Family adaptation in families of individuals with Down syndrome from 12 countries.

Our current understanding of adaptation in families of individuals with Down syndrome (DS) is based primarily on findings from studies focused on participants from a single country. Guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, the purpose of this cross-country investigation, which is part of a larger, mixed methods study, was twofold: (1) to compare family adaptation in 12 countries, and (2) to examine the relationships between family variables and family adaptation. The focus of this study is data collected in the 12 countries where at least 30 parents completed the survey. Descriptive statistics were generated, and mean family adaptation was modeled in terms of each predictor independently, controlling for an effect on covariates. A parsimonious composite model for mean family adaptation was adaptively generated. While there were cross-country differences, standardized family adaptation mean scores fell within the average range for all 12 countries. Key components of the guiding framework (i.e., family demands, family appraisal, family resources, and family problem-solving communication) were important predictors of family adaptation. More cross-country studies, as well as longitudinal studies, are needed to fully understand how culture and social determinants of health influence family adaptation in families of individuals with DS.

Use of Health Information Exchange in the Continuity of Care as Viewed by Patients and Nurses: A Cross-Sectional Study.

Patients' attitudes toward sharing their personal health information are critical for implementation of health information exchange. Nurses contribute significantly to information sharing within the care continuum in hospitals and community. This study aimed to examine the awareness and readiness of patients with chronic illness and nurses to the use health information exchange. A cross-sectional study was conducted among 314 inpatients with a chronic illness, 110 nurses working in internal wards, and 55 contact nurses working in a large health maintenance organization. The findings showed that the mean level of awareness was low across all three groups. Contact nurses expressed more positive attitudes than internal ward nurses or patients and were more willing than patients to share information with healthcare workers. Knowledge, attitudes, and being a nurse predicted the intention to share information with medical healthcare providers and with agents not involved in direct care. Before implementation of a health information exchange system, it is important to raise awareness, readiness, and intention to use it among the public, nurses, and other medical staff. Policy makers should organize national campaigns under the auspices of the Ministry of Health to present the advantages and provide detailed information about the system.

Emotion management of women at risk for premature birth: The association with optimism and social support.

OBJECTIVE: To examine the emotion management of women at risk for premature birth, and the connection to their optimism and social support. BACKGROUND: A shortened uterus cervix in early pregnancy (24-34 weeks gestation) is a predictor of preterm birth and is a common reason for hospitalization in a high-risk unit. Women hospitalized for this reason often feel a wide spectrum of emotions that may require emotional work, where deep acting techniques are used to evoke or suppress emotions in order to meet social expectations. The emotions, optimism, and social support of women with high-risk pregnancies have implications for their health and well-being. DESIGN: A cross sectional study at a high-risk pregnancy unit in a large hospital in Israel. METHOD: Eighty-six pregnant women hospitalized between 24 and 34 weeks of gestation in a high-risk unit due to premature contractions and/or cervical shortening, responded to a structured questionnaire. Data were analyzed using reliability testing, descriptive statistics, correlation analysis, and multiple linear regressions. RESULTS: A significant correlation was found between social support and optimism (r = 0.45, p < .01). A negative correlation was found between optimism and emotion management (r = -0.24, p < .05) and deep acting emotion management (r = -0.21, p < .05). CONCLUSION: High-risk pregnant women manage their emotions mainly through deep emotion work. Social support and optimism contribute to their emotional coping. It is recommended that healthcare professionals working in high-risk pregnancy units, and especially nurses, employ interventions designed to provide professional support and legitimize the sharing of emotions.

Integrating Genomic Professional Skills Into Nursing Practice: Results From a Large Cohort of Israeli Nurses.

PURPOSE: To explore the association of genomic knowledge, self-epistemic authority (SEA; i.e., subjective perception of knowledge expertise), perceived importance of genomics in nursing, and the integration of genomic skills into nursing practice. DESIGN: A cross-sectional study of nurses working in pediatric, obstetric, and internal wards of two medical centers in Israel between February and October 2018. METHODS: Participants completed anonymous questionnaires about genomic knowledge, SEA, perceived importance of genomics, and the performance of genomic skills in nursing practice. Associations between variables were analyzed using Pearson correlations, and a hierarchical regression model was used to determine which variables explained the performance of genomic practices among participants. FINDINGS: Altogether 423 nurses participated in the study. The mean genomic knowledge was low (55.05 ± 14.82%). Nurses reported a low integration of genomic skills in their practice (M = 1.90, SD = 0.71), although their overall perceived importance of genomics was positive (M = 2.88, SD = 0.68). Positive correlations were found between SEA and the integration of genomic skills in nursing practice. Obstetric nurses had more genomic knowledge, more positive perceptions about genomics, and performed more genomic skills in their nursing practice. CONCLUSIONS: Although nurses realized the importance of genomics to their practice, and genomics is part of the Israeli nursing core curriculum, we found disappointingly low levels of knowledge and performance of genomic skills in nursing practice. CLINICAL RELEVANCE: The results call for action to establish ongoing education programs in genomics for nurses, which would lead to the inclusion of genomic skills into routine nursing practice, and prepare nurses for providing personalized medicine.

Assessment of the Intention to Use Mobile Health Applications Using a Technology Acceptance Model in an Israeli Adult Population.

Background: Mobile health applications (mHealth apps) have now gained global popularity. However, evaluating the level of their use over time still remains a pertinent challenge. According to the Technology Acceptance Model (TAM), perceived ease of use and usefulness predict attitudes toward technology utilization. Together, these factors serve as determinants of behavioral intention to use the technology, which in turn predicts actual use. Purpose: We sought to elucidate factors affecting behavioral intention to use mHealth apps in an Israeli adult population sample. Methods: A modified TAM Likert Scale questionnaire-based survey was offered to 200 participants, with 168 respondents. Results: Sixty one percent of participants reported using mHealth apps on their smartphones, 81% of whom used mHealth apps from health maintenance organization providers. Generation Y participants displayed more confidence with the use of mHealth apps, and were less concerned about compromising the confidentiality of their health records. Furthermore, answers to TAM-related questions among mHealth apps users were significantly more positive, compared with nonuser TAM components that accounted for 51% of the total variance in the intention to use mHealth apps. Discussion: TAM constructs were related to the behavioral intention to continue to use mHealth apps. Health organizations as providers of mHealth apps were strong determinants of their acceptance and utilization. Generational differences in user competence were observed; however, whether user experience or interface design represents the underlying differentials remains to be elucidated, and developers of health care-related mobile technologies will need to address this question.

The quality and safety culture in general hospitals: patients', physicians' and nurses' evaluation of its effect on patient satisfaction.

OBJECTIVE: To explore the disparities between patients' and health care workers' perception of the quality and safety culture and to explore the relationship between patient perceptions, and engagement in, and satisfaction with their care and treatment. DESIGN: A cross-sectional study was conducted in medical-surgical wards of four Israeli general hospitals. Data were collected using a self-administered questionnaire. SETTING: Fourteen medical-surgical wards of the four hospitals where data were collected. PARTICIPANTS: The sample comprised of 390 physicians and nurses and 726 inpatients admitted for at least 3 days. MAIN OUTCOME MEASURES: A self-administered questionnaire that covered the following topics: (i) quality and safety culture, (ii) patient engagement, (iii) patient satisfaction, (iv) an assessment of the care quality and safety in the ward and (v) sociodemographic data. The questionnaire was translated into Arabic and Russian. Sixty nine items were directed to the staff and 71 to patients. RESULTS: Patients evaluated the quality and safety culture significantly higher than did the health care workers. Significant correlations were found between patients' engagement in and satisfaction with their care and their quality and safety assessments. Their evaluation of this culture was the only predictor of their satisfaction and engagement. Arabic-speaking patients rated four variables, including patients' satisfaction with their care, lower than did Hebrew and Russian speakers. CONCLUSIONS: Patients have sufficient experience and understanding to form an opinion of the quality and safety of their care. The lower evaluation of the quality and safety culture expressed by health care workers might stem from their more realistic expectations.

Family Health Clinics as a Source of Social Capital.

PURPOSE: To examine the extent to which Family Health Clinics (FHCs) contribute to the formation of social capital among mothers, and determine whether it is influenced by socioeconomic factors. In FHCs, social capital can be gained by relationships between mothers (bonding social capital), by relationships between mothers and FHCs team, or between mothers of different origins/culture (bridging social capital) and health services institutional bodies (linking social capital). DESIGN: This is a mixed method study. For the quantitative part, data were collected from 673 mothers using a questionnaire. The qualitative part was conducted with six focus groups. RESULTS: The FHC constitutes a source of social capital in all dimensions. Bridging social capital was most prominent and is formed by interactions between mothers and FHC nurses. The factors that explain the formation of social capital were: mothers' spoken language being Arabic, participation in group training, and lower level of education. The focus groups revealed that participation in group training increased the social capital. Mothers noted that FHC nurses supplied updated information about their children's care. Regarding linking social capital, mothers perceive FHC nurses as mediators between them and the local and national health services. CONCLUSIONS: FHC clinics are a source for gaining social capital. The FHC services should be adapted to mother's needs. IMPLICATIONS: FHC nurses should try to create conditions for mothers to meet to create bonding social capital, relate to mother's needs for the creation of bridging social capital, and provide culturally adapted care for the formation of linking social capital.

Nurse and Nurse Student Attitudes and Perceived Self-efficacy in Use of Information and Communication Technologies: Professional and Cultural Differences.

Information and communication technologies have become essential and design-effective tools in the global healthcare system. Evidence suggests that information and communication technologies can promote nursing practice and patient satisfaction and quality of care. Competency with information and communication technologies is essential for both nurses and nursing students, and attitudes toward its use and perceived self-efficacy are important for implementation in the workplace. This study aimed to explore nurse and nursing student attitudes and perceived self-efficacy regarding information and communication technologies use in clinical practice and to examine professional and cultural differences between these groups in their attitudes and perceived self-efficacy in information and communication technologies use. A cross-sectional study was conducted among Israeli nursing students (n = 144) and registered nurses (n = 104). The findings revealed that respondents held overall positive attitudes toward information and communication technologies' use in clinical practice and perceived themselves as competent in this context. Significant differences were found between nurses and students in their attitudes toward information and communication technologies and information and communication technologies self-efficacy. Cultural group (Jewish/Arab) was found related to positive attitudes toward use of information and communication technologies in clinical practice. Nurse educators and managers should be aware of the potential impact of cultural and professional differences on the adoption and implementation of information and communication technologies and should institute initiatives within the organization and academia to manage cultural and professional discrepancies.

Israeli E-patients' Informational Needs.

BACKGROUND: Online medical information has transformed the way patients obtain information. PURPOSE: The present study examined patients' informational needs and the patient- Healthcare Provider (HCP) relationship from the perceptions of both patients and HCP. METHODS: The study was a cross-sectional study; data were collected in Israel from100 HCPs (nurses and physicians) and 184 e-patients. FINDINGS: E-patients were comfortable sharing e-information with their HCP and expected them to consider the e-information in treatment decision-making. Physicians thought they provided more information than the patients considered that they received from them, while both nurses and patients were in agreement about their interactions. Patients thought that there was a higher concordance between the e-information and the information they received from the physician/nurse as compared to what physicians and nurses reported. DISCUSSION AND CONCLUSIONS: E-health information does not disrupt the patient-nurse/physician relationship. To promote compliance to treatment, it is important that HCPs consider information presented by patients when preparing the treatment plan.

Experiences, behaviors, and perceptions of registered nurses regarding research ethics and misconduct.

BACKGROUND: Nurses engaging in research are held to research ethics standards. RESEARCH AIM: Examine experiences, behaviors, and perceptions of nurses in Israel regarding research ethics and explore possible related factors. RESEARCH DESIGN: An original investigator-designed self-administered questionnaire measured five variables: (a) ethics in research, (b) encountered research misconduct during the course of one's studies, (c) the inclination to fabricate data, (d) the inclination to select or omit data, and (e) knowledge of research misconduct in the workplace. Additionally, demographic data were collected. PARTICIPANTS AND RESEARCH CONTEXT: The questionnaire was completed by 151 Israeli registered nurses. 10.2% hold a PhD, 34 % hold an MA, 42.2% hold a BA, and 13.6% with no academic degree. ETHICAL CONSIDERATIONS: The study was approved by the University's ethics committee; anonymity and consent of the respondents were respected. FINDINGS: Registered nurses' level of studies achieved was significantly associated with a lower inclination to fabricate data, with one exception-PhD nurses were more inclined to fabricate data than nurses with a Master's degree. A trend was found in which a higher level of studies is associated with higher knowledge of research misconduct in the workplace. DISCUSSION: Results indicate that nurses' perceptions of research ethics change throughout their academic studies, indicating a positive influence of level of studies, research experience, and work experience on ethics perceptions. Nevertheless, PhD nurses showed a greater inclination to actually select, omit, or even fabricate data than MA nurses. This may be related to pressure to publish. CONCLUSION: PhD nursing programs should include ethics training. Academic faculty members should serve as role models regarding research integrity. Research ethics deserves further emphasis on all levels of nurse education in Israel, as well as in the nurses' code of ethics and related documents. This may positively impact ethical research practices.

Companions or patients? The impact of family presence in genetic consultations for inherited breast cancer: Relational autonomy in practice.

As in other areas of medical practice, relatives accompany patients to genetic consultations. However, unlike in other areas, the consultations may be relevant to the relatives' health because they may be at risk of developing the same genetic condition as the patient. The presence of relatives in genetic consultation may affect the decision-making process and it raises questions about the perception of patient autonomy and the way it is practiced in genetics. However, these issues have not been examined in previous empirical studies. This article aims to fill this gap by reporting findings from a qualitative study with clinicians working in the area of inherited breast cancer. The findings indicate that family presence has an impact on the patient's decisions to undergo genetic testing and preventative operations when she is diagnosed as a carrier. The findings further indicate that, unlike in other areas of medical practice, blood relatives who are present in consultations are perceived by clinicians as patients or potential patients, and this in turn increases their involvement in discussions in the consultation room. Finally, the findings indicate that in genetics, a relational approach to autonomy is applied. Decisions are made in a social context, where the relatives' views are heard and taken into account. The findings suggest that the conventional bioethical approach to autonomy, which perceives the decision-making unit as comprising a clinician and an individual patient, is challenged in genetics. The findings thus suggest that bioethicists, lawyers and policy-makers should consider whether this individualistic approach is still valid and applicable.

Quality of life and uncertainty in Crohn's disease.

INTRODUCTION: Crohn's disease impairs patients' perception of health and has a negative impact on health-related quality of life. Although it is apparent that uncertainty is a significant factor that decreases quality of life, it has never been studied in patients with Crohn's disease. The objective of the present study was to examine the association between level of certainty, self-epistemic authority, Internet information gathering habits, and health-related quality of life. METHODS: A cross-sectional study of 105 Crohn's disease patients was conducted. Data were collected using a questionnaire composed of five parts: (1) demographic and clinical information; (2) health-related quality of life; (3) level of certainty; (4) self-epistemic authority; and (5) Internet information gathering habits regarding Crohn's disease. RESULTS: A significant positive correlation was demonstrated between levels of certainty and health-related quality of life. Self-epistemic authority correlated positively with certainty, while information gathering via the Internet was related to decreased certainty. Multiple regression analysis for factors associated with health-related quality of life showed a positive association with the level of certainty, while negative associations were found between Internet information seeking and disease activity with the quality of life. CONCLUSION: Level of certainty proved an important variable associated with health-related quality of life in Crohn's disease patients. Improving patients' self-epistemic authority can increase certainty and, thus, improve health-related quality of life.

Anxiety and support resources for Israeli women before gynecological surgery.

Gynecologic surgery is a frequent procedure for benign and malignant diseases and may evoke anxiety and a need for support. The purpose of the present study was to examine whether women with suspicion of gynecologic malignancy and those with no suspicion of gynecologic malignancy had different sources of social support and the relationship between this support and their anxiety. A descriptive cross-sectional method was used at a large medical center. Data were collected between June and December 2010 from 100 hospitalized women 20-28 hours prior to gynecologic surgery: 50 with suspicion of gynecologic malignancy and 50 with no suspicion of gynecologic malignancy. Social Support and Anxiety Questionnaires were distributed to the participants. The results showed that sources of support differed between the groups: women with suspicion of gynecologic malignancy reported receiving more support from their family and from the nursing staff while women with no suspicion of gynecologic malignancy reported receiving more support from friends or the Internet. Both groups reported similar levels of anxiety. Because women seek support prior to gynecologic surgery, healthcare professionals should play a more active role by offering their support in addition to guiding patients to websites that aim to provide information and support.

Social Inclusion of Children With Down Syndrome: Jewish and Muslim Mothers' Knowledge, Attitudes, Beliefs, and Behavioral Intentions.

PURPOSE: The current study examined mothers' knowledge, beliefs, attitudes, and intention to socially integrate children with Down syndrome (DS) in the family, with children without disabilities and school system. DESIGN AND METHODS: A questionnaire based on a descriptive, cross-sectional design was administered to Jewish and Muslim mothers. The questionnaire included demographics, knowledge, beliefs, attitudes, and intention to integrate children with DS. Analysis included a regression test of intention to integrate children with DS and a one-way ANOVA for differences between Jewish and Muslim mothers. RESULTS: Nearly all the Jewish mothers (93.7%) and about half the Muslim mothers (52.8%) had performed screening tests for DS during their pregnancy. All mothers displayed low knowledge level about DS. Being Jewish (t=2.89; p=0.005) and holding more positive beliefs (t=3.39; p=0.001) were associated with a higher intention to socially integrate children with DS. Significant positive correlations were found between beliefs and attitudes (r=0.65; p<0.001) and between attitudes and intention to socially integrate children with DS (r=0.39; p<0.001). CONCLUSIONS: This study shows that Jewish and Muslim mothers' beliefs and attitudes towards social inclusion of children with DS are quite positive and the intention to integrate children with DS in the family, with children without disabilities, and in the mainstream school system is high. However, their level of knowledge about DS is low. PRACTICE IMPLICATIONS: Nurses, as a critical source of information about DS, should develop an ethno-cultural sensitivity to diverse populations in order to influence attitudes and beliefs regarding the social integration of children with DS.

Professional, generational, and gender differences in perception of organisational values among Israeli physicians and nurses: Implications for retention.

The global health workforce today is more age diverse than ever before and spans three generations: baby boomers, X and Y generations. Each generation has a distinct set of characteristics, values, and beliefs. This diversity can lead to increased creativity and a greater richness of values and skills, but at the same time it can also lead to value clashes, disrespect, and conflicts. This study aimed to examine professional, generational, and gender differences in the perception of the importance of organisational values among nurses and physicians working in both hospitals and outpatient clinics in Israel. Data were collected from a large sample of nurses and physicians (N = 603) from 11 hospitals and community services across Israel. The participants completed a self-administered questionnaire rating the perceived importance of 20 organisational values, such as leadership, risk-taking, competition, power, and collaboration. The five values ranked most important were performance quality, cooperation, commitment, effectiveness, and efficiency. The five values ranked least important were competition, marketing, power, risk-taking, and assertiveness. Significant value differences were found by profession, generation, and gender. Nurses scored efficiency, assertiveness, risk-taking, power, and marketing higher than physicians did. The Y generation scored power higher and marketing lower than the two older generations. Women ranked the values of cooperation, commitment, innovativeness, vision, and marketing significantly higher than men did. Understanding differences between professions, generations, and gender is a useful first step in improving employees' job satisfaction, productivity, and retention.

Nursing Students' Attitudes and Intention to Work with Mentally Ill Patients Before and After a Planned Intervention.

OBJECTIVES: The authors examined changes in attitudes and intention to work with mentally ill patients (treat, specialize, or work in the field) among nursing students after a planned intervention consisting of a mental health course. METHODS: Data were collected before and after a planned intervention. The nature of the intervention was educational, for third year undergraduate nursing students. The core intervention included lectures on mental illness, encounters with people coping with mental illness, simulations, and a film on coping with mental illness. Behavioral intention to work with mentally ill patients and three dimensions of nursing students' attitudes (perceived functional characteristics, perceived danger, and value diminution of mentally ill patients) were measured before and after the intervention. The post-intervention impact of the intervention on participants' attitudes and behavioral intention was measured. RESULTS: One hundred and one undergraduate third year nursing students studying at four nursing schools in Israel participated in the study. The planned intervention improved the students' attitudes towards mentally ill patients but did not improve their intention of working with them. Post-intervention, older and less religious students had more intention to work with mentally ill patients. Moreover, older and Jewish students held better attitudes towards the functional characteristics of mentally ill patients. Being older was also correlated with the perception of mentally ill patients as less dangerous and male students ascribed to them more value diminution. CONCLUSIONS: Students' attitudes towards mentally ill patients and their behavioral intention to work in the psychiatry field should be addressed during the initial training and in continuing education. Teaching methods should include theoretical learning on multicultural mental health practice concurrently with clinical placements.

Patients' Attitudes Towards Disclosure of Genetic Test Results to Family Members: The Impact of Patients' Sociodemographic Background and Counseling Experience.

Many factors predict the intention to disclose genetic information to relatives. The article examines the impact of patients' socio-demographic factors on their intention to disclose genetic testing results to their relatives. Data were collected in eight genetic clinics in Israel. Patients were requested to fill in a questionnaire after counseling. A convenience sample of 564 participants who visited these clinics was collected for a response rate of 85 %. Of them, 282 participants came for susceptibility testing for hereditary cancers (cancer group), and 282 for genetic screening tests (prenatal group). In the cancer group, being secular and having more years of education correlated positively with the intention to disclose test results to relatives. In the prenatal group, being married and female correlated positively with the intention to disclose. In the cancer group, being religious and with less years of education correlated positively with the view that the clinician should deliver the results to the family. In the prenatal group, being male and unmarried correlated positively with this belief. In both groups, being of young age correlated with the perception that genetic information is private. Varied sociodemographic factors affect the intention to inform family members. Thus, knowing the social background of patients will shed light on people's attitudes to genetic information and will help clinicians provide effective counseling in discussions with patients about the implications of test results for relatives.

Factors influencing the decision to comply with nurse recommendations to take or avoid influenza vaccination.

Influenza is a major cause of morbidity and mortality. Although vaccination is an efficient means of prevention, low rates of vaccination are reported periodically. The study aimed to examine factors affecting acceptance of nurses' recommendations to take or avoid influenza vaccination. Study design was quasi-experimental with a 2 × 2 between subjects design: two variables were manipulated and two were not. The research variables were expertise (of nurses and respondents), type of recommendation (to vaccinate or not) and respondents' a-priori intention to vaccinate. Data were collected from 374 respondents. The study was scenario based, differing in nurse expertise and type of recommendation. After each scenario, the respondents were requested to indicate their a-priori intention to vaccinate and to complete questionnaires on epistemic authority (EA) attributed to the nurse, and of self-epistemic authority (SEA). There is a general tendency to avoid vaccination. Intention to vaccinate correlated positively with nurse recommendations, respondent a-priori intention and nurse expertise. A significant three-way interaction between respondents' SEA, nurse recommendations and nurse expertise was found. The nurse's recommendation has the strongest effect when the nurse is an expert and the respondent perceives him/herself as having high self-EA. The results highlight the importance of patients' sense of knowledge for assuring their co-operation and compliance with medical recommendations.

Calpastatin upregulation in Mycoplasma hyorhinis-infected cells is promoted by the mycoplasma lipoproteins via the NF-κB pathway.

Mycoplasma hyorhinis frequently contaminates cultured cells, with effects on synthetic and metabolic pathways. We demonstrated for the first time that contamination of cells by a strain of M. hyorhinis (NDMh) results in increased levels of calpastatin (the endogenous inhibitor of the ubiquitous Ca(2+) -dependent protease calpain). We now show that the calpastatin upregulation by NDMh in neuroblastoma SH-SY5Y cells resides in the NDMh lipoprotein fraction (LPP), via the NF-κB transcription pathway. NF-κB activation requires dissociation of the cytoplasmic NF-κB/IκB complex followed by NF-κB translocation to the nucleus. NDMh-LPP induced translocation of the NF-κB RelA subunit to the nucleus and upregulated calpastatin. RelA translocation and calpastatin elevation were prevented when dissociation of the NF-κB/IκB complex was inhibited either by transfection with the non-phosphorylatable IκB mutant ΔNIκBα, or by using PS1145, an inhibitor of the IκB kinase (IKK complex). Increased calpastatin levels attenuate calpain-related amyloid-ß-peptide and Ca(2+) -toxicity (these are central to the pathogenesis of Alzheimer's Disease). LPP-induced elevation of calpastatin provides an example of effects on non-inflammatory intracellular proteins, the outcome being significant alterations in host cell functions. Since calpastatin level is important in the control of calpain activity, mycoplasmal LPP may be of interest in treating some pathological processes involving excessive calpain activation.