (14/41) did not achieve a perfect score on the six RCT questions. CONCLUSIONS: This first nationwide study of IRB member knowledge about clinical research study designs found significant knowledge deficits. Knowledge deficits were not limited to laypersons or community advocate members of IRBs, as previously suggested. Akin to widespread ethical training requirements for clinical researchers, IRB members should undergo systematic training on clinical research designs.

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.

Understanding and managing disaster evacuation on a transportation network.

Uncertain population behaviors in a regional emergency could potentially harm the performance of the region's transportation system and subsequent evacuation effort. The integration of behavioral survey data with travel demand modeling enables an assessment of transportation system performance and the identification of operational and public health countermeasures. This paper analyzes transportation system demand and system performance for emergency management in three disaster scenarios. A two-step methodology first estimates the number of trips evacuating the region, thereby capturing behavioral aspects in a scientifically defensible manner based on survey results, and second, assigns these trips to a regional highway network, using geographic information systems software, thereby making the methodology transferable to other locations. Performance measures are generated for each scenario including maps of volume-to-capacity ratios, geographic contours of evacuation time from the center of the region, and link-specific metrics such as weighted average speed and traffic volume. The methods are demonstrated on a 600 segment transportation network in Washington, DC (USA) and are applied to three scenarios involving attacks from radiological dispersion devices (e.g., dirty bombs). The results suggests that: (1) a single detonation would degrade transportation system performance two to three times more than that which occurs during a typical weekday afternoon peak hour, (2) volume on several critical arterials within the network would exceed capacity in the represented scenarios, and (3) resulting travel times to reach intended destinations imply that un-aided evacuation is impractical. These results assist decisions made by two categories of emergency responders: (1) transportation managers who provide traveler information and who make operational adjustments to improve the network (e.g., signal retiming) and (2) public health officials who maintain shelters, food and water stations, or first aid centers along evacuation routes. This approach may also interest decisionmakers who are in a position to influence the allocation of emergency resources, including healthcare providers, infrastructure owners, transit providers, and regional or local planning staff.

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.

Population behavioral scenarios influencing radiological disaster preparedness and planning.

Considerable attention is focused on plans for sheltering or evacuating the population of the US national capital region in response to a regional emergency such as a terrorist attack or natural disaster. Such planning engages multiple disciplines spanning infrastructure engineering, emergency management, health care, mass communication, water and food supply, logistics, and others. Knowledge of population behaviors should influence the many dimensions of protection, prevention, response, and recovery. Of particular interest are the behaviors and needs of the resident and non-resident populations in the aftermath of a regional disaster, including those at home, at work, and traveling. The authors deployed a 30-min telephone survey to 2700 residents of the region to gain knowledge of their intended behaviors in the event of a variety of potential dirty bomb attacks. The survey provides a unique foundation for the current paper. The paper will identify and model the assumptions of population behaviors that most affect agency priorities for emergency planning including regional sheltering and evacuation following a radiological disaster such as a dirty bomb. The technical approach assessed several planning initiatives across performance criteria derived from strategic plans and applied combinations of behavioral assumptions to vary the relative importance of each criterion. The results reveal the behavioral scenarios that are most significant to the prioritization of planning initiatives and identify the highest and lowest priority initiatives across the criteria used.