Relative Priority Research Articles

Stereotactic Body Radiation Therapy of Ventricular Tachycardia Using 4pi-Optimized Arc Trajectories

To investigate dose sparing of organs at risk (OARs) by using 4pi-optimized arc trajectories in stereotactic body radiation therapy for treating ventricular tachycardia (VT-SBRT).Computed tomography (CT) datasets of the thorax of 15 patients were used for contouring and planning. A 4pi algorithm was implemented into a treatment planning system via a specific program for generating the optimized trajectories. Optimization is based on geometric penalty of arc overlap with OARs, weighted by relative OAR priority. Following VMAT optimization applied to optimized trajectories, dosimetric results were compared to a conventional trajectory (two full arc) plans.On average, a significant reduction in maximum dose was observed for esophagus (18%), spinal cord (26%) and trachea (22%) with the 4pi-optimized trajectory when compared to the conventional one. Mean doses were also found to decrease for esophagus (19%), spinal cord (33%), skin (18%), liver (59%), lungs (19%), trachea (43%), aorta (11%), inferior vena cava (25%), superior vena cava (33%) and pulmonary trunk (26%). Improvement in dose sparing in terms of median dose was also observed for esophagus (40%), spinal cord (48%), skin (36%), liver (72%), lungs (41%), stomach (45%), trachea (53%), aorta (45%), superior vena cava (38%), pulmonary veins (32%) and pulmonary trunk (39%). No statistically significant differences of maximum dose (P = 0.650) or homogeneity index (P = 0.156) were observed for target volumes. Conformity index was comparable between optimized and non-optimized trajectory plans.While preserving target volume coverage, 4pi-optimized trajectories can provide significant dose reduction to OARs and cardiac substructures especially in terms of mean and median doses. Ours results show that 4pi-optimized arc trajectories represent a promising delivery option for VT-SBRT.

Healthcare organization and management barriers and facilitators for health promotion in primary care

Abstract Background There are challenges in translating evidence-based interventions into practice, and the need for health care organization, management, and policy changes to align with health promotion activities within the health and social care system is well-documented. This study aims to elucidate the role of these factors as barriers/facilitators influencing the implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain. Methods Seven focus groups were conducted with 49 health professionals from 6 primary care centers participating in the Prescribing Healthy Life (PVS) program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management, and policy. Results The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow, and (3) available resources to carry out the program. Specific barriers related to high caseloads, contracting issues, short consultation times, and lack of appointment times for lifestyle counselling. Other barriers/facilitators were related to CFIR constructs networks and communication, culture, relative priority, and leadership engagement. A set of nine specific barriers-facilitators emerged. Conclusions In some centers, certain facilitators addressed barriers identified in other centers influencing implementation of a health promotion intervention in primary care. Proactive identification and modification of barriers by healthcare managers and policy makers can help to ensure effective integration of health promotion into primary care. Key messages Implementation science methods for program evaluation can help identify barriers and facilitators to health promotion implementation in primary care. Policy and incentives, compatibility, available resources, networks and communication, culture, relative priority, and leadership engagement influenced successful health promotion implementation.

Pasture resilience reflects differences in root and shoot responses to defoliation, and water and nitrogen deficits

The yield of a pasture is directly proportional to the amount of light plants intercept and allocate to different organs. When plants are carbon (C) limited, due to defoliation, they allocate more C preferentially to shoots to restore leaf area. In contrast, water and nitrogen (N) limitations lead to a greater allocation of C to roots. Changes in the root:shoot ratio therefore reflect changes in C and N partitioning and indicate their relative priority. A major factor that influences plant responses to stress is their ability to store and remobilise reserves to restore leaf area. Species with tap roots, like lucerne, have a large potential C and N storage capacity that is utilised seasonally for storage and remobilisation. This has been used to develop seasonally based grazing management rules. Similarly, recommendations to graze perennial ryegrass at the 2- or 3-leaf stage are based on the balance between maximizing growth rates and the need to replenish water-soluble carbohydrate reserves. However, perennial ryegrass has lower levels of perennial reserves than other grass species. This reduces its resilience to concurrent water deficits or N deficiency. Under these conditions maintaining the recommended 3-leaf grazing intervals and/or leaving higher post-grazing pasture masses are recommended to assist canopy recovery. Other grass species, such as cocksfoot and tall fescue, provide more resilience, particularly in response to water deficits.

Current Trend of Hydroxychloroquine Research Publications: A Scientometric Analysis

Hydroxychloroquine (HCQ) is one of the extensively used preventive drug in the world. In order to filter out the research strength and weaknesses of research areas of HCQ publications of selective countries, the present study analyses the thematic or subject specialization index, relative priority index, and relative specialization index of hydroxychloroquine research publications from 1989 to 10th June 2020. The top thirty-five productive research areas and fifteen leading countries have been taken for this analysis. The analysis identifies the 209 significant active sub-specialized research areas of the HCQ research of the highest productive countries. India was found to be the most specialized country in Hydroxychloroquine research. Public Environmental Occupational Health is the most specialized research area of HCQ publication. The most significant number of HCQ research publications output is coming under the research areas Rheumatology. The most significant number of research growth was observed in the year 2019. The implications of the study are discussed.

Facilitators and barriers to implementation of Alberta family integrated care (FICare) in level II neonatal intensive care units: a qualitative process evaluation substudy of a multicentre cluster-randomised controlled trial using the consolidated framework for implementation research

ObjectiveTo evaluate the barriers and facilitators to implementing Alberta Family Integrated Care (AB-FICare [2019 Benzies]), a model of care for integrating parents into level II neonatal intensive care units (NICUs)...

고교야구단 숙박결정권자가 고려하는 호텔 선택속성 연구: 비즈니스호텔에 적용가능한 국내 단체고객을 중심으로

The study aims to derive the relative importance and priority between the hotel selection attributes that the decision makers who decide where to stay preferentially consider when the high school baseball team conducts camp training. To achieve this research goal, In-Depth Interview was conducted with 15 people responsible for hotel decisions, including head coaches and chief coaches. As a result, 47 hotel selection attributes judged to be important were derived. Based on this, as a result of using AHP analysis, it was found that secure parking spaces for large buses (10.64%) as the most significant, followed by consideration for the distance to the stadium(9.63%), extension of stay according to the result of the game (9.39%), past experience with the hotel (6.82%), environment around the hotel (4.43%), providing various types of rooms (4.33%), hotel structure that is easy to control the team (4.18%), convenience of laundry (3.59%), and independent room allocation for baseball teams (3.55%) appeared as important. Recently, due to COVID-19, hotel occupancy is declining. This study has the meaning of presenting the merits of the market that have not been noted so far, and suggesting the necessity and importance of research on the high school baseball team in the hospitality industry. The results offers a compelling insight to utilize in product composition, marketing strategies, and decision making for high school baseball market in the future.

The Global Impact of COVID-19 on the Care of People With Endometriosis.

Endometriosis is a chronic condition affecting ~10% of women globally. Little is known about the impact of the coronavirus disease 2019 (COVID-19) pandemic on their care. This brief report is aimed to explore the impact of COVID-19 on the care of people with endometriosis around the world, their priorities in relation to their clinical care during and coming out of the pandemic, and whether they believed that endometriosis makes them more vulnerable to COVID-19. An internet-based survey collected data in five languages between May 11, 2020, and June 8, 2020. Only participants with a surgical or radiological diagnosis of endometriosis aged 18 years or over were included. A total of 6,729 eligible respondents completed the survey with 80.7% [95% CI (79.7, 81.6)] reporting a negative impact on their care. This included difficulties obtaining medication (20.3%), cancelled/postponed gynaecology appointments (50.0%), and cancelled/postponed procedures (37.2%). More than half worried that their endometrioses make them more vulnerable to COVID-19 [54.2%; 95% CI (53.0, 55.4)]. The top three priorities were remarkably consistent around the world: contact with gynaecologists, knowing when procedures would be performed, and support with mental health (20.3% prioritising this aspect during the pandemic and 13.0% as restrictions begin to ease). This study shows the substantial impact the COVID-19 pandemic has had on people with endometriosis and describes how they would like care prioritised moving forwards. The findings regarding significant support needs for mental health add further weight to the growing recognition of attending to such issues as part of good patient-centred care.

Evaluation of the effect of compensatory behavior of planting density, mother corm weight and planting depth on vegetative characteristics and yield of saffron (Crocus.sativus L.)

In order to investigate the effect of compensatory behavior of planting density, corm weight and planting depth on vegetative characteristics and yield of saffron stigma (Crocus. Sativus L.), a factorial split plot experiment with a randomized complete block design with three replications in the research center and Agricultural education and natural resources of Khorasan Razavi (Gonabad Research Station) was conducted in the cropping years 2018-2020. In this study, planting density treatment (in four levels of 60, 90, 120 and 150 corms per square meter) in the main plot and factorial planting depth (in two levels of 15±2 and 25±2 cm from the soil surface) and corm weight (in two Levels 4± 1 and 8 ± 1 gr) were located in the subplot. The results showed that increasing the density from 60 to 150 corms per square meter caused a significant increase in flower number, flower fresh weight and stigma dry weight, number of plants, number of leaves per plant, average length of a leaf and total leaf length per square meter. Accordingly, increasing the weight of coriander from 4 to 8 gr significantly increases flower number, flower fresh weight, stigma dry weight, number of plants, number of leaves per plant, average length of a leaf, total leaf length per square meter and total Leaf length per plant in the first and second years and reduced flower number, flower fresh weight and stigma dry weight in the third year. The results also showed that increasing the planting depth from 15 to 25 cm caused a significant decrease in all studied traits of saffron. The effect of dual and triple interactions on the studied traits was mainly significant. Overall, the results showed that the use of larger mother corms has a relative priority only in the early years and the importance of its effect decreases with increasing farm age. Based on this, it seems that it is possible to have a different strateg and with a combination of less depth and especially more density to compensate for the effect of corm weight and achieved more overall performance.

Identifying and understanding the contextual factors that shaped mid-implementation outcomes during the COVID-19 pandemic in organizations implementing mental health recovery innovations into services

BackgroundSeven housing and health services organizations were guided through a process of translating Chapter Six of the Canadian Guidelines for Recovery-Oriented Practice into a recovery-oriented innovation and plan for its implementation. At the time of the COVID-19 outbreak and lockdown measures, six of the seven organizations had begun implementing their chosen innovation (peer workers, wellness recovery action planning facilitator training, staff training and a family support group). This mid-implementation study used the Consolidated Framework for Implementation Research (CFIR) to identify contextual factors that influenced organizations to continue or postpone implementation of recovery-oriented innovations in the early months of the COVID-19 pandemic.MethodsTwenty-seven semi-structured 45-min interviews were conducted between May and June 2020 (21 implementation team members and six providers of the innovation (trainers, facilitators, peer workers). Interview guides and analysis were based on the CFIR. Content analysis combined deductive and inductive approaches. Summaries of coded data were given ratings based on strength and valence of the construct’s impact on implementation. Ratings were visualized by mid-implementation outcome and recovery innovation to identify constructs which appear to distinguish between sites with a more or less favorable mid-implementation outcomes.ResultsFour mid-implementation outcomes were observed at this snapshot in time (from most to least positive): continued implementation with adaptation (one site), postponement with adaptation and estimated relaunch date (four sites), indefinite postponement with no decision on relaunch date (one site), and no implementation of innovation yet (one site). Two constructs had either a negative influence (external policies and incentives—renamed COVID-19-related external policy for this study) or a positive influence (leadership engagement), regardless of implementation outcome. Four factors appeared to distinguish between more or less positive mid-implementation outcome: adaptability, implementation climate and relative priority, available resources, and formally appointed internal implementation leaders (renamed “engaging implementation teams during the COVID-19 pandemic” for this study).ConclusionsThe COVID-19 pandemic is an unprecedented outer setting factor. Studies that use the CFIR at the mid-implementation stage are rare, as are studies focusing on the outer setting. Through robust qualitative analysis, we identify the key factors that shaped the course of implementation of recovery innovations over this turbulent time.

Barriers and facilitators in the implementation of an evidence-based health promotion intervention in a primary care setting: a qualitative study.

This study aims to elucidate the health care organization, management and policy barriers and facilitators associated with implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain. Seven focus groups were conducted with 49 health professionals from six primary care centers participating in the Prescribing Healthy Life program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management and policy. The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow and (3) available resources to carry out the program. Specific barriers in these areas related to lack of financial and political support, consultation time constraints and difficulty managing competing day-to-day demands. Other barriers and facilitators were related to the constructs networks and communication, culture, relative priority and leadership engagement. A set of six specific barrier-facilitator pairs emerged. Implementation science and, specifically, the CFIR constructs were used as a guide. Barriers and facilitators related to the implementation of a health promotion program in primary care were identified. Healthcare managers and policy makers can modify these factors to foster a more propitious implementation environment. These factors should be appropriately monitored, both in pre-implementation phases and during the implementation process, in order to ensure effective integration of health promotion into the primary care setting.

Provider Barriers and Facilitators of Breast Cancer Guideline-Concordant Therapy Delivery in Botswana: A Consolidated Framework for Implementation Research Analysis.

IntroductionSystemic treatment for breast cancer in sub‐Saharan Africa (SSA) is cost effective. However, there are limited real‐world data on the translation of breast cancer treatment guidelines into clinical practice in SSA. The study aimed to identify provider factors associated with adherence to breast cancer guideline‐concordant care at Princess Marina Hospital (PMH) in Botswana.Materials and MethodsThe Consolidated Framework for Implementation Research was used to conduct one‐on‐one semistructured interviews with breast cancer providers at PMH. Purposive sampling was used, and sample size was determined by thematic saturation. Transcribed interviews were double‐coded and analyzed in NVivo using an integrated analysis approach.ResultsForty‐one providers across eight departments were interviewed. There were variations in breast cancer guidelines used. Facilitators included a strong tension for change and a government‐funded comprehensive cancer care plan. Common provider and health system barriers were lack of available resources, staff shortages and poor skills retention, lack of relative priority compared with HIV/AIDS, suboptimal interdepartmental communication, and lack of a clearly defined national cancer control policy. Community‐level barriers included accessibility and associated transportation costs. Participants recommended the formal implementation of future guidelines that involved key stakeholders in all phases of planning and implementation, strategic government buy‐in, expansion of multidisciplinary tumor boards, leveraging nongovernmental and academic partnerships, and setting up monitoring, evaluation, and feedback processes.DiscussionThe study identified complex, multilevel factors affecting breast cancer treatment delivery in Botswana. These results and recommendations will inform strategies to overcome specific barriers in order to promote standardized breast cancer care delivery and improve survival outcomes.Implications for PracticeTo address the increasing cancer burden in low‐ and middle‐income countries, resource‐stratified guidelines have been developed by multiple international organizations to promote high‐quality guideline‐concordant care. However, these guidelines still require adaptation in order to be successfully translated into clinical practice in the countries where they are intended to be used. This study highlights a systematic approach of evaluating important contextual factors associated with the successful adaptation and implementation of resource‐stratified guidelines in sub‐Saharan Africa. In Botswana, there is a critical need for local stakeholder input to inform country‐level and facility‐level resources, cancer care accessibility, and community‐level barriers and facilitators.

Student Leaders Today, Professional Leaders Tomorrow

One of the core missions of the IEEE Engineering in Medicine and Biology Society (EMBS) is to be a platform for enhancing the personal and professional development of its members. This month we focus on two related priority areas of the IEEE EMBS Student Activities Committee (SAC) [1], namely Leadership Development and Professional Development Portfolios, and bring you up close to the student and professional leaders actively building these programs. The Leadership Development Portfolio, currently led by Agnieszka Łach from Silesian University of Technology, Gliwice, Poland, focuses on nurturing and supporting student leaders of the EMBS globally. The Professional Development Portfolio, currently led by Josée Rosset from the University of Manitoba, Winnipeg, MB, Canada, aims to help EMBS student members develop their skills and experiences in the practice of biomedical engineering.

The Chinese Way of Reforming Global Economic Governance: An Analysis of China’s Rising Role in the Group of Twenty (G-20)

Since the Global Financial Crisis engulfed much of the world in 2008, the Group of Twenty (G-20) has emerged as the self-acclaimed “premium forum” for international economic cooperation and policy coordination. The ascendency of G-20, of which China is a part, indicates the world’s preference for a more inclusive and informal economic governance model, moving away from the relatively restrictive Group of Seven (G-7) and the legalized Bretton Woods settings. This article analyzes China’s participation and increasingly critical role in the G-20. China’s main priorities in relation to the G-20 evolved over time. The initial focuses on containing financial contagion and reforming Bretton Woods institutions were followed by attempts to resolve bilateral trade issues with the US and to fight the Coronavirus Disease 2019 (COVID-19) pandemic. China aspires to transform the G-20 from an ad hoc crisis management platform to one promoting proactive long-term global policy cooperation, partly in support of “a community with shared future for humanity” and the Belt and Road Initiative. However, public distrust of international economic interdependence, populist backlash against neoliberal globalization, as well as geopolitical, ideological, technological tussles between China and the West collectively present significant challenges to the G-20.

Modern communications technology: An essential tool for optimizing hospital operations and improving outcomes.

An ability to rapidly convert data from multiple different sources into actionable information is embodied in a concept called Real-time Health Systems (RTHS). The foundational component of RTHS is a modern Clinical Communication and Collaboration (CC&C) Platform, which translates organizational knowledge into action. Effective communication is the key. A CC&C Platform that can receive data from multiple hospital systems, analyze the data, arbitrate any resulting actions and determine the relative priorities to distribute work to the right person or teams-can lead to improved operational efficiencies and better patient outcomes.

Monte Carlo method for uncertainty evaluation of noise annoyance prevalence

When a decision-making process relies on the information provided by a measurement or simulation result, the right decision demands a good quality result, in other words, a low uncertainty result. In order to establish public policies for environmental noise control, it is essential to identify the impact of each type of noise pollution (e.g. road, aircraft and rail transportation noise) on the population affected. One of the noise impact metrics that can be used is the number of highly noise annoyed people in a region whose estimated value is obtained from the corresponding exposure-response function and noise and population density maps. However, an estimated value of the noise impact metric with high uncertainty makes it difficult to realize the actual severity of the problem and its priority in relation to other public health issues. In this work, a Monte Carlo simulation method is used to assess the uncertainty of a noise impact metric result, namely the number of people highly disturbed by road noise in a city. This article also presents a sensitivity analysis of uncertainty sources that allows quantification of the main uncertainty components, which supports improvements in noise impact metric results.

Evaluating the Implementation of a Multicomponent Intervention Consisting of Education and Feedback on Reducing Benzodiazepine Prescriptions by General Practitioners: BENZORED Hybrid Type I Cluster Randomized Controlled Trial.

Background: General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited, and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type-1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze the facilitators and barriers regarding the implementation of the intervention in primary care settings. Methods: A qualitative interview study with 40 GPs from three Spanish health districts. Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate, and analyze the data. Results: Three of the 41 CFIR constructs strongly distinguished between high and low implementers: the complexity of the intervention, the individual Stage of Change, and the key stakeholder’s engagement. Seven constructs weakly discriminated between the two groups: adaptability in the intervention, external policy and incentives, implementation climate, relative priority, self-efficacy, compatibility, and engaging a formally appointed implementation leader. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation. Conclusions: We identified constructs that could explain differences in the efficacy in implementation of the intervention. This information is relevant for the design of successful strategies for implementation of the intervention.

Evaluation and Analysis of Risk Factors in FMEA Welding Workshops in Zabol City

Background: Welding process is classified as one of the most widespread and widely used activities in industrial environments. Welding is one of the risky professions and the workers working in this sector are exposed to many risks. Identifying and evaluating the existing risks and managing them plays an important role in maintaining the health of workers and making their work environment healthier. The purpose of this study was to identify and evaluate the hazards caused by the use of devices in the welding process using the FMEA method in welding workshops in Zabol in 2021. Methods: This cross-sectional analytical study was performed on 77 welding workshops in Zabol. In this study, in the first step, the main risks in welding workshops were identified and based on FMEA logic, for each risk caused by the machines, three indicators of severity, probability and vulnerability were identified. Specified. Then the prioritization criterion was determined and based on the number obtained from the RPN index, the risks were prioritized. Results: The findings of this study showed that in terms of risk priority in welding workshops, the highest risk priority number (RPN) with 175 is related to welding pliers (and heating of the handle due to loss of handle insulation) and drill (breaking the drill due to use Improper drill and high pressure to the machine) and the lowest risk priority number (RPN) with a value of 12 related to the millstone handle (wasting of the screw connecting the handle to the body due to lack of timely service). The results also showed that the risk priority factor various factors affecting the severity of the hazard, including: breaking the saw blade, burning the welding lathe and hitting the pliers by hand in the welding machine also had high relative priorities. Conclusion: The results showed that based on the number of risks, a scheduled and regular schedule by labor inspectors and health centers and other related organizations to implement engineering control measures including control of chemical, physical, safety and ergonomic factors in the environment of welding workshops. Educate the employers of the workshops to get acquainted with the provisions of the labor law in welding and observe the mandatory laws, the need to use personal protective equipment, to be included in the list of strategic and practical programs.

Optimal Combination Control Technology of Demand Side Resources of Distributed Renewable Energy Power Generation

The paper proposes a new unit commitment model that can promote car-bon emission reduction in distributed renewable energy power systems. Themodel first comprehensively considers the optimal combination of low-carbon demand-side resources such as supply-side resources and demandresponse, electric vehicles, and distributed renewable energy power gener-ation. Secondly, the model unit scheduling rules fully consider the carbonemission target and the economic target and propose a fuzzy dual-objectiveoptimization method that can consider the relative priority of the target. Whensolving the optimization model, we improved the particle swarm optimizationalgorithm. We introduced the “cross” and “mutation” operators in the geneticalgorithm to improve the particle swarm algorithm’s global optimizationcapability. The paper verifies the effectiveness of the model and algorithmthrough the analysis of a ten computer system.

A Study on the Strategic Decision Making Used in the Revitalization of Fishing Village Tourism: Using A’WOT Analysis

As society has developed, fishing villages that have relied solely on traditional fishing have found themselves on the verge of extinction. Therefore, efforts are being made to transform fishing villages into areas with various functions including recreation, tourism, and education. In this regard, the main purpose of this study is to analyze the relative importance and priorities of the multi-criteria decision-making (MCDM) process used in the revitalization of fishing village tourism. To this end, the A’WOT (AHP/SWOT) hybrid approach, developed in combination with the SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis and the AHP (Analytic Hierarchy Process) method, was used to determine the significant factors. The results of the study demonstrated that the ‘opportunities’ and ‘strengths’ areas are relatively important when it comes to the priority of sustainable development. We also identified the high importance in terms of global weight of both ‘Increased demand for leisure, rest and ecotourism’ and ‘Possession of natural resources of diverse and distinctive fishing villages by sea and region’ as sustainable ways to revitalize fishing communities. This study demonstrates that with appropriate data and an applicable systematic process, the A’WOT approach can adequately show where intervention is most needed. The study shows that the application of tourism in the current context has the potential to approach the issue of fishing village tourism. Furthermore, this study is meaningful in that it quantifies the importance of fishing village tourism attributes by using a systematic approach, and it concludes with suggesting where the emphasis should be placed on policy and strategy.

Abstract 55: Cervical Cancer Prevention in sub-Saharan Africa: A Policy Analysis

Abstract Purpose: We analyzed the presence and comprehensiveness of cervical cancer control policies in sub-Saharan Africa, where cervical cancer is the leading cause of cancer death for women. Methods: Publicly-available policies for primary, secondary, and tertiary cervical cancer prevention were collected, and scored for comprehensiveness based on elements included (e.g. vaccination schedule and target age, screening age interval and strategy, precancerous lesion removal method, cancer treatment approach, and presence of palliative care) (summed score, possible range 0- 12). We compared the median number of policy points for countries based on policy environment (availability of other non-communicable disease policy), health financing (external and domestic health expenditures), economic status (poverty prevalence and income inequality), health outcomes (life expectancy, HIV prevalence, cervical cancer mortality), and sub-region. Results: Policies from 47 countries in sub-Saharan Africa were analyzed. Policies were generally most comprehensive for secondary and primary prevention; only 19 countries had any tertiary prevention policy. It was more common for policies to include information about target age (for primary and secondary prevention), vaccine schedule, and screening method, and less common to include information about awareness-raising or accompanying behavior change approaches. Countries with greater external financing for health had more comprehensive cervical cancer policies, as did countries with higher HIV prevalence. Conclusion: Cervical cancer control policies in Africa are highly variable in comprehensiveness. External factors, like the role of global donors, and internal factors, like local disease burden, may influence relative priority of cervical cancer prevention and therefore affect policy comprehensiveness. Future research should use mixed methods to explore reasons for this variation and identify areas for policy strengthening. Citation Format: Rifa Akanda, Corrina Moucheraud. Cervical Cancer Prevention in sub-Saharan Africa: A Policy Analysis [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 55.