Celiac disease: parental knowledge and attitudes of dietary compliance.

Parents of 43 children with celiac disease, 28% of whom were classified as noncompliant, were interviewed. The knowledge, attitudes, and dietary behavior of parents of compliant patients were compared with those of noncompliant patients. Parents of compliant patients are better educated and from a higher social class. Although objective knowledge of the disease is similar in both groups, parents of compliant patients consider themselves adequately informed about the disease and are better able to choose gluten-free items from a menu. Parents of compliant patients are less worried about health in general but are more concerned with possible adverse effects celiac disease might have on the future of their children. Parents of both groups are not significantly different with regard to their understanding of the diet, the tendency to use medical care, and the perception of barriers to compliance or social support. It was concluded that to increase dietary compliance in celiac patients, parents should be guided mainly by the following three purposes: (1) enhancing their subjective evaluation of their own knowledge of celiac disease; (2) improving their practical ability to handle a menu; (3) increasing their anxiety regarding possible long-term adverse effects.

The effects of replacing beta-blockers with an angiotensin converting enzyme inhibitor on the quality of life of hypertensive patients.

The aim was to evaluate the effects of a change of treatment from beta-blocker to captopril on the quality of life of hypertensive patients. One hundred forty-nine mild to moderate hypertensive patients who were being treated with beta-blockers were randomly assigned to receive captopril (12.5 to 50 mg twice daily), or to continue on beta-blocker treatment (atenolol: 25 to 100 mg once daily [n = 121], or propranolol, 10 to 80 mg twice daily [n = 12]). When required, 25 mg hydrochlorothiazide was added in each group. The patients were followed over periods ranging from 6 to 12 months. Blood pressure, treatment side effects, and quality of life were monitored. Blood pressure was equally well managed in both groups, though a lower level of treatment was required in the captopril group. The captopril treated patients exhibited favorable changes in several aspects of quality of life: sleep-related, gastrointestinal, and physical activity-related symptoms improved from baseline to end of follow-up. Drowsiness and the ability to concentrate significantly improved in the captopril group only (P <.01). Change in treatment from beta-blocker to captopril resulted in equally well controlled blood pressure on a lower drug dose. Moreover, the change to captopril had a positive impact on the quality of life.

The effects of diuretics on quality of life of hypertensive patients.

OBJECTIVES: To study the effect of diuretics and diuretics discontinuation on the quality of life (QOL) of hypertensive patients. METHODS: 149 beta blocker treated mild to moderate hypertensive patients were included in the study. Seventy-three were treated by beta blockers (BB's) only and 60 by BB's and diuretics, for 40 patients diuretics was discontinued. Physical symptoms and QOL were assessed before and 9-15 months after the change in treatment. RESULTS: At baseline, subjects on diuretics experienced more gastrointestinal symptoms, weakness, and sex related problems; and their QOL was poorer. At the end of the follow-up, patients on diuretics scored poorest on physical strength items and on health perceptions; those who were never treated by diuretics scored best; and those who stopped were in between. CONCLUSIONS: Diuretics treatment adversely affect patients' QOL. Cessation of diuretics treatment for at least 9 months improved some aspects of patients' QOL, though those who never received diuretics were better of than others.

Living arrangements and women's health.

The recent changes in the traditional patterns of living arrangements in the U.S.A. raise interest in their consequences for the well being of the individuals involved. In this paper the physical health of women in different living arrangements was studied. It was suggested that living arrangements differ in the degree of adult support and the nurturant responsibilities that often accompany women's social support. Since previous research seems to indicate that social support promotes health and nurturant obligations constrains it, it was predicted that women whose living arrangements offer steady adult support with slight nurturant responsibilities will be healthier than women whose living arrangements offer both, and that women whose living arrangements involve nurturant responsibilities without adult support will be the least healthy. It was also suggested that the more legitimate and socially acceptable are one's living arrangements, the fewer the social costs incurred. Health was measured by three health status and three illness behaviour indices. Data were taken from the NHIS of 1979, and a multiple regression analyses were conducted. When a health-profiles approach was taken, the health of women in different living arrangements ranked according to the hypotheses: women who live with their parents are the healthiest, followed by those in children/relatives' households; women head of families are the least healthy, just preceded by those living alone; women who live with their husbands or with unrelated persons are intermediate, and do not differ from each other.

Exploring the bio-psycho--social approach to premenstrual experiences.

A bio-psycho-social approach to the premenstrual syndrome suggests that cyclical hormonal changes are acknowledged and interpreted in light of the expectations and the attitudes acquired in the process of socialization. In this study, attitudes toward menstruation and premenstrual experiences of 229 Israeli students of different ethnic groups and gender role orientations were explored. The findings were consistent with previous reports: attitudes toward menstruation and premenstrual experiences were associated with exposure to premenstrual symptoms in women family members and negative messages during adolescence; respondents of a more traditional background perceived menstruation as relatively debilitating and bothersome but also a natural event and reported more severe experiences. However, models aimed at estimating the causal relationship indicated that attitudes toward menstruation depend on premenstrual experiences rather than predict them. The difficulties of investigating such reciprocal relationships of menstrual attitudes and premenstrual experiences cross-culturally and longitudinally are discussed.

Women's health and labour force status: an enquiry using a multi-point measure of labour force participation.

Previous research indicates that working women are healthier than housewives, that the unemployed are less healthy than those currently employed, and that transitions into and out of paid work may be particularly associated with poor health. Women respondents in the 1979 U.S. National Health Interview Survey were divided into five categories: the long term employee, the newly employed, the unemployed, the recently non-employed and the housewife. The categories were compared on six measures of self-reported health and illness behaviour, controlling for age, SES, marital status, and age of youngest child. As expected the long term employees were the healthiest, followed by the recently employed; the unemployed and the housewives were not distinguishable in terms of their health; and the recently non-employed were the least healthy. This pattern was found for both the total sample, and for the sub sample of married mothers. The dynamic relationship between employment status and health, is discussed.

Death rests a while: holy day and Sabbath effects on Jewish mortality in Israel.

The purpose of this study was to replicate and expand previous research examining the association between holy days and the timing of death. We analysed daily numbers of deaths of Jewish men and women aged 35 and above in Israel from 1983 to 1992, controlling for long term and seasonal trends. For all men, and for younger women (ages 35-74) there was a clear and significant dip-peak pattern in the number of deaths around the Sabbath (Saturday), but no consistent dip-peak pattern around other holy days. This pattern was found for all causes of death (particularly cerebro-vascular causes), was stronger for men than for women, and was not found among young Jewish children, or among the non-Jewish population.

Physical and psychological well-being among immigrant referrals to colonoscopy.

The association between immigration and well-being was studied in 2 groups of referrals to colonoscopy in the Negev region of Israel: Eastern Europe born (n = 278) and Israeli born (n = 70). The findings of this study suggest that the first 3 years after migration are associated with inferior physical and psychological well-being, and, to a lesser degree, with poorer family functioning and limited social interactions. The differences between immigrants and Israeli born tended to fade away as years went by, and the most veteran immigrants, those who immigrated more than 40 years prior to the study, scored best on most physical and psychological well-being indicators. Findings are discussed in terms of a life events approach and in terms of Israeli immigration regulations and absorption policy.

Emergency department utilization by two subcultures in the same geographical region.

An exploratory study of emergency department (ED) utilization, comparing Israeli adult Jews and Bedouin Arabs was conducted. The data interpretation derived from the premise that health services utilization reflects not only morbidity patterns but characteristics of both subcultures and the structure of health services. The Bedouins in the study are a Moslem traditional society going through a rapid process of urbanization and modernization, with a relative deficiency in primary health services. Data were collected from the general ED admissions registry. Patients (17+) who arrived at the ED during the first week of every even month of one calendar year were selected for this study (6815 Jews and 583 Bedouins). The findings indicate that, in general Bedouins use the ED significantly less than Jews. They adjust to the structure of the ED services and use them, more than Jews, as a primary service. Yet, the hospitalization rates of the two populations are similar. In both subcultures the pattern of gender differences changes after the age of 45. The change, however, is in the opposite direction. Differences in ED usage among Bedouin age-sex groups are discussed in terms of changes in social status during a period of socio-cultural transition.

Gender differences in health perceptions and their predictors.

This study explored the degree to which risks embedded in the social construction of gender roles and personality traits explained gender differences in health perceptions and reporting among mild hypertensive patients (134 women and 104 men) under the same treatment regime. Compared with men, women were less educated, less likely to be employed, less happy, more distressed, less satisfied with family functioning, and had a weaker sense of coherence. Twice as many women as men evaluated their health as 'poor', and on average reported 2.6 more symptoms than men. These gender differences largely disappeared when unhappiness, distress, and sense of coherence were controlled. While education attainment, employment, and satisfaction with family functioning decreased gender differences in some half of the symptoms, multivariate analysis suggested that unhappiness, distress, and the sense of coherence are far better predictors of gender differential health perceptions. It is suggested that beyond biological predispositions, women's health is in double jeopardy by gender role related risks, which affect morbidity both directly through immunology system and indirectly through health perceptions.

Life events, sense of coherence and health: gender differences on the kibbutz.

The effects of recently experienced life events (RLE) and of a personal coping resource--the sense of coherence (SOC)--on the health of men and women were investigated among members of two small and cohesive communities--two kibbutzim in Israel (n = 230). Results of analyses lend support to previous findings about the negative effects of life events on health, and to Antonovsky's theory about the positive influence of SOC on health. Separate analyses for men and women, however, show that while RLEs negatively affect women's health, SOC has no significant counterbalancing effect on their health. Among men, an opposite pattern is found; their health is not affected by RLE, but is significantly affected by their SOC. Our findings lead to the conclusion that men and women are differentially affected by stressors and make different use of their coping resources. These findings should be taken into consideration in further research on stress, coping and health.

Human cytomegalovirus salivary antibodies as related to stress.

Human cytomegalovirus (HCMV) is prevalent in 50-80% of the population worldwide. After primary infection it remains in a latent state until reactivation. Stressful events induce the release of corticosteroids which activate HCMV. The effect of examination stress on HCMV reactivation among first year female students was studied by detecting the values of HCMV specific salivary IgG and IgA antibodies before, during and after two important examinations. Hepatitis A virus (HAV) salivary antibodies served as a non-latent virus control. A statistically significant increase in the level of HCMV specific IgG and IgA antibodies was detected in saliva samples collected during the two examinations, as compared with the samples collected one month before them and two weeks after the grades were posted (p<0.05), whereas HAV antibody levels did not change significantly.

Coping with recent life events: the interplay of personal and collective resources.

The importance of personal and collective resources in coping with recent life events was studied among 230 kibbutz members. The sense of coherence, a global life orientation that detects the ability to avoid stressors and to choose appropriate coping strategies and resources, represented personal resources. Collective resources, embedded in the social system to which one belongs, were measured by membership in a religious kibbutz, the kibbutz being viewed as a powerful, collective-coping resource by itself. Physical well-being, psychological distress, and functional limitations were used as outcome measures. Both types of resources have a salutogenic effect, but sense of coherence appears to be a better resource for avoiding the effect of recent life events and for moderating psychological distress and functional limitation after experiencing such events. The two types of resources have no additive effect, nor do they compensate for each other. Only one significant interaction was found, suggesting that the combination of the two resources is useful in avoiding functional limitation. It is also suggested that collective resources have a slight positive effect on personal resources, which, in turn, take over and become most valuable in coping with recent life events. When stress affects social functioning, these same personal resources facilitate the mobilization of whatever collective resources are available.

The Israeli Patient's Rights Law: evidence for deprofessionalization?

In this paper, the Israeli Patient's Rights Law of 1996 is discussed within the framework of Haug's predicted process of deprofessionalization. It is argued that the law reflects global processes such as the diffusion of knowledge, consumerism, and values that emphasize human rights and democracy. By guaranteeing patients' access to medical information, by submitting medical decisions to extra-professional regulation, the law erodes professional power.

Referrals for alternative therapies.

BACKGROUND: The purpose of this study was to examine how allopathic physicians participate in the decision to refer patients for alternative therapies. METHODS: A pretested, self-administered, structured questionnaire was distributed simultaneously to all area physicians at community locations in Washington State, New Mexico, and southern Israel. The primary outcome measures were monthly and yearly rates of referral to alternative therapies. RESULTS: More than 60% of all physicians made referrals to alternative providers at least once in the preceding year and 38% in the preceding month. Referrals were generally based on patient requests, synergy between the alternative therapy and the patients' cultural beliefs, failure of conventional treatment, and the belief that patients have "nonorganic" or "psychological" disease. There was no relationship between the rate of referral and the referring physician's level of knowledge about, beliefs about the effectiveness of, or familiarity with alternative therapies. CONCLUSIONS: Primary care physicians are more likely than other medical specialists to be knowledgeable about, personally subscribe to, and refer patients for alternative therapies. Physicians who use alternative techniques for themselves and their families or who adopt complementary therapies into their practices have higher rates of referrals. Referral rates and patterns were similar between sites despite considerable cross-cultural and health system differences. Given the high rate of referral and the absence of an apparent internal logic for such recommendations, guidelines and physician education may be advisable.

Marital violence: comparing women in violent and nonviolent unions.

PIP: This study examined marital violence among Israeli Jews. Data were obtained from a sample of 161 women who gave birth at Soroka Medical Center in the Negev region of Israel in 1992. The literature reveals that Jewish families tolerate domestic violence if an "evil" woman refuses housework or shows no respect for her husband. It is believed that Jews do not beat their wives. This study explored the degree to which women accept as legitimate the gender division of authority and use of power. It is posited that women in violent marriages (VMs) tend to accept the traditional division of labor and authority and hold more tolerant attitudes toward VMs. It is posited that VMs may be less egalitarian and democratic. VMs may be maintained if women are emotionally dependent on husbands, have a lower self-image, and perceive their husbands more positively. The questionnaire asked about social background and resources, attitudes toward marital power and violence, power relations, self-image, conflict solving, and women's emotional dependency. 18% had 1 domestic violent episode. 8 factors explained 56% of the difference between VMs and non-VMs and 90% of the cases. Husbands tried to avoid conflict. Wives fought for their interests and used external resources when conflict occurred. Husbands were reluctant to share power. There were 2 distinct patterns: the battered women syndrome and the struggle for power. Marital conflict was associated, as in the American literature, with economic hardship, lack of collectiveness in the dyad, and the form of conflict solving tactics used by both spouses. Women in VMs had different attitudes toward husband control and were emotionally dependent on their husbands.^ieng

Surviving the holidays: gender differences in mortality in the context of three Moslem holidays.

"It was hypothesized that holy days may affect mortality patterns differentially by gender. The present study focused on Moslems in Israel.... After removing the long-term growth and the seasonal effects, women's mortality was found to be significantly greater in the month of Ramadan than in the month before, and in the two weeks before the feast of 'Id el-Adhha than in the two weeks after it. For men, mortality was higher in the two weeks after the feast of 'Id el-Fitr than in the two weeks before it."

The health of women married to men in regular army service: women who cannot afford to be ill.

The health, distress, and health services utilization of 44 women married to army men was compared to those of 53 women living in the same community. Army wives were found to have less access to health promoting and maintaining resources such as social support, employment, and the "sense of coherence." Although army wives' health is not significantly different from that of the controls, they visit the family physician with their children more often. It is suggested that women who are married to army men learn to cope with instability and with limited access to salutary factors, but the lay referral system is irreplaceable.

Gender differences in the utilization of emergency department services.

Some of the suggested explanations of the well documented gender morbidity differences imply that these are not 'real' but the result of women's tendency to perceive and report more symptoms, to magnify symptom severity, and to seek help. To contribute to this debate, gender differences in utilization of a general hospital emergency department (ED), often used as a primary care service and for mild conditions, were studied. Data were collected from the general ED admissions registry for 6815 patients. In our data strikingly more men than women visited the ED during the period studied; generally, the same proportion of men and women were self-referred patients; and similar rates of both sexes were hospitalized regardless of type of referral. Thus, these findings suggest that, at least among ED patients, there is no gender differential in symptoms perception, evaluation, or presentation. Indications for these were somewhat found among young patients (aged 17-24) only. Alternatively, the findings with regard to this age group could reflect professional gender stereotyping at the primary care level.