Perceptions of complementary medicine integration in supportive cancer care of Arabs and Jews in Israel: a cross-cultural study.

CONTEXT: There is a dearth of studies on how cultural background influences patients' attitudes and choices regarding complementary and traditional medicine (CTM) integration. OBJECTIVES: To explore Arab and Jewish patients' perspectives regarding CTM use and its possible integration within conventional cancer care. METHODS: This was a cross-cultural study. We developed a 27-item questionnaire that evaluates patients' perceptions regarding CTM integration in supportive cancer care. The questionnaire was administered to a convenience sample of patients receiving cancer care in community and hospital oncology centers. RESULTS: Of the 770 respondents (response rate 88%), 324 defined their religion as Muslim, Christian, or Druze (henceforth, regarded as Arabs) and 446 were Jews. Respondents in the two groups differed significantly in terms of age, gender, marital status, number of children, education, religiosity, and prevalence of cancer types (excluding breast cancer). Although Arab respondents reported less use of CTM for cancer-related outcomes (39.6% vs. 52.1%; P = 0.001), they expressed greater support than Jewish respondents for optional CTM consultation if provided within conventional oncology care (P < 0.0001). Respondents in both groups stated that their primary expectation from the oncologist concerning CTM was to participate in formulating a CTM treatment plan to be provided within the oncology department. Compared with Arab respondents, Jews expected CTM consultations to focus on improving daily functioning and coping, reducing chemotherapy side effects, and providing spiritual support. CONCLUSION: Although quality of life-related expectations are more pronounced among Jewish respondents, both groups share the expectation from their health care providers to be actively involved in construction of a tailored integrative CTM treatment plan.

An orthodox perspective of the Jewish end-of-life experience.

This article provides insight into Jewish law, ethics, and cultural practices regarding pain management, care of the dying Jewish patient, and Jewish rituals after death across the care continuum. Clinically and culturally appropriate care provision is important in the setting of a hospital, nursing home, and community dwelling because of deep religious belief and practices, as well as life experiences such as the Holocaust. The recognition of deep spiritual and cultural practices from the interdisciplinary or interprofessional team serves to fulfill a holistic approach to the overall care of the patient and family.

Dropout from outpatient mental health care: results from the Israel National Health Survey.

OBJECTIVES: To examine the dropout rates from outpatient mental health treatment in the general medical and mental health sectors and to identify the predictors of dropout. METHOD: The study population was extracted from the Israel National Health Survey. The analysis was related to 12-month service utilization for mental health reasons. RESULTS: The total dropout rate from mental health treatment was 24%, but differed between sectors. The dropout rate from general medical care was 32, and 22% from mental health care. In the general medical care sector, 30% ended treatment within two visits, while only 10% did so in the mental health-care sector. Chronic health condition, but not severity of psychiatric disorder, predicted dropout in the mental health sector. DISCUSSION: The higher rate of early dropout in general medical care may be related to the brevity of general medical visits and/or the inexperience of primary care physicians, which limits the opportunity to develop patient-physician rapport. Providers of services will have to promote education programs for GPs and allocate proper time to psychiatric patients. LIMITATION: The sample, although based on a national representative cohort, was small and limited the number of independent variables that could be examined.

Health-promoting behaviors and health locus of control from a multicultural perspective.

OBJECTIVES: To assess the relationships between health-promoting behaviors and health locus of control (HLC) in the context of cultural differences between Jewish and Arab Israelis. METHODS: A random, population-based sample of 358 Jews and 162 Arabs, aged 50-75 years, participated in a telephone survey. Questionnaires included demographic variables and details on three health behaviors, namely balanced nutrition, physical activity and regular checkups, and HLC. RESULTS: Arab respondents, especially Arab women, reported lower internal HLC and lower engagement in physical activity, while external HLC, balanced nutrition, and attending regular checkups varied by ethnicity only. According to multiple regression analyses, Jewish ethnicity and male sex were significantly related to internal HLC, while Arab ethnicity, older age and lower education were significantly related to external HLC. Although internal and external HLC were significantly correlated with balanced nutrition and regular physical activity, the regression analysis revealed that only higher internal HLC explained the variance of balanced nutrition. The variance of all health-promoting behaviors was explained by ethnicity, while physical activity was also explained by sex, and balanced nutrition was explained by higher economic status and higher religiosity. Regular medical checkups were also explained by higher economic status. CONCLUSIONS: Health-promoting behaviors and HLC were each mainly related to ethnicity and sex. Messages to enhance health-promoting behaviors should be adjusted culturally, especially for women.

Psychological distress, life stressors, and social support in new immigrants with HIV.

The expression of psychological distress is culture-dependent. Ethiopian Jewish immigrants' expression of distress is anchored in their unique culture. The authors' aim in this study was to assess the psychological distress of HIV-positive (HIV+) Ethiopian Jewish immigrants in Israel, using a culture-based tool, and to examine the relations of psychological distress, psychosocial variables, and T lymphocyte subset counts and viral load. Participants were 56 HIV+ patients. The authors assessed psychological distress by the self-report questionnaire, which they adjusted for the Ethiopian immigrants (SRQ-E). The authors also assessed adherence to treatment regimen, number of life stressors, and degree of perceived social support, T lymphocyte subset counts, and viral load in plasma. The overall level of psychological distress was in the high range of the SRQ-E scale and was considerably higher in men than in women. Psychological distress was related to more life stressors and lower perceived social support. Women reported having more social support, had better T(CD4+) lymphocyte count and T(CD4+)/T(CD8+) ratio, and lower viral load than did men. Better HIV indicators were related to shorter duration of HIV+ since diagnosis, better adherence, and more social support, but not to psychological distress. The culture-based tool allowed identification of the high degree of psychological distress among the HIV+ Ethiopian immigrants. Researchers need to assess the adaptability of culture-based questionnaires to determine psychological distress in HIV+ patients.

Ethnic differences in preventive medicine: the example of Jewish Ethiopian women in Israel.

BACKGROUND: Studies have found ethno-cultural disparities in health care delivery in different countries. Minority populations may receive lower standards of care. OBJECTIVES: To test a hypothesis that Jewish Ethiopian women may be receiving fewer preventive recommendations than other women in Israel. METHODS: A telephone survey was conducted using a structured questionnaire designed specifically for this study in Hebrew, Russian and Amharic (Semitic language of Ethiopia). The study group included 51 post-menopausal women of Ethiopian origin, aged 50-75. The control group included 226 non-Ethiopians matched for age, some of whom were immigrants from the former Soviet Union. The questionnaire dealt with osteoporosis and breast cancer screening and prevention. RESULTS: All the parameters measured showed that the general population received more preventive recommendations and treatment than did Jewish Ethiopian women, including manual breast examination, mammography, osteoporosis prevention, bone density scans, and recommendations for a calcium-rich diet, calcium supplementation, hormone replacement therapy, biphosphonates and raloxifen. On a logistic regression model the level of knowledge of the Hebrew language, age, ethnicity and not visiting the gynecologist were significantly related to not having received any preventive medicine recommendations. CONCLUSIONS: Differences in cultural backgrounds and language between physicians and their patients may obstruct the performance of screening and preventive medicine. Recognizing this potential for inequity and using methods to overcome these barriers may prevent it in the future.

Drugs held and sold by pharmacists of the Jewish community of medieval (11-14th centuries) Cairo according to lists of materia medica found at the Taylor-Schechter Genizah collection, Cambridge.

The importance of the Genizah for the research of the medieval Mediterranean communities, supplying information on almost every aspect of life, is well known among historian. Less known is that pharmacy was the most popular of all branches of the healing art in the medieval Jewish community of Cairo, according to the Genizah manuscripts. Sources for study of medieval practical drugs are extremely rare since most records naturally vanish over the years, and only some medical books, which contained theoretical pharmacology, have survived to the present day. Drugs lists enable us to understand medieval practical pharmacy and to reconstruct their inventories. This study reports on 71 original drugs lists that were found in the Genizah; they are different from merchants' letters dealing with commerce in drugs and give no instructions for the use or preparation of formulas as usually found in prescriptions. Twenty-six lists are written in Judeo-Arabic and 45 in Arabic, none of the lists is written in Hebrew. The longest list contains 63 identified substances. These lists were apparently used by pharmacists for professional and business purposes as inventories of drugs, records, orders, or even receipts. Two hundred and six different drugs are mentioned in the drugs lists of which 167 are of plant origin, 16 are of animal origin, and the remaining 23 are inorganic. The lists point directly to the place they occupied on the shelves of the pharmacies that could be found in the lanes and alleys of the Jewish quarter of Cairo. The most frequently mentioned substance were myrobalan (27), pepper and saffron (21), lentisk (15), almond, basil, rose, rosemary (14), cattle products, camphor and spikenard (13).

Reconstruction of the inventory of materia medica used by members of the Jewish community of medieval Cairo according to prescriptions found in the Taylor-Schechter Genizah collection, Cambridge.

The Taylor-Schechter (T-S) collection at Cambridge University Library is the biggest of all Cairo Genizah collections in the world. The importance and the potential of research into the medical aspects of the Genizah documents were clear to researcher since the early 1960s. A few works have been published since, usually focusing on one subject, or even important single manuscripts. The current research concerned mainly with one aspect of the history of medicine of the Jewish community of Cairo (as a reflection of Eastern medieval societies), namely the practical uses of natural substances for medicine. The most interesting and original information is undoubtedly to be found in the 141 prescriptions, as they reflect the medical reality that actually existed. And indeed, 242 substances were recorded in the prescriptions identified: 195 substances of plants origin (80.6%), 27 inorganic materials (11.2%) and 20 substances of animal origin (8.2%) were recorded as being in practical used for medicinal purposes. The most frequently mentioned substances were the rose, myrobalan, sugar, almonds, and endive. The most prevalent ailments: eye diseases, headache, constipations (purgative), cough, skin diseases, stomach, fever, gynaecological problems, haemorrhoids, liver ailments, lice, swellings, dental trouble, ulcers, and problems of the urinary tract.

The place of psychoanalysis in the history of the Jews.

Situating psychoanalysis in the context of Jewish history, this paper takes up Freud's famous 1930 question: what is left in Judaism after one has abandoned faith in God, the Hebrew language and nationalism, and his answer: a great deal, perhaps the very essence, but an essence that we do not know. On the one hand, it argues that "not knowing" connects psychoanalysis to Judaism's ancestral preoccupation with God, a preoccupation different from that of the more philosophical Greek, Latin and Christian traditions of theology. On the other hand, "not knowing" connects psychoanalysis to a post-Enlightenment conception of the person (i.e. of personal life), as opposed to the more abstract notion of the subject associated with Kant.

Giving birth: the voices of Orthodox Jewish women living in Canada.

OBJECTIVE: To describe the meaning of the childbirth experience to Orthodox Jewish women living in Canada. DESIGN: In this phenomenologic study, audiotaped interviews were conducted. Tapes were transcribed verbatim and analyzed for emergent themes. Demographic data also were collected. SETTING AND PARTICIPANTS: Thirty Orthodox Jewish women who had given birth to healthy full-term newborns at a university-affiliated Jewish hospital in Montreal, Canada, participated in the study. Data were collected within 2 weeks after childbirth, either in the mother's postpartum hospital room or in her home. RESULTS: The following themes reflecting spiritual/cultural dimensions of the childbirth experience were identified: (a) birth as a significant life event, (b) birth as a bittersweet paradox, (c) the spiritual dimensions of giving birth, (d) the importance of obedience to rabbinical law, and (e) a sense of support and affirmation. CONCLUSION: This study documents cultural, religious, and spiritual dimensions of the childbirth experience of Orthodox Jewish women living in Canada. Knowledge and appreciation of the multiple dimensions of childbirth reflected by this study's findings can contribute to holistic and culturally competent nursing care of women and newborns.

Jewish perspectives on pregnancy and childbearing.

There are approximately 6 million Jewish people in the United States today. They may be affiliated with the Orthodox, Conservative, or Reform streams of Jewish practice, or they may be secular and unaffiliated. Although religious practices and levels of observance among these streams of Judaism vary widely, nurses should become familiar with the religious traditions of Judaism in order to provide the most comprehensive care for a childbearing Jewish woman and her partner. This article describes the range of practices that may be observed, and offers information that may assist the nurse in providing culturally competent care. While it is important to tailor care to the individual needs of each childbearing couple, background knowledge of customs and traditions will help provide a basic context that can be used as a basis for understanding cultural variation and specific practices.

Exe(o)rcising power: women as sorceresses, exorcists, and demonesses in Babylonian Jewish society of late antiquity .

This article examines talmudic discussions and archaeological finds from Sassanian Babylonia to explore two distinct but related topics: how some actual women employed ritual practices to gain power (such as the recitation of incantations and the use of bowls with incantations written on them) and how some rabbis thought about women's relationship to ritual power. First exploring rabbinic statements and narratives about women as sorceresses, the article then turns to the incantation bowls, ordinary earthenware bowls inscribed with Aramaic incantations, which were buried on the thresholds or in the courtyards of dwellings. A comparative look at these two types of sources reveals that rabbinic accounts of witches are actually more nuanced than the bald talmudic statement (b. Sanh. 67a) that "most women are sorceresses" and reveals that both the incantation bowls and the talmudic sources give information about women who used incantations and amulets to protect themselves and their families from demons and illness.