Continued Advocacy Research Articles

Gynecological health care services utilization and violence among female sex workers in Togo in 2021.

Female Sex Workers (FSW) in Sub Saharan Africa face multiple challenges increasing their vulnerability to poor health, particularly poor sexual and reproductive (SRH) health outcomes and violence. The aim of this study was to assess the use of gynecology health care services and factors associated with its use as well as experiences of violence among FSW in Togo. A cross-sectional study was carried out in 2021 among FSW in two cities of Togo. A snowball sampling method was used and initial seeds were identified in each site in collaboration with FSW non-governmental organizations. A logistic regression was performed to identify factors associated with the use of a SRH service and violence. A total of 447 FSW with a median age of 30 [IQR: (24-38)] participated in this study and 43.4% of them had reached at least secondary school. Among them, 29.1% reported having been to a gynecological consultation over the previous year. Factors associated with a gynecological consultation included: living in the Lomé capital city (aOR = 0.35, 95%CI 0.22-0.54), and an experience of condom breakage or slippage (aOR = 2.00; 95%CI 1.19-2.64). The majority reported at least one lifetime pregnancy (87.9%), 39.8% reported ever having an unintended pregnancy and 67.6% of them ever had an abortion. Finally, 61.1% indicated being victims of physical, sexual, or emotional violence in the previous six months. Sex workers living in Lomé (aOR = 1.78; 95%CI 1.16-2.73); a history of abortion (aOR = 1.53; 95%CI 1.03-2.31) and having more than 15 clients per week (aOR = 4.87; 95% CI 1.99-11.94), were more likely to experience violence. There is an under-utilization of health care services among FSW in Togo in addition to overall poor sexual and reproductive health outcomes with a high prevalence of gender-based violence. Those results highlight the importance of continued advocacy for the integration of SRH care with HIV prevention services geared toward FSW as well as a holistic approach to SRH care with innovative ways to prevent violence.

The role of the United States in shaping youth mental health advocacy and suicide prevention through foreign policy and media in conflict zones

This article explores the significant role of the United States in shaping youth mental health advocacy and suicide prevention through its foreign policy and media initiatives in conflict zones such as Iraq, Syria, and the Israeli-Gaza War. The U.S. has actively contributed to improving mental health outcomes by supporting humanitarian programs, facilitating mental health services for displaced youth, and funding initiatives aimed at addressing trauma caused by war. The paper highlights how U.S. foreign policy, through diplomatic efforts and peace-building interventions, has promoted human rights and stability in these regions, providing essential aid to vulnerable populations. In addition, the United States remains a global leader in promoting peace and safety, advocating for the protection of civilians, and upholding international standards of human rights. By working with international organizations, the U.S. has played a key role in ensuring that mental health and suicide prevention programs are integrated into post-conflict recovery efforts, creating safer environments for youth affected by war. Media coverage of U.S. efforts has also helped raise global awareness of the mental health challenges faced by young people in these conflict zones, further amplifying the need for continued advocacy and international support. This paper aims to demonstrate the United States' commitment to fostering global peace and ensuring that young populations have the resources they need to recover from the impacts of conflict, thereby strengthening mental health advocacy on a global scale.

Will Private School Choice Save Catholic Schools in the U.S.? Interrogating the Catholic School Sector’s Relationship to the School Privatization Movement

A central part of the private school choice coalition in the U.S. has been the participation of Catholic school stakeholders. The purpose of this article is to examine how Catholic school advocacy became linked to private school choice advocacy by highlighting the institutional and organizational crises facing Catholic elementary and secondary schools in the U.S. that led to sector-wide policy responses favoring choice. However, through an analysis of emerging trends in private school choice policy implementation, this paper raises questions about the efficacy of continued advocacy for private school choice policy within the Catholic sector.

Enhancing Awareness and Understanding of Autism Spectrum Disorder in Minchinabad A Participatory Action Research Approach

This study investigates the effectiveness of interventions aimed at enhancing awareness of Autism Spectrum Disorder (ASD) in Minchinabad through a participatory action research approach. A total of 100 participants were included in this research. They were Community Leaders, Healthcare Professionals, Religious Leaders, and Educators picked through Convenience Sampling. Initial data collection reveals prevalent misconceptions and barriers surrounding ASD awareness. Among them, 89% of respondents expressed a lack of sufficient awareness and 85% attributed ASD to divine factors. Subsequently, community-led workshops, social media campaigns, and Religious institutions-based awareness activities were implemented to address these challenges. Evaluation indicates a significant improvement in awareness levels. Improvement with 53% acknowledging adequate awareness. However, more than 40% still perceive a stigma associated with seeking an ASD diagnosis. While cultural beliefs persist, such as 60% to 68% believing in the divine causation of ASD. The interventions have contributed to a positive shift in community perceptions. The findings underscore the importance of sustained efforts to promote understanding and acceptance of ASD within the community, emphasizing the need for continued engagement and advocacy for ASD Awareness.

Toward the Institutionalization of a One Health Agenda: What the World can Learn from Bangladesh

Abstract In 2005 and 2007, prompted by Nipah and avian influenza outbreaks, respectively, faculties at Chattogram Veterinary and Animal Sciences University (CVASU) in Bangladesh initiated a civil society network of researchers in animal and human health. This network led to the launch a year later of One Health Bangladesh (OHB), a platform with membership open to multi-disciplinary scientists, practitioners, and activists. Along with continued advocacy to advance One Health agenda, OHB partnered with government, UN agencies, and other stakeholders to develop, in 2012, a National One Health Strategic Framework and Action Plan. The National Plan was later endorsed by the Ministry of Health and Family Welfare (MoHFW), Ministry of Fisheries and Livestock (MoFL), and Ministry of Environment, Forest, and Climate Change (MoEFC) followed by its implementation which introduced a three-tier multi-sectoral coordination mechanism including the establishment of a One Heath Secretariat in 2016. In 2017, an operational budget for the One Health Secretariat (OHS) was allocated by the MoHFW and three mid-level government officers from three government agencies, and the Directorate General of Health Services (DGHS), Department of Livestock Services (DLS), and Bangladesh Forest Department (BFD) were seconded to the OHS to make the Secretariat functional. OHB and the OHS now work together to advance the institutionalization process and implement One Health activities including One Health capacity building, joint surveillance, outbreak investigation and intervention, advocacy in the form of arranging dialogs, seminars, workshops, and conferences, and promoting cross sectoral and transdisciplinary collaboration, networking, and partnership nationally and internationally. Information © The Authors 2024

Determinants of Fertility in Arid Regions of Kenya: A Case of Westpokot County

The world's population has continued to increase and is expected to reach 10.8 billion by 2025. Population growth has negative consequences, including unemployment, food insecurity, and poor quality of life. The Kenyan government has implemented programs over the years aimed at reducing fertility, leading to a reduction in total fertility from 8.2 in the 1970s to 3.9 in 2014. However, counties in the arid and semi-arid regions of Kenya have recorded instances of a rise in fertility, derailing the government's efforts to reduce population and improve quality of life. This study, therefore, investigated the determinants of fertility in West Pokot County and the sociodemographic drivers of fertility. The study used a Poisson regression to analyze the estimates and found that a woman's education had a significant impact on the fertility rate in West Pokot. Women with secondary and tertiary education were more likely to have fewer children than women with no formal education. These findings corroborate previous studies, such as those by Kwame (2002) [35] and Longwe et al. (2012) [37], which also observed that women with higher levels of education tend to have fewer children. The study's recommendations emphasize the continued advocacy for girl-child education as a means of reducing the fertility rate in Kenya. Investing in girls' education, particularly at the secondary and tertiary levels, can empower women, delay marriage and childbearing, and ultimately contribute to the government's efforts to manage population growth and improve the quality of life for its citizens. By addressing the educational disparities and promoting access to higher education for women in the arid and semi-arid regions of Kenya, policymakers can leverage this key determinant of fertility to achieve more sustainable population dynamics and development outcomes.

Physician Associate/Assistant Program Medical Directors Are Important Advocates for the Physician Associate/Assistant Profession: Results From a National Pilot Study.

This pilot study aimed to evaluate whether and how physician associate/assistant (PA) program medical directors play a role in advocating on behalf of PAs and what factors correlate with this. The study used a mixed-methods grounded theory approach and was deemed institutional review board exempt. After literature review, a survey was developed and piloted by study personnel and faculty to affirm validity. Recruits with known email addresses were sent a link to a survey that included demographic information and 10 Likert scale questions. There were 69 respondents, and the response rate was 26%. Fisher's exact test and analysis of variance were performed using the R program. A P-value <.05 indicated significance. Thematic analysis of qualitative data was performed using ChatGPT, followed by iterative analysis by the research team. Consensus was achieved for each response. Most of the respondents had the following characteristics: MD degree, male, White, practicing clinically, and worked as PA medical directors 8 to 12 hours per week. Participants did not support PA title change, nor had they engaged in legislative efforts to support optimal team practice. Participants were strong PA advocates by promoting PA leadership positions, PA employment, improved attitudes in health care organizations toward PAs, and securing clinical rotations. Many respondents (41%) felt that none of their professional organizations supported them in their role as PA program medical director. Exploring ways to support continued advocacy by our valued PA program medical directors within PA professional organizations could be advantageous to PA program medical directors' professional growth and the PA profession.

The validation of aphasia united best practice recommendations with people with aphasia and their caregivers in Vietnam: a nominal group technique study

ABSTRACT Background Speech and language therapy is a relatively new profession in Vietnam and to date, 79 individuals have graduated from Master and Bachelor programs. For the few therapists working with adult populations, clinical guidance tailored to the Vietnamese context is limited. The Aphasia United Best Practice Recommendations were developed to provide multi-national guidance for the management of post-stroke aphasia and have been translated into 29 languages, including Vietnamese. To date however, their applicability to low-middle income countries with emerging speech and language services such as Vietnam has not been explored. Aims To determine the relevance, comprehensibility, and comprehensiveness of the Aphasia United Best Practice Recommendations to people with aphasia and caregivers in Vietnam. Methods and Procedures People with aphasia and their caregivers participated in focus groups, utilising the nominal group technique. Participants were recruited from four hospitals in Ho Chi Minh City. Participants with aphasia were sampled for severity of aphasia, age, sex, time-post onset, geographic location, employment status, and relationship. Participants reviewed the recommendations, rated relevance and comprehensibility (clarity), and made suggestions for improvement. Participants assessed the comprehensiveness of the recommendations and additional items were generated and prioritised. Data were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results People with aphasia (n = 11) and caregivers (n = 17) participated in one of nine focus groups. People with aphasia rated all recommendations as relevant. Levels of agreement varied for caregivers and fell < 85% for one recommendation only (Recommendation 4 – relating to the need for all people with aphasia to have some means of communication prior to discharge). Both participant groups suggested changes to content and wording to reflect the context and culture of Vietnam. Three common themes within the newly proposed recommendations were identified across both participants with aphasia and caregiver groups: (1) easier access to speech and language therapy services and information about aphasia, (2) the need for psychological and social support for people with aphasia and (3) the need for increased community awareness and supports for people with aphasia and their caregivers. Conclusions and Implications The Aphasia United Best Practice Recommendations were perceived to be relevant, however new recommendations reflecting the unique cultural, economic and healthcare environment of Vietnam were identified. Recommendations relating to access to services and community-based rehabilitation were prioritised, supporting the need for continued growth and advocacy for the speech and language therapy profession in Vietnam.

The Perfect Storm: Applying the Multiple Streams Framework to Understand the Adoption of a WHO Framework Convention on Tobacco Control-Based Policy in Mexico.

The aim of this study was to document how Mexico adopted a WHO Framework Convention on Tobacco Control (FCTC)-based national tobacco control law. We analyzed publicly available documents and interviewed 14 key stakeholders. We applied the Multiple Streams Framework (MSF) to analyze these findings. Previous attempts to approve comprehensive FCTC-based initiatives failed due to a lack of political will, the tobacco industry's close connections to policymakers, and a lack of health advocacy coordination. Applying the MSF reveals increased attention towards collecting and sharing data to frame the severity of the problem (problem stream). The expansion of a coordinated health advocacy coalition and activities led to increased support for desired FCTC policy solutions (policy stream). The election of President López Obrador and legislative changes led to a deep renewed focus on tobacco control (politics stream). These three streams converged to create a policy window to secure a strong FCTC-based initiative on the political agenda that was ultimately passed. The Mexican experience illustrates the importance of continued health advocacy and political will in adopting FCTC-based policies. Other countries should follow Mexico's lead by collecting and sharing data through coordinating efforts in order to be prepared to seize political opportunity windows when strong political will is present.

Post-Acute COVID-19 Syndrome and Stroke

This review explores the multifaceted strategies to mitigate the risk of cerebrovascular impairment in young adults recovering from COVID-19. The pandemic has illuminated an increased incidence of stroke in populations traditionally considered at lower risk, underscoring the need for targeted preventative measures. Given the complex interplay between SARS-CoV-2 infection and stroke risk, this article synthesizes current evidence and recommendations across lifestyle modifications, medical interventions, and proactive health monitoring. Key recommendations include adopting a heart-healthy diet, engaging in regular physical activity, and implementing stress reduction techniques. The management of existing cardiovascular risk factors, such as hypertension and diabetes, is emphasized as crucial for minimizing stroke risk post-COVID. Moreover, education on recognizing stroke symptoms is vital for ensuring timely medical response. The review also discusses the importance of avoiding smoking, limiting alcohol intake, and, for specific high-risk individuals, the judicious use of anticoagulants. Regular medical follow-ups for monitoring post-COVID symptoms and addressing any ongoing complications are advocated to identify and manage potential risks early. In conclusion, a comprehensive approach involving lifestyle changes, vigilant management of pre-existing conditions, education on stroke symptoms, and regular healthcare engagement is essential for reducing the risk of cerebrovascular events in young adults recovering from COVID-19. This review underscores the importance of continued research and public health advocacy in addressing the long-term effects of the pandemic on cerebrovascular health.

Understanding Rare Anemias: Emerging Frontiers for Diagnosis and Treatment.

Background-This review provides a comprehensive overview of rare anemias, emphasizing their hereditary and acquired causes, diagnostic advancements, and evolving treatment strategies. It outlines the significance of rare anemias within public health, historical challenges in recognition and treatment, and the role of European initiatives like ENERCA and EuroBloodNet in advancing care. Content-This document discusses diagnostic technologies like next-generation sequencing and the impact of artificial intelligence, alongside the promising avenues of gene therapy, targeted drug treatments, and stem cell transplantation. It underscores the importance of a patient-tailored approach, advances in diagnostic tools, and the necessity for continued research, patient advocacy, and international collaboration to improve outcomes for individuals with rare anemias.

Association of Safety-Net Hospital Status With Outcomes Following Head and Neck Cancer Operations.

To assess perioperative and readmission outcomes of patients undergoing head and neck cancer (HNCA) surgery at safety-net hospitals (SNHs) in a modern cohort. Retrospective cohort study. Nationwide Readmissions Database (NRD), 2010 to 2019. All elective adult (≥18 years) admissions involving HNCA resection were identified from the NRD. To calculate safety-net burden, the proportion of Medicaid or uninsured patients admitted to each hospital for any indication was tabulated annually, with centers in the highest quartile defined as SNHs. To perform risk adjustment in assessing perioperative and readmission outcomes, multivariable regression models were developed. Of an estimated 133,018 head and neck surgical patients, 26.5% (n = 35,268) received treatment at a SNH. Utilization of SNHs increased over the decade-long study period, with 29.8% of individuals treated at these sites in 2019. After multivariable adjustment, several patient factors were noted to be associated with SNHs, including younger age, lower comorbidity burden, and income within the lowest quartile. Although incidence of adverse events decreased at both SNHs and non-SNHs during the study period, treatment at SNHs remained associated with these events after risk adjustment (adjusted odds ratio: 1.17, 95% confidence interval: 1.08-1.28, P < .001). SNHs continue to provide valuable specialty care to underserved populations, often with limited financial resources. Despite promising results from prior decades demonstrating comparable perioperative outcomes, the present study noted increased adverse events following HNCA surgery at these sites. Such findings underscore the need for continued advocacy to secure necessary funding for these centers.

Examining the Utility of the Early Childhood Development Index (ECDI) among Children in the Nigeria Context.

An estimated 6 million children under the age of five in Nigeria (out of nearly 31 million) risk not reaching their full developmental potential. The dearth of context-relevant measures poses a challenge to the planning and implementation of effective interventions. This study assesses the utility of the Early Childhood Development Index (ECDI) in Nigeria. We used the Multiple Indicator Cluster Surveys to track progress among 3- to 4-year-old children (n = 11,073); 3-year-old, 51%; female, 49%. Using random calibration samples, the results from psychometric tests indicate that while over half of the children were on track in their development based on the ECDI, the instrument had low to average internal consistency and weak face validity, suggesting an inadequacy in capturing ECD information of value. At the outset of the launch of the new ECDI2030, the results of this study point to the need for continued discourse and advocacy for the use of culturally appropriate measures of child development, and a child-centered community engagement approach. This is essential in ensuring accountability and responsive interventions for the children served and their families.

Fine-grain Quantitative Analysis of Demand Paging in Unified Virtual Memory

The abstraction of a shared memory space over separate CPU and GPU memory domains has eased the burden of portability for many HPC codebases. However, users pay for ease of use provided by system-managed memory with a moderate-to-high performance overhead. NVIDIA Unified Virtual Memory (UVM) is currently the primary real-world implementation of such abstraction and offers a functionally equivalent testbed for in-depth performance study for both UVM and future Linux Heterogeneous Memory Management (HMM) compatible systems. The continued advocacy for UVM and HMM motivates improvement of the underlying system. We focus on UVM-based systems and investigate the root causes of UVM overhead, a non-trivial task due to complex interactions of multiple hardware and software constituents and the desired cost granularity. In our prior work, we delved deeply into UVM system architecture and showed internal behaviors of page fault servicing in batches. We provided quantitative evaluation of batch handling for various applications under different scenarios, including prefetching and oversubscription. We revealed that the driver workload depends on the interactions among application access patterns, GPU hardware constraints, and host OS components. Host OS components have significant overhead present across implementations, warranting close attention. This extension furthers our prior study in three aspects: fine-grain cost analysis and breakdown, extension to multiple GPUs, and investigation of platforms with different GPU-GPU interconnects. We take a top-down approach to quantitative batch analysis and uncover how constituent component costs accumulate and overlap, governed by synchronous and asynchronous operations. Our multi-GPU analysis shows reduced cost of GPU-GPU batch workloads compared to CPU-GPU workloads. We further demonstrate that while specialized interconnects, NVLink, can improve batch cost, their benefits are limited by host OS software overhead and GPU oversubscription. This study serves as a proxy for future shared memory systems, such as those that interface with HMM, and the development of interconnects.

FIGO position statement on comprehensive sexuality education.

Now is a pivotal moment in the fight for reproductive health and justice internationally. Well-established research has recognized the benefits of comprehensive sexuality education for youth and adolescents-including vast reproductive health benefits, decreased interpersonal violence, and improvements on measures of academic success and well-being. Despite these established benefits, challenges to the implementation of culturally sensitive and holistically framed sexuality education are intensifying across the globe. The International Federation of Gynecology and Obstetrics (FIGO) stands firmly in its support of comprehensive sexuality education and re-emphasizes the importance of the implementation of scientifically accurate, age-appropriate, culturally relevant, and inclusive education. Successful implementation relies on active youth leadership, physician involvement, and a renewed focus on high-quality monitoring mechanisms to assess impact and accountability at all levels. Most importantly, future efforts to improve and scale comprehensive sexuality education must emphasize the importance of an inclusive curriculum that addresses previously marginalized youth, such as LGTBQ+ and disabled individuals, through a reproductive justice lens. FIGO commits, and encourages the international healthcare community, to provide continued advocacy for the rights to health, education, and equality, in order to achieve improvement in health outcomes for young people across the globe.

International Human Rights Law and the Protection of Refugees in the Modern World

Purpose: The main objective of this study was to explore international human rights law and protection of refugees in the modern world.&#x0D; Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.&#x0D; Findings: The findings revealed that there exists a contextual and methodological gap relating to international human rights law and the protection of refugees in the modern world. Preliminary empirical review revealed that while international human rights law serves as a fundamental cornerstone for refugee protection, it is essential to bridge the gap between legal norms and practical implementation. Enhancing the protection of refugees in the modern world requires continued research, advocacy, and concerted efforts at the international, regional, and national levels to ensure that refugees are afforded the rights and dignity they deserve as they seek safety and refuge in an increasingly complex global landscape.&#x0D; Unique Contribution to Theory, Practice and Policy: The Liberalism theory, Constructivism theory and the Critical theory may be used to anchor future studies on the protection of refugees in the modern world. Recommendations made by the study include the following: strengthening implementation and compliance, enhancing regional and international cooperation, addressing root causes and prevention and engaging in legal reforms and adaptation.

Representation of Non-Binary Identities in Feminist Literature of the Early 21st Century: A Literary Critique

This academic paper examines the representation of non-binary identities in early 21st-century feminist literature, focusing on the works Freshwater, An Unkindness of Ghosts, and Middlesex. The analysis explores the nuanced portrayals of non-binary characters, considering the intersections with race, class, and culture. The paper identifies evolving themes throughout the early 21st century, emphasizing the fluidity and complexity of gender in these narratives. Inclusivity is highlighted as foundational to feminist literature, contributing to empowerment and validation for non-binary readers. The impact extends beyond individuals, influencing societal attitudes, challenging stigmas, and catalyzing cultural change. The conclusion emphasizes the need for continued dialogue, intersectional exploration, and advocacy efforts to promote inclusivity in literature and contribute to broader social change.

Kritik Gita Savitri tentang Budaya Patriarki di Media Sosial Youtube: Analisis Feminisme Qāsim Amīn

This article delves into the entrenched patriarchal culture that has long restrained women, perpetuating inequality and giving rise to various social problems. Consequently, there persists a pressing need for continued advocacy to safeguard women’s rights. In today’s technologically advanced era, platforms such as the internet and social media offer unprecedented avenues for communication, serving as potent forums for the exchange of ideas, including critiques of patriarchal norms. One such example is feminist activist Gita Savitri, who utilizes the YouTube platform to disseminate her perspectives on diverse social issues about women. This research employs a qualitative descriptive method, conducting analytical inquiries to elucidate the data in alignment with the research objectives. The primary data source comprises Gita Savitri’s YouTube content addressing patriarchal culture, complemented by secondary sources including scholarly literature. The analysis is conducted through the lens of Qāsim Amīn’s feminist theory. Through this examination, the research aims to contribute to a deeper understanding of patriarchal dynamics and the ongoing efforts towards gender equality. The analysis reveals that Gita Savitri’s utilization of YouTube as a platform facilitates the dissemination of feminist discourse, and the research identifies the emergence of counter-narratives within online spaces, challenging traditional patriarchal ideologies and promoting alternative perspectives on gender roles and societal norms.

Examining Utilization of an Outpatient Telenutrition Service Across Primary Care Clinics in South Carolina.

Introduction: Limited research exists on outpatient telenutrition, and more evidence is needed on service utilization and program evaluation. This study explored service utilization trends and patterns of the Medical University of South Carolina (MUSC) Outpatient Telehealth Nutrition (OT Nutrition) service. Methods: De-identified patient service utilization data were obtained from MUSC's OT Nutrition administrative files (2012-2020). Service utilization (referrals, visits scheduled, consultations, no-shows, no-show rate) was measured at the clinic level and stratified by patient type (adult/pediatric) and clinic rurality (rural/urban). Data were analyzed using descriptive statistics and a K-means cluster analysis. Results: Service utilization (2012-2020) reflected 6,212 referrals, 3,993 visits scheduled, and 2,880 consultations across 56 clinics. Yearly utilization trends showed high variability with no statistically significant differences observed on univariate comparisons of patient type or clinic rurality. The introduction of the Direct-To-Consumer modality mitigated a 36.7% decrease in consultations during the COVID-19 pandemic in 2020. Results of a K-means cluster analysis (p < 0.001) indicated 7% (n = 4) of clinics were very high and high utilizers, 36% (n = 21) were moderate and low utilizers, and 53% (n = 31) were very low utilizers. Discussion: Telenutrition can be delivered effectively to patients without requiring travel outside patients' medical homes or residences. Although continued advocacy is necessary for South Carolina to expand telenutrition coverage, more research is needed to evaluate the OT Nutrition service. Cluster analysis is an effective tool for identifying statistically significant groupings of clinics based on service utilization and could be used with implementation science in future program evaluation.

The impact of staging FDG-PET/CT on treatment for stage III NSCLC - an analysis of population-based data from Ontario, Canada.

Fluoro-2-deoxyglucose positron-emission tomography (FDG-PET/CT) is now considered a standard investigation for the staging of new cases of stage III NSCLC. However, there is not published level 3 evidence demonstrating the impact of FDG-PET/CT on appropriate therapy in this setting. Using retrospective population-based data, we sought to examine the role and timing that FDG-PET/CT scans play in influencing treatment choice, as well as survival in patients diagnosed with stage III NSCLC. A retrospective cohort of patients diagnosed with stage III NSCLC from 2009-2017 in Ontario were identified from the IC/ES (formerly Institute of Clinical Evaluative Sciences) database. FDG-PET/CT utilization over time, trends in mediastinal biopsy technique and usage, the impact of FDG-PET/CT on overall survival (OS), and its influence on use of concurrent chemoradiotherapy (CRT) were explored. The impact of timing of pre-treatment FDG-PET/CT on OS was also analyzed (≤28 days prior to treatment, 29-56 days prior, and >56 days prior). Between 2007 and 2017, a total of 13 796 people were diagnosed with stage III NSCLC in Ontario. FDG-PET/CT utilization increased over time with 0% of cases in 2007 and 74% in 2017 with pre-treatment FDG-PET/CT scans. The number of patients who received a mediastinal biopsy similarly increased in this timeframe increasing from 41% to 53%. More patients with pre-treatment FDG-PET/CT scans received curative-intent therapy than those who did not: 23% vs 13% for CRT (p<0.001), and 23% vs 10% for surgery (p<0.001). Median OS was longer in those with FDG-PET/CT scans prior to treatment (17 vs 11 months), as was 5-year survival (22% vs 14%, p<0.001), and this held true on both univariate and multivariate analyses. Timing of FDG-PET/CT scan relative to treatment was not associated with differences in OS. Improvements in OS were seen in this cohort of stage III NSCLC patients who underwent a pre-treatment FDG-PET/CT scan. This can likely be attributed to stage-appropriate therapy due to more complete staging using FDG-PET/CT. This study stresses the importance of complete staging for suspected stage III NSCLC using FDG-PET/CT, and a need for continued advocacy for increased access to FDG-PET/CT scans.