Ethno-cultural origins, health beliefs and mothers' behavior regarding infant vaccinations in Israel.

To compare the health beliefs and infant vaccination behavior of mothers of four different ethno-cultural backgrounds: Israeli-born Jewish and Arab-Bedouin and immigrants from the Former Soviet Union and Ethiopia; to examine the associations between initial and subsequent infant vaccination behaviors of mothers and to identify predictors of vaccination behaviors. A comparative cross-sectional study was conducted in selected community neighborhoods. A quota sample included 100 mothers with infants aged 18-24 months (N = 400) from each of the four ethno-cultural groups. Data were collected through questionnaires and examination of the infant vaccination cards. Both groups of immigrant mothers had the lowest adherence to the recommended vaccination regime. Our findings indicate that maternal behaviors regarding infant vaccinations were determined mainly by the behavior at the previous recommended vaccination stage. Different ethno-cultural groups presented different sociodemographic predictors of vaccination behaviors. These predictors only affected the vaccinations at the early stage of 2 months. Policy makers should be aware that mother's vaccination behaviors vary according to ethno-cultural groups to establish culturally tailored intervention programs.

Cell-free DNA and telomere length among women undergoing in vitro fertilization treatment.

PURPOSE: The current research is aimed at finding potential non-invasive bio-markers that will help us learn more about the mechanisms at play in failed assisted reproduction treatment. This exploratory pilot study examined the relationship between cell-free DNA (CFD) in plasma and telomere length in lymphocytes among women undergoing in vitro fertilization (IVF) and compared telomere length and CFD levels to a healthy control group. METHODS: Blood of 20 women undergoing IVF was collected at three time points during the IVF cycle. We assessed the relationship between CFD and telomere length as well as controlling for morning cortisol levels. We also collected blood of 10 healthy controls at two time points (luteal and follicular phases of the menstrual cycle) and compared mean telomere length, CFD, and cortisol levels between the IVF patients and healthy controls. RESULTS: The results revealed an inverse relationship between CFD levels and telomere lengths at several time points that remained significant even after controlling for cortisol levels. Women undergoing IVF had statistically significant higher levels of CFD and shorter telomeres compared to healthy controls. CONCLUSIONS: The relationship between telomere length and CFD should be further explored in larger studies in order to uncover potential mechanisms that cause both shortened telomere length and elevated CFD in women undergoing IVF.

A comparison of Israeli Jewish and Arab women's birth perceptions.

BACKGROUND: birth is a normal physiological process, but can also be experienced as a traumatic event. Israeli Jewish and Arab women share Israeli residency, citizenship, and universal access to the Israeli medical system. However, language, religion, values, customs, symbols, and lifestyle differ between the groups. OBJECTIVES: to examine Israeli Arab and Jewish women's perceptions of their birth experience, and to assess the extent to which childbirth details and perceptions predict satisfaction with the birth experience and the extent of assessing the childbirth as traumatic. METHODS: this study was conducted in two post partum units of two major public hospitals in the northern part of Israel. The sample included 171 respondents, including 115 Jewish Israeli and 56 Arab Israeli women who gave birth to their first (33%) or second (67%) child. Respondents described their childbirth experiences using a self-report questionnaire 24-48 hours after childbirth. FINDINGS: the Arab women were much less likely to attend childbirth preparation classes than the Jewish women (5% versus 24%). Forty-three per cent of the respondents reported feeling helpless, and 68% reported feeling lack of control during childbirth. Twenty per cent of the women rated their childbirth experience as traumatic, a rate much lower than the rate of medical indicators of traumatic birth (39%). The rate of self-reported traumatic birth was significantly higher among the Arab women than among the Jewish women (32% versus 14%). A higher percentage of the Arab women reported being afraid during labour (χ(2)=4.97, p<.05), expressed fear for their newborn's safety (χ(2)=12.44, p<.001), and reported that the level of medical intervention was excessive in their opinion, as compared to the Jewish women (χ(2)=5.09, p<.05; χ(2)=7.33, p<.01). However, both the Arab and Jewish women reported similar numbers of medical interventions and levels of satisfaction with their medical treatment. CONCLUSIONS: despite universal access to the Israeli health care system, Arab Israeli women use fewer perinatal medical resources and subjectively report more birth trauma than Jewish Israeli women. Yet, they give birth in the same hospitals with the same practitioners and report similarly high levels of satisfaction with the medical services. Taking into account the fact that perceptions of the birth experience differ between ethno-cultural groups will enable professionals to better tailor intervention and support throughout childbirth in order to increase satisfaction and minimise trauma from the experience.

Attitudes of women with breast cancer regarding the doctor-patient relationship.

Breast cancer is the most common type of cancer among women. The current study uses the qualitative method to examine breast cancer patients' viewpoint regarding the doctor-patient communication and its implications during their treatment. All the women brought up the same central themes: Assuming an active attitude in their life. One of the ways to be active is by helping others in her situation. Dealing with uncertainty. Need for support from the surroundings. Feeling vulnerable in every area of life. The doctor should encourage the patient to adopt an active position, try to minimise their uncertainty, support relatives to become involved and address all problems and not just the medical complaint of their patient. This study is a basis for developing training programmes in the medical professions, in order to improve their communication with cancer patients.

Psychological interactions with infertility among women.

Despite the fact that various studies have demonstrated the importance of the mind-body connection and fertility, the psychosocial aspects of infertility have not been adequately addressed. Fertility treatments, ranging from medical monitoring, to hormonal remedies and in vitro fertilization (IVF), are both a physical and emotional burden on women and their partners. Psychological factors such as depression, state-anxiety, and stress-induced changes in heart rate and cortisol are predictive of a decreased probability of achieving a viable pregnancy. A couple that is trying to conceive will undoubtedly experience feelings of frustration and disappointment if a pregnancy is not easily achieved. However, if the difficulties progress and the man and or woman are labelled as having fertility problems, then this may result in a severe insult to self-esteem, body image, and self-assessed masculinity or femininity. Three types of relationships have been hypothesized between psychological factors and infertility. These include: (1) psychological factors are risk factors of subsequent infertility; (2) the experience of the diagnosis and treatment of infertility causes subsequent psychological distress; (3) a reciprocal relationship exists between psychological factors and infertility. The evidence for these three relationships is reviewed and an alternative approach to the treatment of infertility including stress evaluation that precedes or is concurrent to fertility treatment is suggested.

Trafficked female sex workers awaiting deportation: comparison with brothel workers.

In 2002, we researched the psychosocial characteristics of 55 women working in the commercial brothel-based sex industry in three Israeli cities. This previous social epidemiological study focused exclusively on women working in brothels and the brothel owners consented to their interviews, suggesting that this might be a sample of the most organized brothels with the best social conditions. We therefore decided to study a second sample obtained by different referral methods. The sample consisted of 49 women in a detention center who are awaiting judicial hearings for deportation. This prison sample of sex workers is strikingly similar to the previously studied sample of sex workers working in brothels in terms of demographic features and working conditions. A higher percentage of the prison sample reported depression and somatic symptoms. However, this finding is consistent with a reaction to being arrested and awaiting deportation. Guided by a life course perspective, in the combined sample, we examined whether early exposure to trauma, motherhood and early entry into sex work affected current health and mental health. Those who were mothers were likely to have entered sex work at a later age but no other aspect of their working conditions differed from the non-mothers suggesting that motherhood per se did not appreciably change the experience of these mostly trafficked women sex workers. Early exposure to trauma increased the likelihood for work-related trauma, poor health and mental health outcomes.

Women brothel workers and occupational health risks.

STUDY OBJECTIVES: This study examined working conditions, reported morbidity, symptoms of post-traumatic stress disorder (PTSD) and depression and their relation to an index of occupational health risk among women working in brothels in Israel. DESIGN: Personal structured interviews with a scale of occupational risk that included seven self report items reflecting past and present morbidity and symptoms. PARTICIPANTS AND SETTING: A purposive sample of 55 women in three cities in Israel, between the ages of 18-38. MAIN RESULTS: Most (82%) women were trafficked into Israel to work illegally in prostitution, effectively deriving them of access to discretionary health care. A third of the sample (32%) had a high score (between 3 to 6) on the index of occupational risk factors. A high score was not related to recent physician or gynaecological visits and was more common among illegal workers than those with residence status. A set of regression analyses showed that the most significant predictors of reporting a high level of occupational risk symptoms were starting sex work at an early age, the number of hours worked in a day, a history of suicide attempts and PTSD symptoms. CONCLUSIONS: High occupational risk was found to be unrelated to recent physician or gynaecological visits, indicating that these visits were most probably controlled by the brothel owners and not by medical need as perceived by the women themselves. Furthermore, occupational risk factors were associated with some of the working and background conditions reported by women brothel workers. There is an urgent need for medical care for this high risk group.

Depression and falls among community dwelling elderly people: a search for common risk factors.

STUDY OBJECTIVE: s: Depression and falls are two common conditions that impair the health of older people. Both are relatively underdiagnosed and undertreated problems in primary care. The study objective was to investigate whether there was a common set of risk factors that could predict an increased risk of both falls and depression. DESIGN: This was a cohort study drawn from a primary care clinic, with a one year follow up. Dependent measures included: reporting two or more falls in the past year and a score of 7 or over on the S-GDS (Short Geriatric Depression Scale). A parsimonious set of risk factors was selected that predicted both outcomes based on a series of discriminant function analyses. PARTICIPANTS AND SETTING: The setting was a primary care clinic serving a mixed socioeconomic population, in Beer Sheva, Israel. The sample included 283 General Sick Fund members, aged 60 and over, who completed both baseline assessments and one year follow up interviews. MAIN RESULTS: At the one year follow up, 12% of the sample reported frequent falls in the past year and 25.5% of the sample screened positive for depressive symptoms. A set of five risk factors that included: poor self rated health, poor cognitive status, impaired ADL, two or more clinic visits in the past month, and slow walking speed (g10 seconds over five metres) was successful at discriminating between fallers and non-fallers (86% discrimination) and between those with and without depressive symptoms (76%). For every risk factor added, there was a significant increase in the proportion of respondents who had depressive symptoms. A similar result was found for falls. CONCLUSIONS: These results show that there is a common set of risk factors that increase the risk of two common outcomes in geriatric medicine, falls and depression. For a general practitioner or a geriatric physician, it might be easier to detect these risk factors than to diagnose depression or high risk for falls. When these risk factors are detected in patients the physician can then be more active in direct probing about depression and falls.

[Identifying the elderly at risk for falling and accompanying protocols].

Falling is one of the main problems affecting the health of the elderly. A community project was carried out to detect elderly people at high risk for falls. One of its aims was also to develop tools allowing primary care professionals to detect the elderly at risk for falling. Such a screening test in the community-dwelling elderly (EFST) and a protocol for diagnosis and treatment of the elderly at risk for falls is presented.

Social work with adult cancer patients: a vote-count review of intervention research.

The meaning of a cancer diagnosis has changed in the past decades, bringing with it a myriad of psychosocial interventions to improve the psychological or functional status of those coping with the disease. Today, social workers in oncology need to be current with research in order to integrate empirical and practical knowledge. In an effort to assist in this process, we reviewed empirical studies to address the following questions: (1) When are patients likely to be willing to accept help? (2) Is there sufficient evidence to show that some types of psychosocial treatment are effective in improving psychological or physical functioning? (3) Are certain treatments preferable for some cancer patients depending on the type of cancer and stage of disease? Using a vote-count review of 40 intervention studies in psychosocial oncology, 36 documented some positive outcomes from treatments, 4 studies exhibited null findings, and no studies were found to have clearly negative results. Studies revealed the most positive results from interventions during the treatment phase, next from interventions at diagnosis, and lastly from interventions during the terminal stage. Individual and group formats showed a comparable level of efficacy. Interventions that included cognitive behavioral methods had the most consistently positive results. Those intervention studies where social workers were involved in the research were less successful at demonstrating efficacy. This difference was due primarily to the fact that social workers often did not include cognitive behavioral interventions in their research. Based on the results of this study, social workers might want to reevaluate their intervention strategies.

Organizing social work services with adult cancer patients: integrating empirical research.

Today only half of those diagnosed with cancer will die of the disease, leaving enormous room for psychosocial interventions to improve the psychological or functional status of those coping with the disease. Therefore, social workers in oncology must be current with empirical research. In an effort to integrate current research into social work practice, we reviewed empirical studies with sound research designs to answer the following questions: (1) What portion of cancer patients are likely to need social work services? (2) What types of services do social workers provide to meet these needs? and (3) Who is likely to be (or not to be) the recipient of these services. Does intervention research include diverse (non-traditional, non-white and non-middle class) clients? The results show about one third of patients will be judged at high-risk for psychosocial problems but that only 15-25% of those who are diagnosed with cancer will eventually use psychosocial oncology services. Some have mainly instrumental, concrete needs, and others will use psychosocial counseling. A review of the inclusion of minorities and non-traditional, non-middle-class groups, shows that they are not adequately represented in current intervention research in psychosocial oncology. Methods for enlarging their access and participation are suggested.

Coping with the stress of immigration among new immigrants to Israel from Commonwealth of Independent States (CIS) who were exposed to Chernobyl: the effect of age.

This study examined the differential effect of age on coping and psychological measures among immigrants from Commonwealth of Independent States (CIS) to Israel. Some of these immigrants originated in the Republics adjacent to the Chernobyl Power Plant, site of the 1986 accident. The sample consisted of 708 immigrants who were interviewed between the years 1993-1995 with an average age of 47.5 (sd 11.8). This sample was reinterviewed approximately a year and three months later (n = 520). The sample included two exposure groups--high exposed and low exposed based on the estimated levels of ground cesium contamination from the IAEA maps and a comparison group matched by age, gender, and year of immigration. Those over the age of sixty-five were disadvantaged, compared to those aged fifty to sixty-four, and younger, when it came to the tasks of immigrant absorption; learning the language, working and acquiring an income, and establishing alternative social networks which could offer support in times of illness. The psychological variables showed that over time, somatization, depression, and post-traumatic stress disorder (PTSD) symptoms related to Chernobyl improved, however at a much slower pace for older immigrants (aged 55 and over) compared to younger ones.

Validation of a fall-risk screening test, the Elderly Fall Screening Test (EFST), for community-dwelling elderly.

Falls are the most common type of injury among the elderly, and the source of both functional and psychological morbidity. The aim of this study was to validate the Elderly Fall Screening Test (EFST). In a community primary-care clinic, the members 60 years or older who were functionally independent were screened. Of the 568 elderly persons who met these criteria, 361 were interviewed once and 283 persons were re-interviewed a year later. The EFST, a five-item test, was used to divide participants into low- and high-risk groups. Concurrent criterion validity was assessed by physical examinations conducted by physicians who were blind as to the risk designation. Using data from the follow-up interview, predictive validity was assessed on both fall-related and general health measures. Based on the results of the EFST, 28% of the respondents were designated as being at high risk for falls (i.e. having a score of two or more risk items). The results of physicians' examinations corroborated the screening test results in 75% of the cases, with 83% sensitivity and 69% specificity. In the follow-up interview, the high-risk group, as compared to the low-risk group, was more likely to have high scores on EFST, a fall in the past month or year, frequent near falls, and an injurious fall. Those with high EFST scores were more likely to report four or more sick days in the past six months, a hospitalization in the past year, poor self-rated health, a decline in health in the past 6 months, and symptoms of depression. The EFST has both criterion and predictive validity. It can be useful in community-based prevention programmes with functionally independent elderly people.

Blood pressure among immigrants to Israel from areas affected by the Chernobyl disaster.

OBJECTIVES: To validate and analyze apparent association of hypertension with exposures to radiation at Chernobyl among immigrants to Israel from the contaminated areas. METHODS: Data were collected in 1991 and 1994 from two samples of persons who immigrated to Israel from the contaminated zone around the Chernobyl nuclear power plant. The first sample were self-referred for evaluation in a clinic by whole-body cesium measurement, physical examination, and questionnaire (N = 756, 328 from less exposed and 438 from more exposed areas). The second wave data were collected in 1994 during home interviews for evaluation of psychosocial factors associated with their experience (N = 708, 121 from more exposed and 253 from less exposed areas). In the second study a referent group was included (n = 334) who were matched by age, sex, and year of immigration who immigrated from other areas outside of the contaminated zone. Estimates of exposure were based on the IAEA map of ground-level cesium isotope (137Cs) contamination. RESULTS: In the 1991 sample, 21% from high exposure areas and 16% from less exposed areas had elevated systolic blood pressure (> 140 mmHg). Elevated diastolic blood pressure (> 90 mmHg) had a similar difference between more and less exposed groups (21% and 16%). Age- and sex-specific analyses showed that statistically different levels were found in the older age groups. In the 1994 sample, we confirmed a relationship between exposure and elevated blood pressure. 33% of those from the more exposed areas and 34% of those from less exposed areas had elevated systolic blood pressure, compared with 23% of the comparison group, with a similar trend found in diastolic blood pressure. The relationship between exposure and blood pressure was accentuated in the group of respondents who had high scores on PTSD symptoms. Of the psychological variables analyzed, systolic blood pressure was most strongly related to cancer-related anxiety and somatization. A discriminant function analysis showed that three variables: age, reporting a significant loss from the Chernobyl accident, and fear of cancer correctly differentiated 72% of those with normal and high blood pressure. CONCLUSIONS: There is a relationship between exposure to Chernobyl and high blood pressure, partly due to the psychological reactions to the accident.

Lessons learned from the study of immigrants to Israel from areas of Russia, Belarus, and Ukraine contaminated by the Chernobyl accident.

During the past 6 years, immigration to Israel of 700,000 persons from the former Soviet Union (FSU) included about 140,000 from radiocontaminated regions of Belarus, Ukraine, and Russia near Chernobyl. In Beer Sheva, a major center for immigrant absorption in Israel, a primary objective was to evaluate their health status and to refer them for care. 137Cs levels in 1228 men, women, and children were measured with a portable whole-body counter. Whole-body counts showed clear correlation with the degree of 137Cs ground contamination in previous regions of residence. The population could thus be sub-divided according to degree of exposure, based on previous regions of residence. The thyroid status of 300 local immigrant children was evaluated because of the increased risk of childhood thyroid cancer in the regions from which they came. This group was subdivided into comparative groups of children who came from less and more contaminated areas according to the International Atomic Energy Agency soil 137Cs contamination maps. Enlarged thyroids were found in about 40% of both groups. One 12-year-old girl from Gomel had a malignant papillary carcinoma. Thyroid-stimulating hormone levels, though within normal limits, were significantly greater (p < 0.02) for girls from high exposure regions. Liquidators showed significant increases in serum clastogenic factor and in the number of circulating glycophorin A-mutated red cells. In studies of over 700 people from both radiocontaminated and unaffected regions of the FSU, evidence for posttraumatic stress disorder was found more frequently in persons coming from the more contaminated areas.

Bridging the gap in mental health approaches between east and west: the psychosocial consequences of radiation exposure.

Mental health professionals in Western countries and the Confederation of Independent States ([CIS], the former Soviet Union) have been examining the social and psychological consequences of the 1986 Chernobyl nuclear accident on the people who lived or are living in the exposed areas. Based on reviews of the literature, papers from international conferences, and communication between researchers in various countries, different perspectives have emerged on classifying distress and disorders and designing treatment programs. The origins of these differences lie in philosophical, historical, and political developments in the West and the CIS. These different approaches often have made it difficult for mental health professionals from the CIS and the West to work together. The goal of this paper is 2-fold: to identify and recognize the main differences in these approaches and to propose specific solutions for bridging the gap. The basic approach of mental health professionals in the CIS is a physiological, nosological one--it focuses on the etiology of the illness. Although their main diagnostic tool is the International Classification of Diseases, 10th Revision, it has undergone adaptations that reflect the Soviet medical and physiological attitude toward psychiatry. These changes have resulted in the abrogation and addition of disorder categories. For example, in the CIS edition of the ICD-9, there is no mention of post traumatic stress disorder as a distinct disorder. In contrast, in the West, the dominant approach is a symptomatic, phenomenologic one. Emphasis is placed on a dynamic understanding of the disorder and treatment is conducted by mental health professional (psychologists, social workers, psychiatrists). This contrasts with the approach used in the CIS, where psychological distress often is somaticized and treatment undertaken by physicians rather than mental health professionals. The authors of this paper call on researchers to come together and work jointly on the recognition and resolution of these differences. Then both groups will be able to offer concrete solutions and build tools that can benefit both sides. It is hoped that these new approaches will receive worldwide recognition and prove useful for other mental health professionals working with persons affected by the accident at Chernobyl.

Two-year follow up study of stress-related disorders among immigrants to Israel from the Chernobyl area.

We report on findings from a 2-year follow-up study of immigrants originating from exposed areas around the site of the 1986 Chernobyl accident matched with comparison subjects emigrating from other republics in the Confederation of Independent States. In the initial study of 708 immigrants, the samples were matched by age, gender, and year of immigration. We assessed two exposure groups--high and low--by estimating levels of ground cesium contamination from the International Atomic Energy Agency maps. We reinterviewed 520 immigrants from the first wave of data collection (a reinterview rate of 73%), 87 from high-exposure areas, 217 from low-exposure areas, and 216 comparison subjects. This study examined the prevalence of symptoms of posttraumatic stress disorders (PTSD), depression, somatization, anxiety, and physical effects (high blood pressure, acute symptoms, and chronic illness). The results obtained in the first wave conducted 8 years after the accident showed that psychological symptoms were significantly higher in exposed respondents than in the comparison group. During the second wave (10 years after the accident) we observed a decline in the prevalence of PTSD and related distress except for somatization, which remained at the same level. An association between exposure and high blood pressure was observed in the first wave of data, but was not still significant in the second wave of data collection. The proportion of those who reported three or more chronic health problems was 48.3% among the high-exposure group, 49.3% in the low-exposure group, and 30.6% in the comparison group (p = 0.0003). The most commonly reported problems were heart disease. problems with vision or hearing, migraine headaches, problems with the lymphatic system, and arthritis. Based on the results, it was concluded that the Chernobyl accident was a powerful stressor, having a strong impact on both mental and physical health. Since all respondents were engaged in the process of acculturation and accommodation to a new country after emigration, it is encouraging that this study shows that levels of psychological distress are waning as the new immigrants are absorbed into Israeli society. However, there still remains some independent effect on health associated with the experience of the Chernobyl accident.

Comments on the psychosocial aspects of the International Conference on Radiation and Health.

Summary comments on the psychosocial aspects of the International Conference on Radiation and Health highlighted the issues that were salient in the conference. There was a broad consensus that long-term psychosocial effects may turn out to be the most significant source of morbidity. In addressing health concerns there is a need to consider psychological responses, as they may be the source of the high rate of morbidity and use of health services. The public's response to radiation is one of anxiety, fear, and concerns about lack of control over modern technology. Aside from stress there may be alternative mechanisms that explain the high rates of morbidity, such as direct biological effects of radiation on the cardiovascular system. The issue of social stigma is not addressed in most studies of affected populations but may be a potent social force. There is a need for concerned scientists to reach a better consensus about the health effects of radiation and to communicate effectively with the lay public. We need more cross-cultural research on psychosocial aspects and how to more effectively help affected populations. There are auspicious beginnings in this direction.