Equal Access Research Articles

Socioeconomic background and childhood cancer survival in Germany – A nationwide register study

Abstract Introduction Evidence is accumulating that not all children with cancer have benefitted equally from diagnostic and therapeutic improvements and that socioeconomic conditions are also associated with prognosis - even in high-income countries where equal access to healthcare is presumed. We investigated the association between area-based socioeconomic background and childhood cancer survival in Germany with the ultimate aim to identify groups of children that may benefit from supportive interventions. Methods We identified all children with a first cancer diagnosis before the age of 15 years in 1997-2016 from the German Childhood Cancer Registry (N = 35,443). Based on individual residential address information (at diagnosis) we applied the German Index of Socioeconomic Deprivation as measure of area-based socioeconomic background. Using Cox proportional hazards models, we assessed the association between absolute area-based socioeconomic deprivation (AASD) and ten-year overall survival (OS) to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI). Results The Cox analysis (adjusted for diagnostic year, birth year and place of residence) revealed a null association for AASD and OS from all cancers combined (HR = 1.00, 95% CI 0.97; 1.03). Among children diagnosed with acute myeloid leukemia and germ cell tumors, a higher AASD (implying more severe levels of deprivation) was associated with worse survival, particularly pronounced in boys (HR = 1.18, 95% CI 1.01; 1.37; HR = 1.67, 95% CI 1.13; 2.45, respectively). The opposite was observed for childhood CNS tumours, yielding worse survival by decreasing AASD (HR = 0.93, 95% CI 0.88; 0.98) for both malignant and non-malignant CNS tumours. Conclusions Contrary to reports from other European countries, we found little evidence for pronounced social inequalities in childhood cancer survival in Germany based on a composite score, with inconsistent patterns across cancer types and age at diagnosis. Key messages • We found little evidence for pronounced social inequalities in childhood cancer survival in Germany on the area-based level. • Our findings indicated inconsistent patterns of social inequalities across cancer types and age at diagnosis.and age at diagnosis.

Global health

Abstract Global health emphasizes the importance of addressing health challenges that transcend national borders and require strong international collaboration and governance. This concept is grounded in collaborative transnational actions aimed at promoting health for all, reducing disparities, and protecting against threats. Strengthening health systems, public health infrastructure, improving health service delivery, and ensuring equal access to healthcare for all are key focus areas in global health. This plenary will address several major health challenges and critical issues, such as the rising burden of non-communicable diseases, re-emerging pandemics, environmental threats, and the suboptimal responses of national healthcare systems to manage these challenges. The need to focus on vulnerable and marginalized populations, particularly those affected by migration and ethnicity, will be highlighted. The discussion will also showcase the importance of including ethnic minority and Indigenous people’s perspectives in health policy and decision-making processes, as well as addressing the social determinants of health that disproportionately affect these communities. Central to the discussion on global health is the role of global health policy and diplomacy, focusing on how countries can collaborate to address health threats and challenges, shaping international strategies and frameworks. Innovation, including reverse innovation and the development of evidence-informed policies and effective public health strategies that can be implemented globally and is relevant also in resource-constrained contexts, is another critical aspect in addressing the intersection of health and development. Finally, strong public health leadership is needed to shape practices and policies, as well as fostering the next generation of global health leaders. The multifaceted nature of global health calls for a comprehensive approach to health—one that integrates policy, leadership, and equity into the core of public health strategies. The integration of health into all policies at the global level is vital for creating supportive environments, policies, services, and communications that promote better health for all. Moderators Iveta Nagyova President EUPHA Henrique Barros President ASPHER Speakers/Panellists Emma Rawson Te Patu President World Federation of Public Health Associations Charles Agyemang Professor of Global Migration, Ethnicity & Health, University of Amsterdam, Netherlands Agnès Buzyn Former Minister of Health and Social Affairs, France Moredreck Chibi Public Health Innovation Lead, WHO Regional Office for Europe

The Role of Artificial Intelligence (AI) in Personalized Learning: A Case Study in K-12 Education

This study investigated the mediating role of artificial intelligence (AI) in intensifying personalized learning in K-12 education by employing qualitative case research. The study examines how an AI deployed within a K-12 school changes the engagement, academic performance, and role of teachers through its implementation. Results show that AI tools lead to large improvements in student achievement through personalized learning paths, increased engagement, and the immediacy of feedback. Nevertheless, challenges including data privacy ponderings and the digital gap are significant insights for educators to consider as well. The report suggests guidelines for policymakers and practitioners to ensure the productive application of AI in personalized learning, including equal access to technology and continuous teacher upskilling.

INNOVATIONS IN HUMAN RESOURCE MANAGEMENT IN THE PUBLIC SECTOR OF UKRAINE

The article examines the characteristics of innovations in human resource management within Ukraine’s public sector. It defines the concept of innovation in human resource management as the introduction of new ideas, methods, technologies, and processes aimed at enhancing the efficiency and effectiveness of managing human resources. The importance of studying this topic is highlighted, particularly in light of the need for the public sector and government bodies to adapt to the demands of wartime and the socio-political crisis, as well as the necessity to develop a strategy for advancing the public sector through the implementation of various international agreements. The main objective of the study is to analyze the specific features of introducing innovations in the human resource management system of Ukraine’s public sector. This includes identifying successful practices for implementing electronic systems, key areas for the digitalization of public administration, and promising research directions. The study demonstrates that several organizational, technological, and social variables influence the interactions between employees, management, and other stakeholders. For instance, technological innovations enable the automation of HR processes (e.g., talent management systems, HR analytics, electronic document management platforms) and the use of online tools for employee training and development (e-learning, webinars). Organizational innovations promote the adoption of new management models. The study highlights several priority areas for further development: strategic communications in public policy, shaping the corporate culture of government agencies, defining their mission, strategic goals, values, and vision; fostering innovative leadership; developing horizontal connections within organizations through innovation; and ensuring principles such as fairness, transparency, openness, and equal access through the digital transformation of public administration.

A Comparison Between Chinese and American Education Models Based on Case Study of Education Assistance in China and Inclusive Education in the United States

Abstract: Educational inequity has always been an issue that needs to be addressed in every country. However, due to the differences in social backgrounds and educational systems, the approaches taken by China and the United States are not the same. This study compares the differences in education between China and the United States through the research methods of case study and literature review, based on the study of the policies and programs of China and the United States to address this issue. China's educational assistance has narrowed the urban-rural education gap in a short period of time, and there is instability in teaching resources. Teachers' teaching skills need to be improved and educational resources optimized to ensure that the benefits of educational assistance are maximized. In the United States, inclusive education aims to ensure that all children have equal access to education, but there are still problems in practice, and there is a need to strengthen the protection of minorities so as to ensure a balanced allocation of teaching resources.

Oncogenic Alterations, Race, and Survival in US Veterans with Metastatic Prostate Cancer Undergoing Somatic Tumor Next Generation Sequencing.

National guidelines recommend next generation sequencing (NGS) of tumors in patients diagnosed with metastatic prostate cancer (mPCa) to identify potential actionable alterations. We sought to describe the spectrum and frequency of alterations in PCa-related genes and pathways, as well as associations with self-identified race/ethnicity, and overall survival in US Veterans. This retrospective cohort study included Non-Hispanic Black (NHB) and Non-Hispanic white (NHW) Veterans with mPCa who obtained NGS through the Veterans Affairs National Precision Oncology Program. 45 genes in seven canonical or targetable mPCa pathways were evaluated in addition to TMB and MSI status. Multivariable logistic regression evaluated associations between race/ethnicity and genomic alteration frequencies. Cox proportional hazards models were used to determine associations between race/ethnicity, specific gene/pathway alteration, and overall survival. 5,015 Veterans with mPCa who had NGS conducted were included (1,784 NHB, 3,231 NHW). NHB Veterans were younger, had higher PSA at diagnosis, were less likely to report Agent Orange exposure, and resided in more deprived neighborhoods compared to NHW Veterans. Nine of the top ten most commonly altered genes were the same in NHB v NHW Veterans; however, the frequencies of alterations varied by race/ethnicity. NHB race/ethnicity was associated with higher odds of genomic alterations in SPOP (OR 1.7 [1.2-2.6]) as well as immunotherapy targets (OR 1.7 [1.1-2.7]) including MSI high status (OR 3.1 [1.1-9.4]). Furthermore, NHB race/ethnicity was significantly associated with lower odds of genomic alterations in the AKT/PI3K pathway (OR 0.6 [0.4-0.7]), AR axis (OR 0.7 [0.5-0.9]), and tumor suppressor genes (OR 0.7 [0.5-0.8]). Cox proportional hazards modelling stratified by race/ethnicity demonstrated alterations in tumor suppressor genes including TP53 were associated with shorter OS in both NHB (HR 1.54 [1.13-2.11] and NHW individuals (HR 1.52 [1.25-1.85]). In the equal access VA healthcare setting, Veterans undergoing NGS for mPCa exhibited differences in alteration frequencies in both actionable and non-actionable pathways that may be associated with survival. This analysis affirms the utility of genomic testing for identifying candidates irrespective of race/ethnicity for precision oncology treatments, which could contribute to equitable outcomes in patients with mPCa.

The lived experiences of Women's identities and intersections in accessing social justice within the Ghanaian informal legal system: A phenomenological investigation

In sub-Saharan Africa, there is insufficient formal justice infrastructure in many countries, so informal courts play a significant role. This paper examines the intersections of women's identities and access to social justice within Ghana's informal court system. Using an exploratory qualitative research approach, the study involved 15 women who utilised the informal court system. Findings indicate that traditional gender roles, social harmony-based adjudication, and the social consequences of court decisions on family households hinder women's access to justice. While these courts are accessible and affordable, their decisions primarily focus on reconciliation, failing to provide women with equal access to social justice. The study emphasizes the need for promoting gender equity, enhancing fairness in informal justice mechanisms, and creating supportive environments for women's access to justice. It suggests socio-legal reforms to address socio-cultural barriers and promote gender equality within informal justice systems.

SOCIAL POLICY IN THE PUBLIC ADMINISTRATION SYSTEM: ENSURING EQUAL ACCESS TO SOCIAL SERVICES

he article explores current issues of social policy within the public administration system of Ukraine in the context of decentralization, focusing on ensuring equal access to social services for all population groups. The relevance of the research is driven by the need to adapt social policy to new challenges. Key problems identified include socio-economic instability and the consequences of the war. The objective is to identify the main problems and factors affecting the effectiveness of social services delivery. The research aims to find ways to improve social policy at the regional level. The study employs methods such as comparative analysis, statistical review, index-based approach, and social service efficiency evaluation methodology. A comparative analysis of countries like Sweden, Germany, France, and Estonia revealed effective approaches to organizing social policy, with their practices partially applicable in today’s Ukraine. The research results indicate that decentralization has expanded the financial and organizational autonomy of local communities. The war’s impact has been significant, leading to reduced institutional capacity of authorities, the destruction of social infrastructure, and workforce shortages. The article proposes a conceptual model for assessing equal access to social services, which includes five key components: social capital, economic potential, infrastructure, governance level, and digital capabilities. This model enables the evaluation of access to social services based on objective indicators while accounting for regional specificities. The practical application of this model will help identify strengths and weaknesses in social policy at the local level and determine priority areas for future development. The conclusions emphasize that improving the mechanisms of financing, organizing, and monitoring social service delivery is a crucial task today. A key consideration is the specific characteristics of regions and contemporary challenges. Future research prospects include developing new approaches to evaluating the effectiveness of social services. Additionally, future studies should focus on examining the impact of digitalization on access to social services and integrating international experience to enhance the resilience of Ukraine’s social system.

Legal Review of Legal Protection of People with Mental Disorders (ODGJ) Against Medical Actions based on Human Rights Principles

Every international human rights convention is based on the same principles that underlie health care. These principles include the following three fundamental ideas: equality, non-discrimination, and government obligations. Everyone has a fundamental right to mental health care, including those who are sick (ODGJ). Government funding is available for mental health institutions, mental health professionals, and mental health equipment so that ODGJ have equal access to treatment. This type of research is known as normative legal research, which analyzes and investigates the norms, doctrines, or principles of legal science by discussing legal issues and attempting to determine the basic concepts of certain legal events, relationships, rights, and legal entities in codified and structured law. A conceptual and legislative approach was taken in this study.

The Lau decision and the San Diego National Origin Desegregation Assistance Center

ABSTRACT This article documents the San Diego National Origin Desegregation Assistance Center (NODAC), one of the nine national centers established by the U.S. Office of Education to provide technical assistance to school districts cited under Section 601 of Title VI, from the Office for Civil Rights, to meet the Lau compliance requirement based on the Lau v. Nichols Supreme Court decision (Title VI. 42 U. S. C). Additionally, it provides insights into the ideological and political challenges and triumphs of implementing federal mandates for educational equity. The focus of this article is on the San Diego NODAC which provided technical assistance to the Southern California area consisting of 10 counties with the highest concentration of national origin students in the nation. This evaluation case study documents the work, process, and impact, of the San Diego NODAC and reflects on the enforcement of the Lau Task Force Remedies under the Region IX U.S. Office of Civil Rights, the process used by the NODAC, and the organizational receptivity and perceptions of school districts personnel responsible for coordinating compliance at or beyond minimal compliance. This article concludes with an evaluation process using lessons learned by the NODAC based on more than a decade of work and advocacy for students’ equal access to opportunity, quality bilingual education, and democratic schooling.

Bereaved parents' perceptions of their cancer-ill child's last month with or without palliative care -a nationwide study.

Cancer is still the leading cause of non-accidental death in childhood, although the majority of children diagnosed in high-income countries survive their illness. In accordance with international standards, equal and early access to palliative care should be available to children and adults. Yet communication and prognostic disclosure may influence the timing of involvement in palliative care. Purpose: To investigate whether parents perceived that their child received palliative care and to what extent that contrasted parents' perceptions of their child's care and symptoms in the last month of life. A nationwide population-based parental questionnaire study in Sweden, one to five years after their child's death (n=226). Descriptive statistics were used. A majority of parents (70%) reported that they were aware that their child received palliative care and they were informed about the incurable disease (57%) within 3 months before the child died. The most common diagnosis among children receiving palliative care was a brain tumor (45%) with a disease related death (90%) and the care was often received at home (44%). Based on the reports of parents who felt that their child did not receive palliative care, 45% were informed within days or hours about the child's incurable disease, 45% of these children were diagnosed with leukemia, 60% died at the intensive care unit, and 49% died of treatment-related complications. It was most common for families who lived in urban areas (28%) to report their child received palliative care, in comparison to families living in sparsely populated areas (11%). A significant proportion of parents whose child received palliative care (96%) stated that the healthcare professionals were competent in caring for their child, for those who reported no palliative care it was slightly lower (74%). In both groups many children were affected by multiple symptoms the last month of life. The study findings highlight the role of understanding parental perceptions of pediatric palliative oncology care, the role of initiating palliative care early, the need of access to national equitable PC and professional competence across the lifespan, regardless of diagnosis and place of residence.

Zbyt długi żywot ustawy o pracownikach urzędów państwowych

In 1982, the Act on State Office Employees was passed. Despite the establishment of the civil service, which, according to Art. 153 of the Constitution should serve government administration offices, the 1982 Act is still in force, although its repeal has been announced many times. This is mainly because the 1982 Act, unlike the Civil Service Act, does not provide for a public procedure for equal recruitment for vacant official positions, which allows all political decision-makers to fill these positions through their discretion. However, this constitutes a violation of Art. 60 of the Constitution, which provides citizens with equal access to public service. The data collected under the Act on Access to Public Information shows that the number of people subject to the 1982 Act is very large and, moreover, that numerous important positions in the offices of the supreme state administration bodies are filled on its basis. This is to the obvious detriment of the public interest, especially since the 1982 Act does not contain a whole range of legal structures and requirements intended to ensure professional, reliable and impartial operation of the administration, as required by Art. 153 of the Constitution. The article contains a polemic with arguments about the need for special trust in employees, pointing out their extra-legal nature, as well as the dangers resulting from these assumptions. The thesis is the need to repeal the 1982 Act as soon as possible, as it has already been announced many times.

Sociodemographic inequalities in the uptake of prenatal HIV testing in Ethiopia: Systematic review and meta-analysis.

In order to attain the ambitious 95-95-95 UNAIDS goals, HIV testing serves as the pivotal starting point and plays a crucial role in preventing, treating, and managing HIV. Equal access to HIV testing is crucial to stop the spread of the virus. Measuring healthcare disparities is vital for promoting fairness in health services and achieving global goals for HIV prevention and treatment. Ethiopia is actively engaged in efforts to achieve these goals and is dedicated to combating HIV/AIDS. To the best of our knowledge, no previous systematic review or meta-analysis has been conducted on sociodemographic inequalities in prenatal HIV testing in Ethiopia. Hence, this study aims to assess sociodemographic inequalities in prenatal HIV testing in Ethiopia. We conducted an extensive search across various databases, such as PubMed, Scopus, Google Scholar, and Embase, to collect articles and reports. The data we gathered was then exported to R software for further analysis. Our analysis involved performing a meta-analysis of proportions using a random effect model. To assess the variability among the included studies, we used statistical measures such as I2 statistics and the Cochran's Q test. The results of the pooled prenatal HIV testing, along with its corresponding 95% confidence interval, were presented using a forest plot. A comprehensive analysis of 20 research papers on prenatal HIV testing in Ethiopia revealed that the overall pooled prevalence of testing was 69% (95% CI [60.0-80.0]). Factors such as higher education, urban residence, income, a positive attitude towards testing, marriage, and discussions about testing during antenatal care (ANC) were found to positively influence testing rates. The prevalence of prenatal HIV testing among antenatal care attendees in Ethiopia falls short of the UNAIDS target. In order to enhance the testing rates, it is advised to implement targeted initiatives within Ethiopia's public health programs. To ensure effectiveness, these initiatives should adopt a sustainable and customized approach that takes into account the specific needs and circumstances of women, particularly those who are economically disadvantaged. Ethiopia can make significant strides in enhancing the prenatal HIV testing landscape by effectively implementing policies and programs that prioritize the welfare of the less privileged. As limitation this systematic review did not include longitudinal and qualitative studies that might have provided different results. Trial registration in PROSPERO with ID: CRD42024550564.

Comparing Black and White Patients in Treatment of Advanced Prostate Cancer and Survival in an Equal Access Health System.

Racial disparities in prostate cancer treatment and survival in the U.S. have been attributed to differences in access to care and medical insurance. We aimed to compare treatment and survival of advanced prostate cancers between White and Black men in the equal access Military Health System (MHS). We accessed the MilCanEpi database to study a cohort of non-Hispanic White and Black men diagnosed with stage III or IV prostate cancer between 1998 and 2014 in the MHS. The racial groups were compared in receiving curative treatment of radical prostatectomy (RP) only, RP with (neo)adjuvant radiation or hormone therapy, radiation only, or combination radiation and hormone therapy; and overall survival using multivariable regression models. The study included 1476 White and 531 Black men. Overall, there was no racial difference in receiving any curative treatment (AOR = 0.85, 95% CI = 0.67, 1.08 for Black vs. White). By treatment type, Black men were statistically as likely to receive RP only (AOR = 0.87, 95% CI = 0.67, 1.14), radiation only (AOR = 0.81, 95% CI = 0.49, 1.34), or combination radiation and hormone therapy (AOR = 1.12, 95% CI = 0.71, 1.78) but statistically less likely to receive RP with (neo)adjuvant treatment (AOR = 0.56, 95% CI = 0.37, 0.86) relative to no curative treatment compared to White men. The difference in RP with (neo)adjuvant treatment was also statistically significant among patients with stage III tumors, but not stage IV. Survival was similar overall (AHR = 1.12, 95% CI = 0.88, 1.42 for Black vs. White) and when evaluated by tumor stage. In the MHS, the overall likelihood to receive any treatment for advanced prostate cancers and survival was similar between races, which might result from universal health care. Racial differences in receipt of RP with (neo)adjuvant treatment, especially for patients with stage III prostate cancer, may be related to factors other than access to care and warrants further research.

The Adverse Effect of Dehumanizing Practices on Student Engagement and Learning in English Language Teaching Classroom

Knowingly or unknowingly, forgetting our multilingual and multicultural scenario, teachers’ behaviors may create social inequalities and injustices in the classroom; in the name of the dominant language of the school and power relation. Our classroom context is multilingual, multicultural and bilingual where students come from different economic and linguistic background. To some extent, our school system, including textbooks, instruction, curriculum, teaching practices seem to have influenced by the dominant ‘English/Nepali only’ approach. Furthermore, some teachers may not motivate minority students looking their low economic status, uncombed hair, roughly managed shirt-paint, unpolished shoes and low proficiency in English language. In this context, this paper aims to analyze the difficulties and struggle of demotivated (due to teachers’ bias behaviors and friends’ insult upon their appearance and language) Nepali language speaking children’s experiences as they feel insulted in school environment. To fulfill this objective, I adopted narrative research design in line with the qualitative research method. Discussing on the basis of classroom observation and unstructured interviews with the student, this paper analyzes that how the learners are marginalized and forbidden equal access to participate in the mainstream of social and political life that enhances their better learning opportunity and participation in classroom and society to what Bourdieu’s word symbolic violence with some examples of how such social inequalities and injustices are seen in school’s teaching-learning practices. Specially, given the problematic nature of schooling for such learners in some of the schools in Nepal, this paper highlights the need for socially responsive school policies and critical pedagogy, aiming at challenging and changing certain practices having identified a problem; originally propounded by Paulo Freire, a Brazilian educator; understanding the difficulties of living in poverty, local context entertaining the linguistic and cultural diversity of students. This study contributes to all the educational stakeholders to update and change themselves as human- friendly behaviours with the learners that can maintain social equalities and justice.

Racial disparities in prostate cancer in the UK and the USA: similarities, differences and steps forwards.

In the USA, Black men are approximatelytwice as likely to be diagnosed with and to die of prostate cancer than white men. In the UK, despite Black men having vastly different ancestral contexts and health-care systems from Black men in the USA, the lifetime risk of being diagnosed with prostate cancer is two-to-three times higher among Black British men than among white British men and Black British men are twice as likely to die of prostate cancer as white British men. Examination of racial disparities in prostate cancer in the USA and UK highlights systemic, socio-economic and sociocultural factors that might contribute to these differences. Variation by ancestry could affect incidence and tumour genomics. Disparities in incidence might alsobe affected by screening guidelines and access to and uptake of screening. Disparities in treatment access, continuity of care and outcomes could contribute to survival differences. In both localized and metastatic settings, equal access could diminish the observed disparities in both the USA and the UK. An understanding of behavioural medicine, especially an appreciation of cultural beliefs about illness and treatment, could inform and improve the ways in which health systems can engage withand deliver care to patients in minoritized groups affected by prostate cancer. Methods of promotingequity include targeting systemic barriers including systemic racism,proportional recruitment of patients into clinical trials, diversifying the health-care workforce and facilitating care informed by cultural humility.Actively engaging patients and communities in research and intervention might enable the translation of research into increasingly equitable care for patients with prostate cancer in the UK, the USAand globally.

Evaluating Disability Rights Legislation: The Impact of the Americans with Disabilities Act on Social Equality in the United States

The Americans with Disabilities Act (ADA), enacted in 1990, set a milestone in protecting the civil rights of disabled Americans. This paper evaluates the impact of the ADA through its historical contexts, components, challenges in enforcement, and contributions of the ADA to the lives of the American people, including employment, equal access to education, public space and transportation. The ADA has successfully reduced barriers and fostered greater inclusion in society. However, its enforcement also faced many significant challenges, especially in rural areas and for small businesses due to limited economic conditions and lack of resources. Furthermore, the ADA places a significant focus on accommodating the need for physical abilities, which makes public society question whether the ADA can satisfy the needs of people with mental health and cognitive disabilities. Finally, the paper recommends regularly updating the ADA to integrate assistive technical supports. Continuous advocacy is required to enhance the position of the ADA as a legal tool for promoting equality and ensuring that all Americans can participate fully in their lives.

Toward energy for all? Heterogeneous electricity constellations in Mozambique’s Greater Maputo region

ABSTRACT Debates on urban infrastructures in the global South have suggested that heterogeneous infrastructures may help improve urban electricity access yet also raise equality concerns. However, neither the urban inequalities associated with such electricity access nor how those inequalities play out in different urban neighbourhoods has been systematically studied. To better understand how electricity access develops in the context of heterogeneity, we examine five urban neighbourhood types in Mozambique’s Greater Maputo region, where heterogeneous electricity constellations provide some access to critical services yet have been unable to advance equal access to electricity. Connectivity is increasing at city level, but affordability and reliability are compromised in some neighbourhoods, and negative health, safety, and environmental impacts are observed in others. To accelerate equal electricity access throughout the city more attention must be paid to reducing trade-offs between different access dimensions that affect specific user groups in different settlements.

Ethnic Access to and Usage of Microsatellite Instability/Mismatch Repair Testing on Colon Cancers at a Regional Veteran Affairs Medical Center

Abstract Introduction/Objective It has been a National Comprehensive Cancer Network (NCCN) recommendation since 2015 that all colon carcinoma cases should receive mismatch repair and microsatellite instability (MSI/MMR) testing. However, literature on MSI/MMR testing compliance with this recommendation particularly for ethnic minorities and veterans, are sparse in the literature. Methods/Case Report A retrospective review of all invasive colon carcinoma cases from colon or rectum specimens was performed from 2017 to March 8th, 2024, at a regional Veteran Affairs Medical Center (VAMC) as part quality assurance (QA) to collect test performance and demographic information. There had been clinical team/pathologist regular education about the NCCN guidelines. Results (if a Case Study enter NA) There were 210 cases from which 183 out of 219 cases (84%) included MSI/MMR testing. From the total population of 210, 92 (43.8%) were African American, 107 were Caucasian American (51.0%) and others were 11 (5.2%). Among the 183 with MSI/MMR testing, 79 (43.2%) were African American, 94 were Caucasian American (51.4%), with the remainder being 10 (5.5%). Testing rate for MSI/MMR over the years increased from 2021 onwards: 40 out of 43 cases in 2017 (93%), 22 out of 27 in 2018 (81%), 27 out of 33 in 2019 (81%), 24 out of 27 in 2020 (88%), 25 out of 34 in 2021 (74%), 21 out of 21 out of in 2022 (100%), and 24 out of 25 in 2023 to 2024 (96% with 1 patient expiring before testing could be sent). Conclusion From 2022 onwards, all patients received MSI/MMR testing if not expired, which is a substantial improvement demonstrating the impact of education and awareness of the current NCCN guidelines along with its impact on patient management. Furthermore, the VAMC provided equal access to MSI/MMR testing to all ethnic groups, thus serving as a paradigm for health equity for colon cancer testing.

General and special education teachers' attitudes towards evidence‐based practice

AbstractIn the context of special and inclusive education, applying evidence‐based practice (EBP) is important for providing equal access to effective and efficient education for students, regardless of their ability status. However, there is a relevant research‐practice gap in this area. To better understand how teachers can be supported using evidence‐based interventions and to identify training and development needs, we developed a questionnaire on attitudes towards EBP and piloted it with a sample of 809 teachers in Germany. The factor structure was determined using categorical exploratory factor analysis in half of the sample and then confirmed using categorical confirmatory factor analysis in the other half. Good model fit and factor reliability were observed. The instrument is measurement‐invariant between general and special education teachers. As expected, we found more positive attitudes towards EBP among special education teachers. No significant differences were observed between the different age groups. Based on these findings, it can be assumed that the measurement instrument is suitable for use in implementation research, as well as in the evaluation of initial and in‐service teacher training programmes. Further studies on convergent, divergent and prognostic validities are necessary.