RESUMEN
The aim of this study was to examine whether collective moral disengagement and authoritative teaching at the classroom level, and student-teacher relationship quality at the individual level, predicted individual moral disengagement among pre-adolescent students 1 year later. In this short-term longitudinal study, 1,373 students from 108 classrooms answered a web-based questionnaire on tablets during school, once in fifth grade (T1) and once in sixth grade (T2). The results showed, after controlling for T1 moral disengagement, gender, and immigrant background, that students with better student-teacher relationship quality at T1 were more inclined to score lower on moral disengagement at T2, whereas students in classrooms with higher levels of collective moral disengagement at T1 were more inclined to score higher on moral disengagement at T2. In addition, both collective moral disengagement and authoritative teaching were found to moderate the associations between student-teacher relationship quality at T1 and moral disengagement at T2. These findings underscore the importance of fostering positive relationships between students and teachers, as well as minimizing collective moral disengagement in classrooms. These measures may prevent the potential escalation of moral disengagement in a negative direction.
RESUMEN
BACKGROUND: Early extensive surgery is a cornerstone in treatment of diffuse low-grade gliomas (DLGGs), and an additional survival benefit has been demonstrated from early radiochemotherapy in selected "high-risk" patients. Still, there are a number of controversies related to DLGG management. The objective of this multicenter population-based cohort study was to explore potential variations in diagnostic work-up and treatment between treating centers in 2 Scandinavian countries with similar public health care systems. METHODS: Patients screened for inclusion underwent primary surgery of a histopathologically verified diffuse WHO grade II glioma in the time period 2012 through 2017. Clinical and radiological data were collected from medical records and locally conducted research projects, whereupon differences between countries and inter-hospital variations were explored. RESULTS: A total of 642 patients were included (male:female ratio 1:4), and annual age-standardized incidence rates were 0.9 and 0.8 per 100 000 in Norway and Sweden, respectively. Considerable inter-hospital variations were observed in preoperative work-up, tumor diagnostics, surgical strategies, techniques for intraoperative guidance, as well as choice and timing of adjuvant therapy. CONCLUSIONS: Despite geographical population-based case selection, similar health care organizations, and existing guidelines, there were considerable variations in DLGG management. While some can be attributed to differences in clinical implementation of current scientific knowledge, some of the observed inter-hospital variations reflect controversies related to diagnostics and treatment. Quantification of these disparities renders possible identification of treatment patterns associated with better or worse outcomes and may thus represent a step toward more uniform evidence-based care.
