Too much equity - is there such a thing? The public discourse surrounding elective egg freezing subsidy in Israel.

BACKGROUND: The preservation of human ova for future fertilization has been made available to healthy women in 2011-2012. This treatment, dubbed elective egg freezing (EEF), is undertaken primarily by highly educated unpartnered women without children, concerned of age-related fertility decline. In Israel, treatment is available to women aged 30-41. However, unlike many other fertility treatments, EEF is not state subsidized. The public discourse of EEF funding in Israel is the focus of the present study. METHOD: The article analyzes three sources of data: press presentations of EEF; a Parliamentary Committee discussion dedicated to EEF funding; interviews with 36 Israeli women who have undertaken EEF. RESULTS: Numerous speakers raised the issue of equity, claiming that reproduction was a state interest and therefore, a state responsibility, including securing equitable treatment to Israeli women of all economic strata. Highlighting the generous funding of other fertility treatments, they claimed that EEF was inequitable, discriminating against poorer single women, who could not afford it. Few actors, however, rejected state funding as intervention in women's reproductive lives and called for reconsideration of the local reproductive imperative. CONCLUSION: The invocation of equity by Israeli users of EEF, clinicians and some policy makers as grounds for a call to fund a treatment that serves a well-established subpopulation seeking to relieve a social rather than a medical problem, illustrates the profound context-embeddedness of notions of health equity. More generally, it may suggest that using an inclusive language in a discourse of equity may potentially be invoked so as to promote the interests of a particular subpopulation.

Elective egg freezing and male support: a qualitative study of men's roles in women's fertility preservation.

How do men participate in women's fertility preservation decisions and procedures? This binational, qualitative study assessed whether men play supportive roles either before, during or after women's elective egg freezing (EEF) cycles. From June 2014 to August 2016, 150 women (114 in the USA and 36 in Israel) who had completed at least one cycle of EEF were interviewed by two medical anthropologists, one in each country. The majority (85%) of women in the study identified the lack of a male partner as their main reason for pursuing EEF. However, nearly two-thirds (63%) of women relied on some form of male support during their EEF decision making processes and procedures. Five categories of men, in order of support, included: (i) fathers (or other male father figures), (ii) male partners (past or present), (iii) male friends, (iv) brothers and (v) male judges (some of whom supported EEF in divorce settlements). More than a dozen different forms of assistance were offered by men in four major categories: (i) instrumental, (ii) financial, (iii) physical and (iv) psychological. Although one-third (37%) of women went through EEF alone or with only female support, this study reveals the 'hidden' roles men play in supporting the reproductive aspirations of women.

Health and socio-demographic implications of the Covid-19 second pandemic wave in Israel, compared with the first wave.

BACKGROUND: Israel's containment of the first wave of Covid-19 was relatively successful. Soon afterwards, however, in the summer months, a harsher pandemic wave developed, resulting in many more seriously ill and dead Israelis. Israel was the world's first country to impose a second general lockdown. The present study outlines the early months of Israel's second pandemic wave, until the imposition of the second general lockdown, and their impact on various communities. The investigation is conducted in conjunction with five sociodemographic variables: population density, socioeconomic status, rate of elderly population, minority status (Jewish / Arab identity) and religiosity (Ultra-Orthodox vs. other Jewish communities). METHODS: The analysis is based on a cross sectional study of morbidity rates, investigated on a residential community basis. Following the descriptive statistics, we move on to present a multivariate analysis to explore associations between the five aforementioned sociodemographic variables and Covid-19 morbidity in Israel in the early second pandemic wave vs. the first Covid-19 outbreak. RESULTS: Both the descriptive statistics and regressions show morbidity rates to be significantly and positively associated with communities' population density and significantly and negatively associated with socioeconomic status (SES) and the size of elderly population. These results differ from Wave I morbidity, which was not significantly associated with SES. Another difference vis-a-vis Wave I is the rise of morbidity in Arab communities that led to the disappearance of the previously observed significant negative association of morbidity with minority (Arab) status. Exceptional morbidity was found in Ultra-Orthodox Jewish communities. CONCLUSION: The second wave of Covid-19 in Israel has profoundly affected marginalized communities characterized by high residential density, low SES and minority status. Other marginalized and disempowered communities have also been badly hit. While acknowledging the potential contribution of various possible causes, we highlight the policy response of Israel's government during the early weeks of the second Covid-19 outbreak, suggesting that the severe second wave might possibly be associated with belated, undecided government response during this period.

The Effect of Information Placebo on Physical Activity in Overweight and Obese Children.

PURPOSE: To assess the effect of 1 week of consuming a placebo "energy drink" compared with a week of drinking regular water on daily physical activity in obese children participating in a weight reduction multidisciplinary program. METHODS: Seventeen prepubertal (age = 128.7 [26.6] m) overweight and obese children (7 females and 10 males) participated in the study. Participants received 7 bottles of mineral water per week for 2 weeks. Different types of information were randomly provided regarding the drink consumed in each week: standard (water) versus deliberate positive information (presumed energy drink and placebo). Daily step count was measured using pedometers and compared using paired t test. RESULTS: After consuming the placebo drink, children demonstrated a significantly higher average daily step number (10,452 [4107]) compared with the days they drank water (8168 [2928], P < .005). This difference was attributed mainly to male participants. CONCLUSION: The use of placebo in the form of deliberate positive information was associated with a significant increase in real-life physical activity in overweight and obese children, especially in boys. Positive information may be used to encourage children with obesity to enhance daily physical activity and energy expenditure.

Cryopreserving Jewish Motherhood: Egg Freezing in Israel and the United States.

Oocyte cryopreservation (i.e., egg freezing) is one of the newest forms of assisted reproduction and is increasingly being used primarily by two groups of women: (1) young cancer patients at risk of losing their fertility through cytotoxic chemotherapy (i.e., medical egg freezing); and (2) single professionals in their late 30s who are facing age-related fertility decline in the absence of reproductive partners (i.e., elective egg freezing). Based on a binational ethnographic study, this article examines the significance of egg freezing among Jewish women in Israel and the United States. As they face the Jewish maternal imperative, these women are turning to egg freezing to relieve both medical and marital uncertainties. In both secular and religious Jewish contexts, egg freezing is now becoming naturalized as acceptable and desirable precisely because it cryopreserves Jewish motherhood, keeping reproductive options open for Jewish women, and serving as a protective self-preservation technology within their pronatalist social environments.

Transgender men's fertility preservation: experiences, social support, and the quest for genetic parenthood.

Transgender people assigned female at birth may undergo fertility preservation by egg or embryo freezing, usually prior to gender affirming treatment. In this binational ethnographic study, four transgender men were included as part of a larger comparative project on fertility preservation. In-depth ethnographic interviews allowed informants to talk freely about their fertility preservation experiences, and the circumstances that had enabled them to pursue this option. Prominent in men's accounts were the importance of genetic parenthood and the role of social support from others in the fertility preservation process. Indeed, in all cases, social support-from parents, siblings, partners, peers, physicians and employers-was critical, effectively enabling young transgender men to embark on their fertility preservation journeys and undergo the physically taxing process. This study illustrates the power of thriving through relationships that were critical in young transgender men's experiences of fertility preservation.

Covid-19 in Israel: socio-demographic characteristics of first wave morbidity in Jewish and Arab communities.

BACKGROUND: The first wave of the Covid-19 pandemic hit Israel in late February 2020. The present study examines patterns of the first wave of Covid-19 morbidity in Israel at the macro level, during the period of late February to early June 2020, when the first wave has faded out. The analysis focuses on the significance of four sociodemographic variables: socioeconomic status, population density, rate of elderly population and minority status (Jewish / Arab identity) of the population in cities with 5000 residents or more. Additionally, we take a closer look into the association between morbidity rates and one SES component - home Internet access. METHODS: The article is a cross sectional study of morbidity rates, investigated on a residential community basis. Following the descriptive statistics, we move on to present multivariate analysis to explore associations between these variables and Covid-19 morbidity in Israel. RESULTS: Both the descriptive statistics and regressions show morbidity rates to be positively associated with population density. Socioeconomic status as well as the size of elderly population were both significantly related to morbidity, but only in Jewish communities. Interestingly, the association was inverse in both cases. i.e., the higher the SES the lower the morbidity and the larger the elderly population, the lower the community's morbidity. Another interesting result is that overall, morbidity rates in Jewish cities were consistently higher than in Arab communities. CONCLUSIONS: We attribute the low morbidity rates in communities with relatively small elderly populations to the exceptionally high fertility rates in ultra-orthodox communities that sustained increased rates of morbidity; the lower morbidity in Arab communities is attributed to several factors, including the spatial Jewish-Arab segregation.

Abrahamic traditions and egg freezing: Religious Women's experiences in local moral worlds.

In this article, we elucidate how elective egg freezing (EEF) has been received within the three Abrahamic traditions-Judaism, Christianity, and Islam-and how these religion-specific standpoints have affected the EEF experiences of women who self-identify as religiously observant. Through an analysis of religious women's narratives, the study explores the "local moral worlds" of religious women who chose to freeze their eggs for non-medical reasons. It draws on ethnographic interviews with 14 women in the United States and Israel who had completed at least one EEF cycle, and who were part of a large, binational study that interviewed, between 2014 and 2016, 150 women who pursued EEF. These religious women, who were all highly educated, faced a particular challenge in finding appropriate marriage partners. Feeling pressured but still hopeful to marry and create large families, the women used EEF to extend their reproductive timelines and reduce their anxieties. As the study showed, the women reinterpreted or reconciled religious restrictions on the use of EEF in various ways, believing that their ultimate pursuit of religiously sanctioned reproduction justified the means. This study, which is the first to compare Jewish, Christian, and Muslim women's experiences of EEF, illustrates how this novel technology is now shaping the local moral worlds of religious women.

Effect of lactation on the recurrence rate of gestational diabetes mellitus: a retrospective cohort study.

PURPOSE: To examine the impact of lactation on the recurrence rate of gestational diabetes mellitus (GDM). METHODS: Retrospective cohort study performed in a single teaching hospital on data between 2009 and 2016. The study group consisted of women who had a diagnosis of GDM and breastfed exclusively for ≥ 1 month. The control group consisted of women who had a diagnosis of GDM and did not breastfeed or added formula < 1 month postpartum. Data regarding breastfeeding duration, timing and amount of formula supplementation were obtained by a telephone questionnaire. We hypothesized that the recurrence of GDM would be lower in women who breastfed exclusively for ≥ 1 month. Therefore, to detect a decrease from 50 to 30% in the recurrence rate of GDM with alpha (one-sided) of 0.05 and 80% power, a sample size of 168 (84 per group) was needed. RESULTS: Overall, 229 women were found eligible; 139 and 90 in the study and control groups, respectively. Except for parity, baseline demographic and obstetric variables were not different between the two groups. After adjusting for parity, the incidence of GDM in subsequent pregnancy was significantly lower among the study compared to the control group [48 (34.5%) and 41 (45.6%), respectively; one-tailed p = 0.043; RR 0.56; 95% CI 0.35-0.90)]. The cesarean delivery (CD) rate was significantly lower as well [28 (20.1%) and 31 (34.4%), respectively; two-tailed p = 0.02; RR 0.48, 95% CI 0.26-0.89)]. CONCLUSION: Exclusive lactation for ≥ 1 month reduced the recurrence rate of GDM and possibly the risk of CD in the subsequent pregnancy.

Significant effect of information placebo on exercise test results in children with normal weight, overweight and obesity.

AIM: The aim of the study was to examine the effect of information placebo on fitness test results in normal weight, overweight and obese children. METHODS: Twenty-four pre-pubertal children with overweight or obesity and 24 age and maturity-matched normal weight children performed a progressive treadmill exercise test twice. Different types of information were randomly provided regarding a water drink consumed prior to testing; standard (water) vs deliberate positive (presumed energy drink, placebo) information. RESULTS: Following the placebo drink, both groups demonstrated significantly higher peak heart rate (overweight 165.8 ± 16.7 vs 174.2 ± 14.8 bpm and normal weight 177.9 ± 13.6 vs 189.8 ± 12.2 bpm) and longer time to exhaustion (overweight 396.9 ± 161.9 vs 521.5 ± 182.5 seconds; normal weight: 700.1 ± 155.2 vs 893.3 ± 150.1 seconds). Despite longer exercise duration and higher peak heart rate, average and peak rate of perceived exertion were significantly lower after the placebo drink (overweight 14.1 ± 2.5 vs 12.5 ± 2.5; normal weight 12.1 ± 1.4 vs 10.7 ± 1.5), with significantly shorter recovery time (overweight 132.2 ± 28.5 vs 118.4 ± 31.6; normal weight: 106.7 ± 18.6 vs 96.7 ± 17.8 seconds). CONCLUSION: Our results demonstrate a significant effect of information placebo on fitness test results that is unrelated to body weight. Children with obesity may enhance their physical activity levels and energy expenditure if properly encouraged.

The placebo effect on aerobic fitness test results is preserved following a multidisciplinary intervention program for treating childhood obesity.

BACKGROUND: The aim of the study was to examine the placebo effect on fitness test results in trained and untrained overweight and obese children. METHODS: Twenty pre-pubertal overweight children performed two pairs of progressive treadmill exercise tests before and 12 weeks into a multidisciplinary program for the treatment of childhood obesity. In each test pair, at random order, participants received different types of information regarding a water drink consumed prior to testing-standard information (water) vs deliberate positive information (presumed energy drink, placebo). RESULTS: The intervention led to a significant change (P < .05) in BMI%ile (95.6 ± 4.4 vs 93.6 ± 6.9), % fat (35.4 ± 6.0 vs 31.6 ± 5.8), baseline heart rate (104.2 ± 11.6 vs 94.0 ± 7.0 bpm), total leisure activity score-Godin (9.3 ± 8.8 vs 41.5 ± 15.2), total screen time (6.9 ± 5.8 vs 3.1 ± 1.4 h/d), and a significant improvement in fitness. Following the placebo drink, both groups achieved a significantly higher peak heart rate (untrained: 176.1 ± 13.7 vs 167.5 ± 16.8; trained: 170.7 ± 11.6 vs 166.2 ± 11.4 bpm) and longer running time (untrained: 559.9 ± 151.0 vs 434.4 ± 140.3 seconds; trained: 728.3 ± 177.3 vs 667.1 ± 176.1 seconds). Despite longer exercise duration and higher peak exercise heart rate, average, and peak RPE were lower after the placebo drink (untrained: 12.1 ± 2.3 vs 13.6 ± 2.1; trained:10.0 ± 1.8 vs 11.6 ± 2.1), recovery time was shorter (untrained: 119.2 ± 25.3 vs 133.2 ± 23.7 seconds; trained: 92.6 ± 18.9 vs 102.7 ± 18.3 seconds). The placebo-induced change in running time and peak RPE were significantly greater prior to training. CONCLUSION: The significant information placebo effect is preserved in trained overweight children. Information, as well as other motivating aids and fatigue distractors may be useful in enhancing physical performance in obese children.

Incidence of surrogacy in the USA and Israel and implications on women's health: a quantitative comparison.

PURPOSE: Gestational surrogacy (GS) has been researched in multiple qualitative studies. In contrast, quantitative aspects of the practice are conspicuously understudied. The present article assesses and compares the incidence of GS in the USA and Israel, two industrialized countries that have maintained active commercial surrogacy practice, for over two decades. METHOD: The article is a secondary analysis of GS figures published by the Israeli Parliament's Centre for Research and Information (2018) and by the USA's Centers for Disease Control (2016) and related professional publications. Each dataset is analyzed in reference to the respective country, so as to devise local incidence scores that are then juxtaposed in inter-country comparison. RESULTS: The incidence of GS rises steeply in both countries. Though US surrogates are contracted by local and international, heterosexual and gay, and partnered and single intended parents, the relative incidence of GS is lower in the USA than in Israel, where only local heterosexual couples could contract a gestational surrogate. An exceptionally high rate of multiple births was observed in both settings, suggesting some overlooking of professional recommendations for elective single-embryo transfer. CONCLUSION: GS incidence appears to resemble the ratio between the countries' respective fertility rates. The paper underscores two main risks facing gestational surrogates: the risk of not conceiving and not being paid and the risk of carrying a multiple pregnancy, which is extremely prevalent in GS pregnancies, and sustaining the short- and long-term health complications that are more prevalent in such pregnancies.

The impact of adolescents' racial and ethnic self-identity on hope.

The two components of hope (i.e., hope-agency defined as the ability to envision and believe in one's ability to achieve goals; hope-pathway defined as belief in one's ability to devise strategies to achieve one's goals) propel adolescents toward well-being, academic achievement and personal fulfillment. This study compares levels of hope and its components, for different groups of immigrant and ethnic non-immigrant youths, while adjusting for and measuring the impact of racism, school and family characteristics, and the youth's unique individual attributes. Using a community-based participatory research approach and a cross-sectional study design, data were collected from immigrant and non-immigrant youth (n = 567) between May 2015 and December 2015 at three Israeli public high schools. The study included five groups of youth based on their self-descriptions: Ethiopian immigrant (n = 48), Russian immigrant (n = 145), Israeli-born Mizrachi/Sephardi (n = 59), Israeli-born Ashkenazi (n = 49), or Israeli-born Unspecified (n = 266). Linear regression models showed that Ethiopian immigrant youth, compared to Russian immigrant youth and all Israeli-born groups of youth, had significantly lower hope-agency, hope-pathway and overall hope. However, an interaction effect between racism and ethnicity indicated that adolescents who perceived racism and self-identified as Ethiopian had higher hope-agency, hope-pathway and overall hope. This effect was not found with Russian immigrant or Israeli-born youth. Immigrants of color compared to other immigrants and ethnicities have less overall hope; but those who acknowledge racism feel more control over their future (hope-agency), able to devise strategies to surmount barriers blocking goals (hope-pathway), and have greater overall hope.

Patient-centered elective egg freezing: a binational qualitative study of best practices for women's quality of care.

PURPOSE: How can elective egg freezing (EEF) be made patient centered? This study asked women to reflect on their experiences of EEF, which included their insights and recommendations on the optimal delivery of patient-centered care. METHODS: In this binational, qualitative study, 150 women (114 in the USA, 36 in Israel) who had completed at least one cycle of EEF were recruited from four American IVF clinics (two academic, two private) and three in Israel (one academic, two private) over a two-year period (June 2014-August 2016). Women who volunteered for the study were interviewed by two medical anthropologists. Interviews were audio recorded, transcribed, and entered into a qualitative data management program (Dedoose) for analysis. RESULTS: The majority (85%) of women were without partners at the time of EEF, and thus were undertaking EEF alone in mostly couples-oriented IVF clinics. Following the conceptual framework known as "patient-centered infertility care," we identified two broad categories and eleven specific dimensions of patient-centered EEF care, including (1) system factors: information, competence of clinic and staff, coordination and integration, accessibility, physical comfort, continuity and transition, and cost and (2) human factors: attitude and relationship with staff, communication, patient involvement and privacy, and emotional support. Cost was a unique factor of importance in both countries, despite their different healthcare delivery systems. CONCLUSIONS: Single women who are pursuing EEF alone in the mostly couples-oriented world of IVF have distinct and multifaceted needs. IVF clinics should strive to make best practices for patient-centered EEF care a high priority.

The effect of placebo on endurance capacity in normal weight children - a randomized trial.

BACKGROUND: The aim of the study was to examine the influence of the placebo effect on the endurance capacity results in normal weight children. METHODS: Twenty-four pre-pubertal normal-weight children aged 6-13 years participated in the study. Subjects underwent anthropometric measurements (weight, height, BMI percentile, and fat percentage), a progressive treadmill exercise test to evaluate endurance capacity, and filled habitual activity questionnaire. The participants were examined twice, in a random order, with each child being compared to him/herself. Different types of information were provided regarding a water drink consumed prior to testing- standard information (water) vs. deliberate positive information (presumed energy drink, placebo). RESULTS: Following the placebo drink, children demonstrated significantly higher peak pulse (177.9 ± 13.6 vs. 189.8 ± 12.2 bpm), higher stage achieved and longer time of exercise to exhaustion (700.1 ± 155.2 vs. 893.3 ± 150.1 s). Although the exercise duration was longer, stage and heart rate achieved were higher, the reported average, and peak rate of perceived exertion (RPE) were significantly lower for the placebo (18.3 ± 1.4 vs 16.2 ± 1.5). Although the effort was higher while drinking placebo (longer run, higher exercise phase, higher heart rate), recovery time was significantly shorter. The reported differences were not associated with order of tests, age, gender or child activity level. CONCLUSION: Our results demonstrate a significant information placebo effect on children's endurance capacity test results. This highlights the possible role of positive information (placebo) in trying to encourage physical activity in children. Whether this effect could be applied to longer-term interventions has yet to be tested. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT03165604 , Registered May 24, 2017.

Ten pathways to elective egg freezing: a binational analysis.

PURPOSE: What are the specific pathways that lead women to freeze their eggs? In this binational study, women were asked directly about the life circumstances that led them on the path to elective egg freezing (EEF). METHODS: From June 2014 to August 2016, 150 women (114 in the USA, 36 in Israel) who had completed at least 1 cycle of EEF were interviewed by two medical anthropologists. Study participants were recruited through four American IVF clinics (two academic, two private) and three in Israel (one academic, two private). Interviews were audio-recorded, transcribed verbatim, and entered into a qualitative data management program (Dedoose) for analysis. RESULTS: The majority (85%) of women in the study were without partners, while 15% had partners at the time of EEF. Six pathways to EEF were found among women without partners (being single, divorced, broken up, deployed overseas, single mother, career planner), with career planning being the least common pathway to EEF. Among women with partners, four pathways to EEF were found (relationship too new or uncertain, partner not ready to have children, partner refusing to have children, or partner having multiple partners). With only one exception, the pathways and their frequencies were similar in both countries. CONCLUSIONS: Partnership problems, not career planning, lead most women on pathways to EEF. These pathways should be studied in a variety of national settings, and fertility clinics should offer patient-centered care for single women pursuing EEF in the couples-oriented world of IVF.

Medical egg freezing: How cost and lack of insurance cover impact women and their families.

Medical egg freezing (MEF) is being recommended increasingly for women at risk of losing their reproductive ability due to cancer chemotherapy or other fertility-threatening medical conditions. This first, binational, ethnographic study of women who had undergone MEF sought to explore women's experiences under two different funding systems: (i) the USA, where the cost of MEF is rarely covered by private or state health insurance; and (ii) Israel, where the cost of MEF is covered by national health insurance. Women were recruited from four American and two Israeli in-vitro fertilization clinics where MEF is offered. In-depth, semi-structured interviews were conducted with 45 women (33 Americans, 12 Israelis) who had completed at least one cycle of MEF. All of the Israeli women had cancer diagnoses, but were not faced with the additional burden of funding an MEF cycle. In marked contrast, the American women - 23 with cancer diagnoses and 10 with other fertility-threatening medical conditions - struggled, along with their families, to 'piece together' MEF funding, which added significant financial pressure to an already stressful situation. Given the high priority that both American and Israeli women in this study placed on survival and future motherhood, it is suggested that insurance funding for MEF should be mandated in the USA, as it is in Israel. This article concludes by describing new state legislative efforts in this regard.

Medical egg freezing: the importance of a patient-centered approach to fertility preservation.

PURPOSE: This binational qualitative study of medical egg freezing (MEF) examined women's motivations and experiences, including their perceived needs for patient-centered care in the midst of fertility- and life-threatening diagnoses. METHODS: Forty-five women who had undertaken MEF were interviewed in the USA (33 women) and in Israel (12 women) between June 2014 and August 2016. Interviews lasted approximately 1 h and were conducted by two senior medical anthropologists, one in each country. Women were recruited from four American IVF clinics (two academic, two private) and two Israeli clinics (both academic) where MEF is being offered to cancer patients and women with other fertility-threatening medical conditions. RESULTS: Women who undertake MEF view their fertility and future motherhood as important components of their identities and recovery and, thus, are grateful for the opportunity to pursue fertility preservation. However, women who undergo MEF have special needs, given that they tend to be a "vulnerable" population of young (age < 30), unmarried, resource-constrained women, who are facing not only fertility loss but also the "double jeopardy" of cancer. Through in-depth, qualitative interviews, these women's MEF stories reveal 10 dimensions of care important to fertility preservation, including five "system factors" (information, coordination and integration, accessibility, physical comfort, cost) and five "human factors" (adolescent issues, male partner involvement, family involvement, egg disposition decisions, emotional support). Together, these dimensions of care constitute an important framework that can be best described as "patient-centered MEF." CONCLUSIONS: Women pursuing MEF have special medical needs and concerns, which require particular forms of patient-centered care. This study outlines 10 dimensions of patient-centered fertility preservation that are appropriate for MEF patients. This approach may help IVF clinics to be better prepared for delivering top-quality care to mostly young, single women facing the daunting prospect of fertility loss and life-threatening medical diagnoses.

Health indicators and social gradient in adolescent immigrants' health risk and healthcare experiences.

Few studies have assessed healthcare experiences in apparently healthy adolescents, or whether healthcare attitudes are linked to the two leading adolescent health indicators, smoking and obesity. Even fewer have examined these relationships in adolescent immigrant groups or made comparisons to adolescent non-immigrants. Using a cross-sectional study, healthcare experiences were compared among three groups of adolescents (n = 589) including Russian immigrants (n = 154), Ethiopian immigrants (n = 54), and non-immigrants (n = 381). Bootstrap estimates indicated positive healthcare experiences were less common among Russian adolescent immigrants (OR = 0.38, CI = 0.17, 0.86) compared to non-immigrants, unless the Russian adolescent immigrants reported above average socioeconomic status, in which case they were more likely than non-immigrant adolescents to report positive healthcare experiences (OR = 3.22, CI = 1.05, 9.85). Positive healthcare experiences were less likely among adolescents who were smokers (OR = 0.50, CI = 0.27, 0.91), and more likely for adolescents with a normal or low BMI (OR = 3.16, CI = 1.56, 6.40) and for those relying on parents for health information (OR = 1.97, CI = 1.05, 3.70). CONCLUSION: Findings suggest a social gradient in which positive healthcare experiences were more common among adolescence with higher socioeconomic status for some immigrants (Russian adolescents) but not for others. The two leading health indicators were related to healthcare experiences, but as adolescent smokers were less likely to have positive healthcare experiences, proactive efforts are needed to engage this group. What is Known: • Health indicators (such as obesity) and healthcare attitudes are linked to healthcare service use among adolescents sampled from outpatient and inpatient populations. What is New: • A social gradient involving socioeconomic status and being an adolescent immigrant was found regarding risky health indicators (i.e., smoking, use of internet as the primary source of health information). • Problematic health indicators, such as smoking, is linked to less positive healthcare attitudes in apparently healthy adolescents (both immigrants and non-immigrants).

Medical egg freezing and cancer patients' hopes: Fertility preservation at the intersection of life and death.

Egg freezing (i.e., oocyte cryopreservation) is a new reproductive technology that allows women's eggs to be frozen and stored for future use. Over the past five years, so-called "medical egg freezing" (MEF) has begun to play a major role as a form of fertility preservation for young women with cancer and other fertility-threatening medical conditions. Indeed, women who are candidates for MEF are often facing the "double jeopardy" of fertility loss and potential death. In this article, we examine the experiences of the first generation of women to use MEF in the United States and Israel, two countries where experimental use of MEF began early, and where MEF is now offered clinically in many in vitro fertilization (IVF) clinics. Through an ethnographic, interview-based study carried out between June 2014 and August 2016 with 45 women (33 American, 12 Israeli) who had completed at least one cycle of MEF, we highlight women's reflections on their egg freezing experiences, and their considerable hopes for future recovery and motherhood. However, MEF is a Janus-faced new "hope technology." On the one hand, it holds out the promise of life in terms of recovery and future childbearing. As such, women's reflections on MEF reveal hope and gratitude for the technology's existence. However, as with IVF itself, future motherhood can never be guaranteed. This is especially true for women facing death from advanced or aggressive forms of cancers. Three ethnographic case studies of cancer patients, two from the US and one from Israel, highlight how MEF offers hope for life among women confronted with a deadly disease.