The Way Older Childless Women Value Their Life-A Qualitative Study.

Older women without children, like all older adults, evaluate their lives and face a conflict between despair and ego integrity as proposed by Erikson's theory of development. Their uniqueness lies in their deviation from the societal norm of parenthood prevalent in pro-natalist societies such as Israel. This study aims to explore how older childless women evaluate their lives. Using a qualitative approach, 20 semi-structured, in-depth interviews were conducted with women over 60 years of age who do not have children. Three main themes emerged from the participants' responses: their experiences as women without children in a pro-natalist society, the significance of freedom in their lives, and their life experiences from conflicting perspectives-an internal and external locus of control. The study's findings demonstrate that older childless women adeptly utilize different perspectives across various aspects of their lives, contributing to ego integrity, contrary to the prevailing societal notion that in the absence of children, women are damaged and lack identity. It is conceivable that other segments of the older adult population, diverging from mainstream societal norms, may similarly leverage these different perspectives to uphold their ego.

Effect of Social Support on Psychological Distress and Disease Activity in Inflammatory Bowel Disease Patients.

Background: Psychological distress increases morbidity in ulcerative colitis (UC) and Crohn's disease (CD). We examined whether social support is associated with distress and disease activity. Methods: There were 110 UC and 147 CD patients who completed sociodemography, economic status, disease activity (UC: Patient Simple Clinical Colitis Activity Index (P-SCCAI), CD: Patient Harvey-Bradshaw Index . (P-HBI), Multidimensional Scale of Perceived Social Support (MSPSS), Brief Symptom Inventory with Global Severity Index (GSI) of psychological distress, and 2 health-related quality-of-life scales (SF-36 Physical Health and Mental Health, and Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Analysis included multiple linear regressions and structural equation modeling. Results: Disease activity was mild: UC: P-SCCAI 2.9 ± 3.5, CD: P-HBI 4.7 ± 4.7. Physical Health was better in UC 46.6 ± 11.4 versus CD 43.7 ± 10.9 (P < .02). GSI was lower in UC 0.6 ± 0.7 than CD 0.8 ± 0.7 (P = .002). MSPSS total score was equal in UC (5.9 ± 1.2) and CD (5.9 ± 1.1). MSPSS total correlated with P-SCCAI (correlation coefficient ‒0.240), GSI in UC (‒0.470), and GSI in CD (‒0.333). Economic status correlated with GSI in UC (‒0.408) and CD (‒0.356). MSPSS predicted GSI, Mental Health, and SIBDQ in UC and CD, and predicted P-SCCAI but not P-HBI; economic status predicted all the foregoing. Path analysis depicted GSI as mediating the effects of MSPSS and economic status on disease activity in both UC and CD. MSPSS (UC: ß â€’0.34, CD: ß â€’0.37) and economic status (UC: ß â€’0.38, CD: ß â€’0.22) reduced GSI, which then increased the disease activity (UC: ß 0.56, CD: ß 0.42). Conclusions: Social support and economic status are linked to UC and CD patients' well-being. Interventions addressing these issues should be part of management.

Daily hassles score associates with the somatic and psychological health of patients with Crohn's disease.

OBJECTIVE: To examine the associations of daily hassles with the somatic and psychological health of Crohn's disease (CD) patients. METHOD: A cross-sectional study of 400 self-selected adult CD patients was performed with completion of demographic, medical, and psychosocial questionnaires: economic status; Patient Harvey-Bradshaw Index of disease activity; Daily Hassles Scale (DHS); Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and Short-Form Health Survey (SF-36 Physical and Mental Health) quality of life measures; Brief Symptom Inventory of psychological stress with summary Global Severity Index (GSI); Family Assessment Device; and List of Threatening Life Experiences. Analyses included correlations, regressions, and Sobel test statistic. RESULTS: The patients were aged 38.7 ± 14.1 years, 61% female and 67% working. The Patient Harvey-Bradshaw Index was 5.52 ± 4.87. The DHS was 88.0 ± 23.2, similar in men and women, higher in smokers, and increased with greater disease activity (p < .001). The most commonly reported hassles were time, social, and work. DHS had significant negative correlations with age, disease duration, and economic status and positive correlations with GSI, SF-36, and SIBDQ. An increased Daily Hassles score was associated with reduced SIBDQ (p < .001) and SF-36 Mental Health (p < .001) and increased GSI (p < .001) and Patient Harvey-Bradshaw Index (p < .001). This effect of DHS on Patient Harvey-Bradshaw Index was mediated by GSI (Sobel t = 6.09, p < 0.001). CONCLUSION: Daily hassles in CD patients are shown for the first time to be associated with increased psychological stress and disease activity and reduced quality of life and lower economic status. This has psychotherapeutic implications.

Effect of psychosocial stressors on patients with Crohn's disease: threatening life experiences and family relations.

BACKGROUND AND AIMS: Threatening life experiences and adverse family relations are major psychosocial stressors affecting mental and physical health in chronic illnesses, but their influence in Crohn's disease (CD) is unclear. We assessed whether these stressors would predict the psychological and medical condition of CD patients. METHODS: Consecutive adult CD patients completed a series of instruments including demography, Patient Harvey-Bradshaw Index (P-HBI), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), short-form survey instrument (SF-36), brief symptom inventory (BSI), family assessment device (FAD), and list of threatening life experiences (LTE). Associations of FAD and LTE with P-HBI, SIBDQ, SF-36, and BSI were examined by multiple linear and quantile regression analyses. RESULTS: The cohort included 391 patients, mean age 38.38±13.95 years, 59.6% women, with intermediate economic status. The median scores were as follows: P-HBI 4 (2-8), FAD 1.67 (1.3-2.1), LTE 1 (0-3), SF-36 physical health 43.75 (33.7-51.0), SF-36 mental health 42.99 (34.1-51.9), and BSI-Global Severity Index 0.81 (0.4-1.4). The SIBDQ was 47.27±13.9. LTE was associated with increased P-HBI in all quantiles and FAD in the 50% quantile. FAD and LTE were associated with reduced SIBDQ (P<0.001). Higher LTE was associated with lower SF-36 physical and mental health (P<0.001); FAD was associated with reduced mental health (P<0.001). FAD and LTE were associated positively with GSI in all quantiles; age was associated negatively. CONCLUSION: CD patients with more threatening life experiences and adverse family relations were less healthy both physically and mentally. Physicians offering patients sociopsychological therapy should relate to threatening life experiences and family relations.

Health-Related Utility Weights in a Cohort of Real-World Crohn's Disease Patients.

BACKGROUND AND AIMS: Estimating health-related utility weights in Crohn's Disease [CD] patients is crucial for assessing the cost-effectiveness of new pharmaceutical interventions. Values used in most analyses are based on secondary data and vary substantially among studies. We estimated utility weights in a consecutive sample of real-world CD patients. METHODS: Patients enrolled in an ongoing socioeconomic study of CD in the Israeli adult patient population completed a self-administered Short Form 36 health survey [SF-36] and Short Inflammatory Bowel Disease [SIBDQ] questionnaires and were assessed for their current clinical status, including the Harvey-Bradshaw Index [HBI] of disease severity. For each patient enrolled we calculated a utility weight using the SF-6D scoring system. RESULTS: The cohort comprised 425 patients [40% male] with mean age of 39.1 [± 14.0] years. The average HBI was 6.1 [± 5.4]; 198 [47%] patients were in remission state [HBI < 5], 99 [23%] had mild disease [HBI 5-7], 102 [25%] moderate [HBI 8-16], and 26 [6%] severe disease [HBI > 16]. Mean utility weights were: 0.667 in all patients, 0.744 in patients with disease remission, 0.638 in mild disease, 0.587 in moderate disease, and 0.505 in severe disease. The significant predictors of utility weights in a multivariable regression analysis were the HBI [ß = -0.494; p < 0.001], economic status [ß = 0.198; p < 0.001], time since diagnosis [ß = 0.106; p < 0.001], male [compared with female] gender [ß = 0.099; p = 0.009], hospital admission in the past year for any cause [ß = -0.086; p = 0.027], and treatment with steroids [ß = -0.100; p = 0.012] where ß denotes the standardised regression coefficients; model adjusted R(2) = 0.428. CONCLUSIONS: Utility weights for patients in the remission and mild disease states were generally lower as compared with values used in published cost-effectiveness analyses. These values should be considered when assessing the value for money of future interventions for CD.

AIDS-related knowledge, attitudes and behavior among adolescents in Zambia.

AIDS-related knowledge, attitudes, self-efficacy, and behavior were examined among 3,360 adolescents aged 10-19 years old in Zambia, including in-school and out-of-school, rural and urban, and married and unmarried adolescents. The adolescents reported a moderate to high AIDS knowledge; positive attitudes towards prevention; and low to moderate self-efficacy about AIDS prevention. Although these factors were significantly related to adolescents' engagement in high-risk behavior, the results indicated that these variables add only 3% of explained variance beyond the socio-demographic variables, which explains 14% of the variance. Three groups were identified as at most risk for HIV: out-of-school adolescents, adolescents from rural areas, and married adolescents. Prevention programs that emphasize the use of condoms should be implemented for these groups and future studies should evaluate their effectiveness in reducing risk.