Disparities In Attitudes Research Articles

Should we perform orchidopexy for cryptorchidism in children with severe encephalopathy?

To conduct a survey of practices in France concerning cryptorchidism in patients presenting with severe encephalopathy. We conducted an e-mail survey of current practices in 27 pediatric surgery departments in 27 French university or general hospitals. The study concerned children with severe mental deficiency. The survey showed a disparity in attitudes towards cryptorchidism in patients with severe encephalopathy, ranging from no treatment to orchidopexy in all cases. In most cases, the indication for surgery was the psychological aspect for the parents or accessibility to clinical examination. This survey illustrates the unease concerning the pertinence of performing orchidopexy in these children. As improved fertility is not really an issue in children with severe encephalopathy, psychological aspects apply only to the family, and, as the benefit of orchidopexy for prevention or early diagnosis of testicular cancer is marginal, the risk/benefit ratio of orchidopexy for children with severe encephalopathy and cryptorchidism is unclear.

Adolescent Tdap Vaccine Use Among Primary Care Physicians

Purpose In 2006 the Advisory Committee on Immunization Practices (ACIP) recommended replacement of the adolescent tetanus and diphtheria toxoids (Td) booster with combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap). We examined the degree to which pediatricians and family practitioners have adopted this recommendation. Methods National mail-based survey of a random sample of 725 pediatricians and 725 family practitioners from January through March, 2007. Results Overall response rate was 60%. The majority of respondents indicated they routinely recommended Tdap to adolescents at the preferred age for vaccination, 11–12 years old (87%), and also for “catch up” vaccination among adolescents 13–18 years old (89%). In bivariate analyses, pediatrician specialty, specialty society membership, stocking Tdap in the office, and prior experience diagnosing adolescent pertussis were associated with routinely recommending Tdap to adolescents. In multivariable models adjusting for these factors simultaneously, only pediatrician specialty (OR = 4.8, 95% CI = 2.5–9.3) and stocking Tdap in the office (OR = 14.5, 95% CI = 7.5–28.5) remained significantly associated with routine recommendation. Pediatricians were significantly more likely than family practitioners to accept shorter time intervals for administering Tdap following Td vaccination, and to co-administer Tdap with MCV4. Lack of adolescent visits was the most commonly cited major barrier to adolescent Tdap administration. Conclusions Based on self report, our results indicate the majority of physicians have adopted recent recommendations from the ACIP to administer Tdap to adolescents. However, specialty-based disparities in attitudes and practices persist, suggesting that ongoing efforts are needed to motivate physicians to recommend this vaccine to adolescents and to clarify how to integrate Tdap with other adolescent vaccinations.

American Balancing and German Proportionality: The Historical Origins

American and European constitutional systems have two similar doctrines: balancing and proportionality. Both resemble each other in important aspects and are often discussed in tandem. However, balancing has never attained the status of an established doctrine in American constitutional law in the same way that proportionality has in European constitutional law. Moreover, balancing has always been the subject of fierce criticism and is very much a controversial concept in American constitutional law. European proponents of proportionality are perplexed by this American resistance which is sometimes viewed as based on American isolationalism and unilateralism. In this article we suggest an original, and often overlooked, explanation to the difference between balancing and proportionality - the historical origins of the two concepts. We examine the ways in which proportionality developed in Germany and balancing in the United States and show that the origins of both concepts were very different. For instance, proportionality was originally developed in administrative law, and was only tangentially (if at all) related to private law, whereas balancing arose in private law and was only later extended to public law; proportionality was created as part of an attempt to protect individual rights, whereas balancing was created for the exact opposite purpose - to check overzealous protection of rights by the Supreme Court during the Lochner era. We suggest that these differences may go a long way in explaining current disparities in attitudes and current barriers to dialogue and convergence between these two concepts.

Perspective: After a Century of Criticizing Premedical Education, Are We Missing the Point?

Ever since Abraham Flexner formalized the idea of premedical education in 1910, medical educators have argued about how best to prepare students for medical school. This back-and-forth about the premedical years has focused almost exclusively on the range and content of the required course work; noticeably absent from the debate is consideration of the ways in which the experience of the premedical years-including the curricular and noncurricular demands placed on students-shape the moral education of the next generation of physicians. The authors review the century-long conversation about premedical education, highlighting the themes of that discussion and the important aspects of being a "premed" that have not been a part of the conversation. From their systematic review of college and university Web sites designed for premedical students and from comments collected from a symposium on the premedical years, the authors describe how life as a premedical student, and not just curricular content, teaches important lessons about what it means to be a professional. The authors also report important disparities in attitudes about premedical education; for example, premedical advisors regard the "sifting process" of premedical education as a "journey of discovery," whereas students describe their premedical years as a competition. The authors' work suggests a new approach to premedical education, an approach that combines the coursework needed to succeed in medical school with formal opportunities to reflect on both the positive and pernicious effects of the premedical years.

Trapper Attitudes and Industrial Development on Registered Traplines in West-Central Alberta

Rapid industrial development can have unplanned consequences for the landscape and lead to conflicts among stakeholders. Impacts to traditional and subsistence-based land users can be significant, but have gone largely unexamined. We studied marten trapper attitudes toward industrial development and how these perceptions coincide with measurements of land-use activities in western Alberta, Canada. Sampled trappers had negative attitudes toward industrial activity, with a disproportionate emphasis on timber harvesting. Trappers with concerns about industrial activity had more developed traplines. Trappers who were less concerned about industrial development were more likely to have good working relationships with specific companies and felt involved in land management decisions. Our findings indicate that the extent of disturbance alone does not determine the level of trapper concern and discuss the factors that could lead to disparity in attitudes and improve communications.

The ‘hows’, ‘whos’, and ‘whens’ of screening: gynaecologists’ perspectives on cervical cancer screening in urban Sweden

Population-based screening has contributed to decreased mortality in cervical cancer. However, the ‘hows’, ‘whos’ and ‘whens’ of screening still concern health professionals and policy makers. As part of a research project aimed at examining a population-based cervical cancer screening program (PCCSP) from different stakeholders’ perspectives, the aim of this qualitative interview study was to elucidate the views of gynaecologists, working in both public and private settings, as stakeholders in the PCCSP in the county of Stockholm, Sweden. Results from semi structured interviews with 17 physicians indicate ambiguity in their descriptions of the purpose of both the PCCSP and smear testing in general, leading to different views about appropriate time intervals for Pap-smear testing. The gynaecologists also described experiencing a number of dilemmas related to information content and provision—both prior to screening and in relation to test results. In addition, the gynaecologists tended to differentiate morally through choice of language between women who participate in some form of screening and non-attendees of the PCCSP. There also appeared to be distinctions in how these gynaecologists conceptualised and discussed women receiving Pap-smears, dependent on whether they were regarded as within the category of ‘my patients’ (seen by the gynaecologist in a private or public setting) or ‘the population’ (women unknown to the gynaecologist). This study indicates the importance of comprehensively analysing the context of professionals’ work when attempting to understand professional attitudes. Seeming disparities in attitudes as well as varying practices may be explained by the simultaneous existence of multiple value systems, applied to different patient populations, as found in this study.

An investigation of the differences in attitude and achievement between male and female second and fifth grade science students

Research has indicated a strong decline in science interest and achievement among students in middle school and high school, with significantly greater declines among female students. This study investigated the differences in attitudes toward and achievement in science between boys and girls in grades two and five to see if the gender differences observed in middle school and high school may apply to elementary students. No significant gender differences were observed in grades two and five. Therefore, it appeared that the disparity of attitudes and achievement between female and male students may originate after grade five.