Nursing students' experiences of unprofessional behaviours and associations with guideline compliance: A multicenter survey

AIMS

To assess the reported prevalence of unprofessional behaviours, including incivility and bullying, experienced by nursing students during their clinical practice. To assess the prevalence of students' abilities to speak up about unprofessional behaviours encountered and infection control concerns; their compliance with standard precautions and COVID-19 guidelines; and their perceived responsibility for infection prevention. Lastly, to describe the potential impact of unprofessional behaviour on compliance with these guidelines.

BACKGROUND

Unprofessional behaviours in healthcare settings are associated with a wide range of individual and organisational negative outcomes for nurses and nursing students, which may affect patient safety. The COVID-19 pandemic created new challenges for clinical education and for infection control.

DESIGN

A descriptive cross-sectional design.

METHODS

A multi-centre survey was carried out in six academic universities and colleges in Israel. The research study involved 369 undergraduate nursing students during 2022. Their clinical experiences were assessed using an online questionnaire. The STROBE guideline was used for accurate reporting.

RESULTS

301 (81.6%) students reported experience of unprofessional behaviour while undertaking clinical practice. Students with reported skills to speak up about unprofessional behaviour were less likely to report having experienced these behaviours (p = 0.003). Students who did not experience unprofessional behaviours were more likely to report higher compliance with standard and COVID-19 precaution guidelines (OR 3.624, 95% CI 1.790-7.335, p < 0.001). These students also had a higher perception of personal responsibility toward patient safety (OR 1.757, 95% CI 1.215-2.541, p = 0.003).

CONCLUSIONS

Nursing students experiencing unprofessional behaviours in the clinical setting reported lower compliance with standard and COVID-19 precautions. In addition, cultivating personal responsibility towards patients' safety may have a positive impact on guidelines compliance. Nursing educators and leaders should develop strategies to enable students to better cope with unprofessional behaviours. Closer cooperation between all stakeholders may promote civility among nurses and nursing students in the clinical setting.

Nursing students' beliefs about mental health, interest in work, and job tendencies

PURPOSE

To explore nursing students' mental health educational level, mental illness beliefs, and interest in working in mental health.

DESIGN AND METHODS

Descriptive research conducted with 173 nursing students which convenience sampled. The questionnaire was composed of mental illness beliefs, interest in working in mental health, and tendency to work in nursing areas.

FINDINGS

Main finding demonstarted perception of dangerous from mental illness related to low interest in working in mental health regarding all nursing students.

PRACTICE IMPLICATIONS

There is a necessity to discuss mental health beliefs within theoretical and practical learning as it may eventually can contribute to the quality of care and improve the image of mental healthcare.

Using Telemedicine During the COVID-19 Pandemic: Attitudes of Adult Health Care Consumers in Israel

Introduction: The COVID-19 pandemic has affected health care services worldwide due to lockdowns, prevention measures, and social distancing. During this period, patients, including older adults and those with chronic conditions, need ways to obtain medical attention other than going physically to the clinic, such as telemedicine services. The purpose of the present study was to evaluate attitudes toward telemedicine during the COVID-19 lockdown in Israel, assess willingness to use such services in the future, and evaluate the extent to which consumers have changed their minds regarding these services. Method: A cross-sectional, descriptive, correlational study was conducted among adults (age 20-90) using social media networks (N = 693). Data were collected using an online questionnaire explicitly designed to measure attitudes toward telemedicine. Results: Most of the participants had to use telemedicine during the lockdown and were satisfied therewith. The majority also stated that they would continue using telemedicine in the future. However, only a third stated that they had changed their minds regarding telemedicine. The main predictors of willingness to use telemedicine in the future were the necessity of using such services during lockdown, preference for going to a clinic, and satisfaction with telemedicine, alongside gender and having a chronic illness. Importantly, we found that a preference for visiting the clinic was negatively correlated with willingness to use telemedicine in the future. Education and being single were predictors of the change of mind regarding telemedicine. Participants with chronic conditions are more likely to use these services, and specific attention should be directed to their needs. A small portion of the study sample prefers live appointments with a physician. Conclusions: Telemedicine use is rapidly changing. It is vital for health care providers to identify non-telemedicine users and their common characteristics. Monitoring patients' attitudes regarding telemedicine is essential in the future after the pandemic ends. Targeted outreach plans should be formulated. These plans should be directed at identifying barriers to using telemedicine, and they should generate specific, focused plans.

Attitudes toward euthanasia-dual view: Nursing students and nurses

Caregivers such as nurses and nursing students have different religiosity backgrounds and have important roles as to terminally ill patients and euthanasia; however, they have different levels of knowledge and experience. Accordingly, the study identify differences between caregivers' religiosity level and euthanasia attitudes, examine differences between caregivers regarding attitude to euthanasia and identify differences between nurses by incidence of terminal patient caring and their relationship to euthanasia. Caregivers (210) volunteered fulfill survey. Main result suggests differences mostly between secular and traditional groups as to euthanasia. Accordingly, our suggestion is that the caregivers should improve communication via simulation of discussing euthanasia.

Factors influencing nursing career choices and choice of study program

In advance of a recruitment campaign, Israeli first-year nursing students of all ethnicities were surveyed to elucidate what factors had influenced them to make nursing their career and what sort of training track they preferred. The responses made it clear that different factors influence different groups differently. There were noticeable differences by gender, age, and ethnicity. Overall, training institutions were chosen for their closeness to the student's home but other factors also operated among particular groups, such as institutional prestige and flexible entry criteria. There was a blatant preference for academic, particularly university-sited, programs over diploma programs.

Turnover of registered nurses in Israel: characteristics and predictors

BACKGROUND

In an era of global and local nursing shortages, nursing turnover has negative consequences in terms of diminished quality of care, increased costs and economic losses and decreased job satisfaction.

OBJECTIVE

To examine the turnover rate of registered nurses in Israel by assessing the varying degree of turnover between economic sectors, between hospital and community facilities, and/or between types of hospitals; and by examining potential predicting factors of turnover among registered nurses.

METHODS

A national phone survey was undertaken in Israel consisting of a random sampling of registered nurses of working age (up to age 60). The subjects comprised 10% of a national database of 32,000 registered nurses.

RESULTS

The turnover rate among working nurses in Israel currently stands at 23%. In addition, 13% of employed nurses have taken a temporary leave of absence for a period greater than 6 months in the past 10 years, most up to 1 year. While job satisfaction rates were relatively high (72%), Professional satisfaction rates were 60% with no significant difference between hospital and community nurses. The turnover rate of registered nurses from a hospital setting to the community was significantly higher (p<.01) than that of community registered nurses to hospitals. Predicting factors of turnover were found to be: young age, part-time work, lack of advanced professional education, academic education and low satisfaction with the nursing profession.

CONCLUSIONS

The shift of nursing workforce is mainly from hospitals to community health settings. There is a need to monitor and understand the characteristics of job and professional satisfaction among hospital nurses in order to implement crucial organizational interventions and retain hospital nursing staffs. Since young nurses, nurses working part time and nurses with no advanced professional and academic education, tend to move more than others, efforts should be targeted at these specific groups.

Registered nurses in Israel - workforce employment characteristics and projected supply

Background

Surveys of nursing supplies around the world have furnished a better understanding of the structure of the workforce, helped identify shortages, and plan professional training. This study aimed to examine the employment and workforce characteristics of registered nurses and the projected supply in Israel as a tool for planning.

Methods

1. A survey of a national sample of 10% of the RNs of working age (3,200 nurses). 2. Analysis of administrative data from the Ministry of Health' Nursing Division and the Central Bureau of Statistics.

Results

Most registered nurses are employed (89%) - 67% work full time. The workforce is mature (45% are above 45), trained (55% qualified beyond the basic course, 48% hold a BA, 18% hold an MA or PhD), and stable: few quit the profession altogether. The likelihood of "survival" in the profession after 10 years is 93%; after 20 years - 88%. 23% have made some transition in the last 10 years (most - a single transition). Most of the transitions are from hospital to community work. Supply projections show a decrease in the total number of RNs in the nursing workforce from 28,500 in 2008 to 21,201 in 2028 - i.e., of 25% by the end of the period. As for the ratio per 1,000 population, the drop is from 4 registered nurses/1,000 in 2008 to 2/1,000 in 2028.

Conclusions

The study findings provide more rigorous projections of supply than in the past on the declining rates of the nursing workforce in the coming decades, and contribute to decision making about the scope of training and recruitment. The study also points to the implications for policy decisions regarding the findings that the young nursing workforce is less stable, that there are advantages to recruiting a more mature workforce, and that post-basic education is connected with workforce stability.

Nonsynonymous natural genetic polymorphisms in the bovine leptin gene affect biochemical and biological characteristics of the mature hormone

Leptin (LEP) is a cytokine-like hormone proven to be involved in diverse biological processes. In livestock, it regulates feed intake, BW homeostasis, and energy balance, among other traits. Natural nonsynonymous genetic polymorphisms in the ovine leptin (oLEP) alter the biochemical and physiological characteristics of its gene products. Here we studied in vitro and in vivo the biochemical and physiological characteristics of recombinant hormones representing the oLEP and bovine leptin (bLEP) reference sequences of wild-type (WT) leptins (GenBank accession No. U84247 and U50365, respectively), oLEP and bLEP recombinant muteins carrying the R4C mutation, and oLEP recombinant hormones carrying the A59V and Q62R mutations, which were detected in bLEP. All proteins were purified to homogeneity as monomers and formed 1:1 molar ratio complexes with the chicken leptin-binding domain (LBD). Surface plasmon resonance experiments revealed that all protein variants exhibit reduced (P < 0.05) affinity to chicken (ch) and human (h) LBD compared with the WT oLEP and bLEP recombinant proteins. The ovine and bovine R4C muteins exhibited significantly (P < 0.05) greater induction of cell proliferation in a Baf/3 cell line bioassay, despite lower affinity toward both hLBD and chLBD. Intra-third cerebral ventricle infusion of oLEP and its 3 muteins in sheep resulted in reduced feed intake. However, the 3 tested muteins had a decreased (P < 0.05) inhibitory effect than the WT LEP. It was concluded that natural genetic polymorphisms in the bLEP are associated with variation in the biochemical and physiological properties of the protein.

Staining for intracytoplasmic lumina and CAM5.2 increases the detection rate for bile duct cancers

BACKGROUND AND STUDY AIMS

Endoscopic biopsies have a low sensitivity for diagnosing malignant bile duct strictures. Tumor markers detected by mucin staining and immunohistochemistry may help to determine the malignancy of a biopsy specimen where histologic evaluation alone is nondiagnostic.

PATIENTS AND METHODS

61 patients who underwent forceps biopsies were retrospectively identified, yielding 49 and 40 biopsy specimens for strictures finally diagnosed as benign and malignant, respectively. Biopsy specimens were histologically evaluated and stained for p53, Ki-67, carcinoembryonic antigen (CEA), CA19-9, CAM5.2, and presence of intracytoplasmic lumina (ICL). Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (PLR and NLR) were calculated to evaluate the performance of each test.

RESULTS

Histology alone provided sensitivity and specificity of 53 % and 100 %. Addition of ICL or CAM5.2 increased sensitivity to 73 % or 60 %, respectively, and provided excellent specificity, PPV, and PLR (ICL, 98 %, 97 %, and 36; CAM5.2, 100 %, 100 %, and infinite). Both stains in combination increased the sensitivity to 75 %. Staining for Ki-67, p53, CEA, and CA19-9 increased the sensitivity to detect malignancy (range 60 % to 83 %), but significantly reduced the specificity, PPV and PLR (ranges 73 % to 90 %, 72 % to 86 %, and 3 to 7, respectively). Markers in all combinations performed poorly as a negative test (NPV 69 % to 87 %, and NLR 0.19 to 0.55).

CONCLUSIONS

Staining for tumor markers ICL and CAM5.2 can improve the diagnostic value of endoscopic biopsies, and may change the course of management for patients with indeterminate histological findings.

Pilot series of radiofrequency ablation of Barrett's esophagus with or without neoplasia

BACKGROUND AND STUDY AIMS

Radiofrequency ablation is a rapidly evolving therapeutic modality for Barrett's esophagus. The aim of this ongoing 12-month trial is to assess Barrett's esophagus eradication after radiofrequency ablation using a balloon-based (HALO-360) and a plate-based (HALO-90) device. We report here our experience with the first 10 patients (out of 40) who have completed 12 months of follow-up.

PATIENTS AND METHODS

Following radiofrequency ablation using the HALO-360 device all patients were maintained on double-dose proton pump inhibitor therapy. Endoscopic evaluation was performed at 3 and 12 months postablation. Patients with residual Barrett's esophagus at 3 months underwent repeat ablation. Ten patients, seven with nondysplastic Barrett's esophagus, two with low-grade and one with high-grade dysplasia have completed the study to date.

RESULTS

Complete Barrett's esophagus eradication was achieved in seven patients, and partial eradication was achieved in three. There were no major complications. One case of buried Barrett's metaplasia was encountered and successfully re-ablated, with complete Barrett's esophagus eradication achieved at 12 months.

CONCLUSIONS

In this study, Barrett's eradication rates were comparable to previously published reports. One case of buried Barrett's metaplasia was identified out of 247 biopsies and was eradicated with repeat ablation.

Economic value evaluation in disease management programs

Chronic disease management has been a rapidly growing entity in the 21st century as a strategy for managing chronic illnesses in large populations. However, experience has shown that disease management programs have not been able to demonstrate their financial value. The objectives of disease management programs are to create quality benchmarks, such as principles and guidelines, and to establish a uniform set of metrics and a standardized methodology for evaluating them. In order to illuminate the essence of disease management and its components, as well as the complexity and the problematic nature of performing economic calculations of their profitability and value, we collected data from several reports that dealt with the economic intervention of disease management programs. The disease management economic evaluation is composed of a series of steps, including the following major categories: data/information technology, information generation, assessment/recommendations, actionable customer plans, and program assessment/reassessment. We demonstrate the elements necessary for economic analysis. Disease management is one of the most innovative tools in the managed care environment and is still in the process of being defined. Therefore, objectives should include the creation of quality measures, such as principles and guidelines, and the establishment of a uniform set of metrics and a standardized methodology for evaluating them.

Pituitary and placental ovine growth hormone variants differ in their receptor-binding ability and in their biological properties

The wild-type (WT) GH2-N ovine growth hormone (oGH) and duplicated GH2-Z genes differ in their open reading frame by two nonsynonymous substitutions, predicting a two-amino-acid difference in their product (G9R/G63S). Three recombinant oGH muteins: G9R, G63S and G9R/G63S, were prepared by site-directed mutagenesis of the WT oGH gene, expressed in E. coli, refolded and purified as monomers with over 98% homogeneity. Gel-filtration experiments with WT oGH and the three muteins indicated formation of 1:2 complexes with oGH receptor extracellular domain (oGHR-ECD). Interactions of oGHR-ECD with the WT and the muteins were studied by surface plasmon resonance. Kinetics constants calculated using a two-site model predicted that G9R/G63S has the highest affinity to oGHR-ECD, WT oGH the lowest, and G9R and G63S have intermediate affinities. These relative affinities were further investigated by radioreceptor assay with EC50 values were the lowest for G9R/G63S, highest for WT oGH, and intermediate for G9R and G63S. Bioactivity of the WT oGH and oGH muteins was determined by proliferation assay with FDC-P1-3B9 cells stably transfected with rabbit GHR. Relative proliferation rates of cells in cultures treated with the WT, G63S, G9R or G9R/G63S variants were 100%, 183%, 259% and 498%, respectively. In COS-7 transfected with oGHR, LHRE-TK-luciferase and beta-galactosidase plasmids G9R/G63S showed 18% higher activity than WT oGH (P<0.001). Thus the product of the oGH duplicated copy has higher affinity for GHR and higher somatogenic activity. As the GH2-Z gene copy is expressed in the placenta, allelic differences at the oGH locus may influence feto-placental development.

Large-scale preparation and in vitro characterization of biologically active human placental (20 and 22K) and pituitary (20K) growth hormones: placental growth hormones have no lactogenic activity in humans

Expression plasmids containing DNA sequences optimized for expression in Escherichia coli were prepared encoding human pituitary (hGH-N 20K) and placental (hGH-V 20 and 22K) growth hormones. The proteins were expressed in bacteria, refolded and purified to homogeneity by anion-exchange chromatography on Q-Sepharose according to a unique protocol developed for each protein. The yields from 5l of fermentation culture varied between 400 and 700mg of electrophoretically pure, over 95% monomeric protein. Circular dichroism (CD) analysis revealed similarity of the purified hGHs' secondary structure to that of the pituitary hGH-N 22K, except for hGH-V 20K, in which the alpha-helix content was lower. The purified proteins were stable as a 0.1% sterile solution held at pH 10-11 at 4 degrees C for at least one month. All three purified hGH molecules formed a 1:2 complex with hGH receptor extracellular domain (hGHR-ECD), similar to hGH-N 22K. Binding experiments using hGHR-ECD revealed that the differences between the two 22K variants or between the two 20K variants were not significant, except that hGH-V 20K exhibited slightly lower affinity. Somatogenic activity was tested in vitro using FDC-P1 cell lines. Whereas the bioactivity of 22K hGHs and hGH-N 20K in FDC-P1-9D11 cells stably transfected with hGHR was almost equal and two to threefold higher than that of hGH-V 20K, in FDC-P1 3B9 cells stably transfected with rabbit (rb) GHR, the bioactivity of both 20K analogues was significantly (five to ninefold) lower than that of the 22K hormones. The lactogenic activity measured in heterologous assays (Nb2-11C cells and Baf/3 cells stably transfected with the long form of rabbit prolactin receptor) revealed that the activity of hGH-N 20K was close to that of hGH-N 22K in the Baf/3 cells, but 4.5-fold lower in the Nb2 cells. The activity of hGH-V 22K was ninefold less in Nb2 cells and 55-fold less in Baf/3 cells, whereas hGH-V 20K had no lactogenic activity in either bioassay. In contrast, in a homologous lactogenic assay using Baf/3 LP cells stably transfected with hPRLR, the activity of both placental hGHs was nil and the activity of hGH-N 20K was 4.3-fold lower than that of hGH-N 22K. The latter finding raises the question of whether the lack of intrinsic lactogenic activity in the placental hGHs that dominate during pregnancy has any physiological relevance.

Carrying the FecB (Booroola) mutation is associated with lower birth weight and slower post-weaning growth rate for lambs, as well as a lighter mature bodyweight for ewes

The present study was conducted in an Assaf flock in which the FecB (Booroola) mutation was segregated to determine whether the FecB mutation affects birthweight and the pre- and post-weaning growth rate of ewe lambs, as well as the mature bodyweight of ewes. Significant differences (P = 0.01) in birthweight (mean ± s.e.m.) were found between BB ewe lambs (4.03 ± 0.08 kg) and B+ and ++ ewe lambs (4.16 ± 0.04 and 4.32 ± 0.07 kg, respectively), which themselves did not differ significantly (P > 0.05). An FecB-associated maternal effect on the birthweight of ewe lambs was also detected, with the birthweight of lambs born to BB mothers (3.93 ± 0.08 kg) being significantly (P < 0.0001) different from the birthweight of lambs born to B+ and ++ mothers (4.26 ± 0.04 and 4.33 ± 0.07 kg, respectively), which did not differ significantly. The genotypes of the lambs did not affect their preweaning growth rate. However, the post-weaning growth rate of ewe BB lambs (274 ± 5 g day−1) was significantly (P = 0.05) different from the similar (P > 0.05) post-weaning growth rates of B+ and ++ lambs (284 ± 3 and 290 ± 4 g day−1, respectively). The genotype at the FecB locus also affected the mature bodyweight of ewes, with that of BB ewes (67.3 ± 1.4 kg) being significantly (P < 0.001) different from the similar mature bodyweight of B+ and ++ ewes (70.8 ± 1.1 and 70.1 ± 1.7 kg, respectively).

Collective action and psychological change: the emergence of new social identities

The study comprises an analysis of processes of psychological change among participants at an environmental protest. A participant observation study found evidence of a radicalized self concept among a number of crowd members, and indicates a link between radicalization, an asymmetry of categorical representations between protesters and the police, and the subsequent interaction premised on these divergent representations. The analysis supports an elaborated social identity model of crowd behaviour (Reicher, 1996, 1997a, 1997b; Stott & Reicher, 1998). It is argued that, in order to account for both social determination and social change in collective behaviour, it is necessary to analyse crowd events as developing interactions between groups. Where crowd members hold a different understanding of their social position to that held by an out-group (e.g. the police) and where the out-group has the power to treat crowd members in terms of its understandings, then those members who act on the basis of one understanding of their social relations find themselves in an unexpected and novel set of social relations. This then provides the basis for a series of changes, including the self-understanding of crowd members.

Contested identities and schisms in groups: opposing the ordination of women as priests in the Church of England

Schisms constitute a common characteristic of human groups. Nevertheless, they have been neglected by social psychology, mainly because social psychological theories either dismiss group consensus or else depict groups as monolithic. This study proposes a social psychological approach to schism which integrates recent developments of self-categorization theory (SCT) with work on category argumentation. According to SCT, shared group identification leads to a process by which members should reach agreement. However, it is suggested that where members construe the positions of others as fundamentally altering group identity, then consensus is impossible. The corollary of assuming that groups will be consensual is that lack of consensus indicates the existence of different groups. This idea is examined through an analysis of a video and booklet produced for a rally organized by Forward in Faith, an organization opposed to the ordination of women as priests within the Church of England. It is shown that the existence of women priests is construed as changing the essence of the Church both on a structural level (by dividing it from the rest of the Christian community and turning it into a sect) and doctrinally. Such changes are seen as threatening the very existence of the Church of England and therefore demanding all out opposition. However, it is also shown that the decision of whether opponents fight the changes from inside the Church or by splitting from it depends upon the perception of whether they will be accorded the opportunity to advance their position from within. Thus schism is associated with both a perceived 'change of essence' and also with 'lack of voice'.

Seeking influence through characterizing self-categories: an analysis of anti-abortionist rhetoric

This paper presents an analysis of an anti-abortionist's speech to a medical audience. It is shown that central to the speech is the way in which the speaker defines the context of the abortion debate and hence the categories of people involved. In particular, the speaker construes himself as a member of a common in-group with his audience, construes the entire audience as part of an anti-abortion category and claims that abortion is in contradiction with the defining features of the audience's medical identity on a series of levels. This analysis is used to make two suggestions. Firstly, following self-categorization theory, that the ways in which self-categories are defined may be central to the process of mass social influence. Secondly, however, self-categories may not be specified by intra-psychic processes but rather are discursively constructed and argued over. The implications of such a position for future research on self-categorization and category salience are discussed.

Tacrine or arecoline mediates reversal of anoxia- or AF64A-induced behavioural disorders in the developing rat

A 25 min anoxia, or an intracerebroventricular bilateral 2 nmol dose of ethylcholine aziridinium (AF-64A), administered postnatally to male rat pups, elicited on further development of these behavioural disorders, which are partly related to central cholinergic hypofunction. These included a hyperkinetic syndrome and inferior performance in the passive avoidance test. The anoxia-lesioned group but not the AF-64-A-lesioned one, showed an inferior performance in the active avoidance test. Administration of tacrine, an inhibitor of cholinesterase, or arecoline, a cholinergic agonist, in the drinking water to the nursing mothers, at an estimated daily dose of 15 and 10 mg/kg, then directly to the juvenile rats after weaning and until the age of 40 days, partly reversed the effects of anoxia or AF-64A, normalizing the level of locomotor activity and improving performance in passive avoidance, but not in active avoidance. These beneficial effects persisted long after discontinuation of administration of either drug, suggesting that stimulation of spared cholinoceptors in brain at development had prompted the recovery of cholinergic function.

The social context of delinquent conduct

Findings from two studies are presented on degree of group involvement in delinquency among young people. The first study indicates that among boys, although there is wide variation in the degree to which particular types of offence are committed alone or in the company of others, there is no general category of offence that is predominantly solitary. Moreover we could identify no individuals who always offended alone. The second study compared adolescent boys and girls and indicated that girls are if anything even more likely than boys to commit any offences in the company of others. The findings are discussed in terms of their implications for the role of the group context in delinquency.

Delinquent behaviour and attitudes to formal authority

A scale was developed to assess attitudes towards formal authority in the school and in the public domain (police and law). Data derived from a sample of young adolescents (13 years) indicated that attitudes towards authority in these two domains were highly rated (r = 0.57, P less than 0.001). Factor analysis yielded four interpretable factors--alienation from the institutional system, belief in the absolute priority of rules, perception of the bias vs. impartiality of authorities, and personal relationship to school life--accounting for 47.6, 13.9, 9.3 and 8.0 per cent of common variance respectively. Both overall attitude scores and factor scores were significantly related to self-reported delinquencies. Finally, covariance analysis of the results indicated that the attitude variable accounted for a substantial proportion of the sex difference in delinquency.