Correlates of women's cancer screening and contraceptive knowledge among female emergency department patients

Women's perceptions about female reproductive system: a survey from an academic obstetrics and gynecology practice

OBJECTIVE

To assess women's knowledge about female reproductive system and the demographic factors that may influence their perceptions.

STUDY DESIGN

In this cross-sectional study, all qualifying adult women at our academic practice were asked to complete a self-administered anonymous questionnaire about the effects of female reproductive system between June and August 2009. We assessed the accuracy of their knowledge and analyzed the effect of demographic factors.

RESULTS

The majority of the 500 participants were in 18- to 59-year age range (93 %), Caucasian (81 %), married (56 %), college graduates (74 %) and had private insurance (82 %). Mean correct score was 63 ± 20 %. In univariate analysis, those respondents who were older, Caucasian, and had private insurance scored significantly higher (p < 0.05) When all the variables were entered in a fractional logit model, only age, race and reason for the visit remained as independent predictors for a better overall score in this survey. Twenty-nine percent of the participants thought hysterectomy included removal of ovaries and tubes. About a quarter of the respondents thought menstrual function would continue after hysterectomy. The question for whether removal of the uterus resulted in climacteric changes was correctly answered only by 34 %. While 59 % of women did not agree that removing the entire uterus eliminated the cervical cancer risk, 66 % concluded that they would continue to need Pap smears after total hysterectomy.

CONCLUSION

Women's knowledge about female reproductive system is limited, especially for those who are younger and from a minority.

Beliefs regarding mammography screening among women visiting the emergency department for nonurgent care

INTRODUCTION

One in 8 US women will develop invasive breast cancer in their lifetime. Despite evidence that mammography is an effective method of early detection, certain vulnerable groups, such as those using the emergency department as a medical home, do not adhere to mammography screening guidelines, and suffer disparate mortality from breast cancer. The purpose of this study was to investigate differences in beliefs regarding mammography screening among women attending the emergency department for nonurgent care and ultimately to develop interventions that promote mammography for this vulnerable population.

METHODS

We explored the relationship between stage of readiness to adopt mammography behavior and barriers, benefits, and perceived susceptibility by administering scales for risk, benefits, and barriers to a sample of 110 women who had presented to the emergency department of a public hospital for nonurgent complaints or were seated in the ED waiting room. We also collected sociodemographic information and stage of readiness.

RESULTS

Mammography adherence was about 60%. Most women who were not compliant with current guidelines were contemplators. Those who were not contemplating being screened were significantly less likely to perceive themselves to be at risk of getting breast cancer. Women who had more barriers to mammography perceived less benefit from having a mammogram. African American women perceived less benefit from having a mammogram.

DISCUSSION

Mammography promotion is appropriately placed in the ED waiting room given the suboptimal rate at which this population is being screened. Beliefs regarding mammography differ for women in various stages of mammography adoption and for minority women. Understanding these differences will allow intervention in this setting to be tailored to the population. ED nurses are an important and sometimes sole point of health care contact for patients who routinely visit the emergency department. As such, they have a valuable opportunity to provide cancer screening promotion messages. It is critical that nurses in this setting understand the complexities of delivering this information and the need to do so.

Mouse mammary tumor like virus sequences in breast milk from healthy lactating women

Mouse mammary tumor virus (MMTV) has been a long standing candidate as a potential cause of some human breast cancers. Forty years ago, electron microscopic images of MMTV-like particles were identified in milk from 5% of healthy lactating women. These observations, however, have not been confirmed by modern methods. The purpose of this study was to confirm the presence of MMTV-like DNA sequences in human milk from normal lactating women. Standard and in situ PCR analyses were conducted on DNA extracted from fresh breast milk samples collected from a group of 91 healthy lactating women volunteers. The MMTV-like viral positive PCR products were sequenced and a phylogenetic tree was constructed to compare these sequences. Immunohistochemistry analyses were performed on breast milk cells using polyclonal rabbit antibodies against affinity-purified MMTV envelope glycoproteins 52/36. MMTV-like envelope gene sequences were identified by PCR in 5% (4/91) of breast milk samples from healthy lactating women volunteers. These observations were confirmed by in situ PCR and immunohistochemistry using MMTV gp52/36 antibodies. These findings confirm the presence of MMTV-like gene sequences in human milk. As MMTV is transmitted via milk from mouse mothers to their newborn pups to cause mammary tumors when they become adults, this indicates a means of transmission of this virus in humans.

Improving cancer knowledge and screening awareness: test of a telephone interviewer intervention

BACKGROUND

Appalachian respondents were surveyed about their knowledge of cancer and screening intentions in a pre/post research design.

METHODS

At baseline, 696 telephone interviews were conducted of randomly selected respondents. Half were randomly assigned to a control group and half were provided correct information to incorrect responses. Four months later, respondents were re-interviewed.

RESULTS

Provision of correct information did not produce major differences in the intervention group.

CONCLUSIONS

Although the intervention was less effective than anticipated, the pilot test provided possible explanations/variables that educators may be able to control or incorporate as features in future studies.

Negative opinions about cancer screening and contraceptive measures by female emergency department patients

We sought to determine the extent to which adult female emergency department participants viewed two women's cancer screening and two contraceptive measures negatively. The study also explored the relationship between having a negative opinion about these measures and participant demography, lack of knowledge, and lack of usage of these measures. Few women expressed negative opinions about these measures. Lack of knowledge about and lack of use of these measures were associated with having negative opinions on these cancer screening and contraceptive measures. Having any negative opinion about one cancer screening or contraceptive measure was associated with a higher risk of having any negative opinion on another measure. The results suggest that influencing opinion and knowledge about these measures might impact the success of emergency department-based cancer screening and contraceptive health programs. Editors' Strategic Implications: Emergency departments (and primary care settings) provide key opportunities for prevention. Replication is needed, but the authors present important data on knowledge, attitudes, and characteristics that might influence women's receptivity to consent to and engage in behaviors consistent with prevention, screening, and health promotion.

Factors associated with failure to complete isoniazid treatment for latent tuberculosis infection in Rhode Island

BACKGROUND

The treatment of latent tuberculosis infection (LTBI) is essential for tuberculosis elimination in the United States, but the major limitation is poor adherence to therapy. To aid the design of targeted adherence interventions, we investigated the factors associated with noncompletion of isoniazid (INH) therapy for LTBI.

METHODS

A retrospective analysis of patients with who failed to complete vs those who completed 9 months of INH therapy at the RISE TB Clinic (Miriam Hospital; Providence, RI) in 2003 was performed. Factors associated with treatment noncompletion were examined using univariate and multiple logistic regression analysis.

RESULTS

Of 845 patients with LTBI, 690 patients (81.6%) initiated INH therapy, of whom 426 patients (61.7%) completed therapy, and 246 patients (35.6%) were lost to follow-up. Treatment was discontinued in 18 patients (2.6%). Patients who failed to complete therapy were younger (mean age, 30.6 vs 33.8 years, respectively; p = 0.006), and were more likely to be uninsured (42.9% vs 29.8%, respectively; p = 0.0004), to be postpartum (66.7% vs 37.3%, respectively; p = 0.043), and to report treatment side effects (54.8% vs 30.1%, respectively; p < 0.0001). Reported treatment side effects (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.2 to 6.2) and lack of medical insurance (OR, 1.7; 95% CI, 1.1 to 2.7) were each associated with treatment noncompletion in a model including both. Also, pregnant women were more likely than nonpregnant women to fail to initiate INH treatment (52.1% vs 14.7%, respectively; p < 0.0001).

CONCLUSIONS

LTBI patients who are young, pregnant or postpartum, uninsured, and/or report treatment side effects may require additional case management to improve INH treatment completion rates.