Religious Disaffiliates' Experiences and Challenges with Sex, Sexuality, and Body Image.

In recent years, an increasing number of ultra-Orthodox Jews have left their insular communities, choosing instead to lead a secular life. This article illuminates their perceptions and experiences related to sexuality, sexual behavior, and sexual health. Based on thematic analysis of 37 in-depth, semi-structured interviews with ultra-Orthodox disaffiliates, we found that sexual experiences have played a decisive role in the disaffiliates' lives. First, some participants shared that experiencing sexual abuse during childhood led them to disaffiliate. Second, prior to disaffiliating, participants had very little knowledge about sex, which was an unspoken issue. This resulted in misunderstandings and miscommunication related to courtship and dating after disaffiliating. Moreover, the knowledge gap of secular social norms led to disaffiliates being sexually exploited, as well as to male disaffiliates behaving inappropriately and consequently suffering from social rejection and loneliness. While some participants celebrated their new sexual freedom, others were fearful and reluctant to have sex. We suggest that in transgressing social, cultural, and identity boundaries, disaffiliates experience "cleft habitus" and are situated in a prolonged liminal position that affects their sexual behavior, intimate relations, sexual health, and body image. During the liminal period, disaffiliates typically learn threshold concepts, which are often troublesome and threatening. There is a striking need to offer disaffiliates assistance and support throughout this difficult process. This analysis can shed light on other groups of religious disaffiliates and cultural immigrants.

Occupational rehabilitation of Israel Defense Forces veterans with PTSD: A 5-year follow-up.

The MOD Rehabilitation Department (RD) offers three types of rehabilitation tracks (RTs): (a) education, (b) work placement, (c) economic independence. This study aimed to examine which of the offered RTs predicted a better integration into the workforce. This is an observational, prospective, case-controlled study. Data were collected from administrative files. The data pertained to soldiers injured in military service, under RD care and recognised as posttraumatic stress disorder (PTSD) patients between 2001 and 2006. As rehabilitation takes 5-6 years, we examined two points in time: 2015 and 5 years later, in 2020. The studied population comprised 462 male military veterans injured during military service and diagnosed with PTSD (mean age at the time of injury was 24.60 [SD 5.70]; median = 22). Of the participants, 87.9% (n = 406) also sustained physical injury, and 12.1% were not injured physically (n = 56; 12.1%). A regression analysis indicated that the educational RT (OR = 19.509; p = .001) predicted integration into the workforce. The whole model explained 49.0% of the variance. Of the three RT types examined, education is the most important. The more years of study, the better the ability to integrate into the workforce.

Anxiety, post-traumatic symptoms, media-induced secondary trauma, post-traumatic growth, and resilience among mental health workers during the Israel-Hamas war.

The ongoing Israel-Hamas war is posing additional challenges for mental health workers in an already stressful workplace. This study centres on the psychological effects of the shared traumatic reality on mental health workers, arising from the Israel-Hamas war. One month after exposure to the terrorist attack of 7 October 2023 and the outbreak of war following this event, 147 mental health workers completed questionnaires regarding a variety of variables such as demographics, anxiety symptoms, acute stress symptoms, media-induced secondary trauma, personal resilience, National resilience (NR), and post-traumatic growth (PTG). The study found that mental health workers with previous trauma displayed higher anxiety symptoms, acute stress symptoms, and media-induced secondary trauma. Additionally, acute stress and anxiety were positively correlated with media-induced secondary trauma. Religiosity, personal resilience, and NR were found associated with lower anxiety and acute stress symptoms. Religiosity was also positively correlated with personal resilience, NR, and PTG. The PTG of mental health workers working with trauma survivors and evacuees was higher compared to that of other mental health workers. Both adverse and adaptive reactions were evident among mental health workers. While traumatic stress is expected, individual, professional, and NR factors may mitigate its effects. Providing training, social support, regulated media exposure, stress management, and meaning-focused coping strategies can help safeguard workers' well-being.

Geographic Inequity in Physical Medicine and Rehabilitation Services: An Administrative Case Report of Successful Advocacy for Change.

OBJECTIVE: Following an injury or disease, physical medicine and rehabilitation (PM&R) services are often necessary to help patients recover function, activity, and community participation. Ten years ago, there was a significant gap between PM&R services in central Israel and those in the rural north of the country in terms of quality, quantity, and layout. The purpose of this administrative case report is to outline the gap in PM&R services between regions in Israel, as portrayed above; to describe a decade of civil action; and to describe civil action administrative approaches and actions that contributed to changes in the PM&R services now available in northern Israel. METHODS: A decade of civil action to promote PM&R services is reviewed, illustrating the main administrative steps, including initiating and organizing meetings with key partners, lobbying, testifying in front of parliament and government committees, garnering media attention to promote public awareness, and filing a case with the Supreme Court of Israel. The encountered challenges and the subsequent actions are also described. RESULTS: Awareness of the significance of PM&R services and of the inadequacy of such services in the northern part of Israel rose due to our actions, with practical field results, including an 180-bed government rehabilitation center that plans to open during 2024, and 5 daycare rehabilitation clinics and a private inpatient center that opened between 2020 and 2023. Data-driven research will aid in understanding the current gaps and tracking improvements with the opening of the new rehabilitation facility. CONCLUSION: When inequality is brought to light, and legislation for equality exists, civil action can promote change to reduce these gaps. IMPACT STATEMENT: Others can follow the steps taken in this administrative case report to achieve success in struggles aiming to correct comparative inequality.

The Use of National Cancer Registry Data for Breast Cancer Family History Assessment in Premenopausal Women.

Background: Population-based cancer registries are the best source of information to measure cancer burden. However, little is done to use this information for individual cancer risk assessment. In this study, we aimed at identifying women at high risk of breast and ovarian cancer using data on family history of cancer from the Israel national cancer registry. Methods: We used the family history assessment tool (FHAT) to score all females, 26 to 45 years of age, in a 2.6-million-member health provider in Israel (Maccabi Healthcare Services). Data on breast, ovarian, prostate, and pancreatic cancer history among the participants and their parents (identified using the national census) were retrieved from the national cancer registry. These data were used to calculate individual FHAT scores. Results: A total of 377,931 eligible women were included in the analysis. A relevant family history of cancer was detected in 20,386 (5.4%), with FHAT scores ranging from 1 to 16. FHAT score was higher in older women and among those with a history of breast cancer. Among women aged 35-39, an FHAT score of 10 or above was associated with an OR of 15.23 (95%CI: 7.41-28.19) for breast cancer compared to women with an FHAT of 0. Conclusions: Using individual-level data from national cancer registries may assist in detecting women with a relevant family history of cancer.

Personal value preferences, multifaceted job satisfaction and burnout in Israeli high-tech.

This study investigates connections between personal value preferences, satisfaction with different facets of the job and burnout among high-tech workers. The study's sample included 175 individuals (43% females) working in the high-tech industry in Israel. A high level of satisfaction with work content was associated with low burnout and high professional accomplishment, and satisfaction with coworkers was associated with low burnout. Satisfaction with supervisor, salary and promotion opportunities did not affect high-tech workers' burnout and professional accomplishment. A high preference for achievement values was associated with high professional accomplishment. A high preference for power values was associated with low satisfaction with all job facets. In addition, power values increased burnout indirectly by reducing satisfaction with work content and coworkers. Power values also decreased personal accomplishment indirectly by reducing satisfaction with work content. A high preference for self-direction values was associated with high satisfaction with salary and promotion opportunities. Finally, high preferences for achievement and universalism values were associated with high satisfaction with promotion opportunities. The theoretical and practical implications of the obtained results are discussed.

Incidence of laboratory-confirmed influenza and RSV and associated presenteeism and absenteeism among healthcare personnel, Israel, influenza seasons 2016 to 2019.

BackgroundHealthcare personnel (HCP) are at high risk for respiratory infections through occupational exposure to respiratory viruses.AimWe used data from a prospective influenza vaccine effectiveness study in HCP to quantify the incidence of acute respiratory infections (ARI) and their associated presenteeism and absenteeism.MethodsAt the start and end of each season, HCP at two Israeli hospitals provided serum to screen for antibodies to influenza virus using the haemagglutination inhibition assay. During the season, active monitoring for the development of ARI symptoms was conducted twice a week by RT-PCR testing of nasal swabs for influenza and respiratory syncytial virus (RSV). Workplace presenteeism and absenteeism were documented. We calculated incidences of influenza- and RSV-associated ARI and applied sampling weights to make estimates representative of the source population.ResultsThe median age of 2,505 participating HCP was 41 years, and 70% were female. Incidence was 9.1 per 100 person-seasons (95% CI: 5.8-14.2) for RT-PCR-confirmed influenza and 2.5 per 100 person-seasons (95% CI: 0.9-7.1) for RSV illness. Each season, 18-23% of unvaccinated and influenza-negative HCP seroconverted. The incidence of seroconversion or RT-PCR-confirmed influenza was 27.5 per 100 person-seasons (95% CI: 17.8-42.5). Work during illness occurred in 92% (95% CI: 91-93) of ARI episodes, absence from work in 38% (95% CI: 36-40).ConclusionInfluenza virus and RSV infections and associated presenteeism and absenteeism were common among HCP. Improving vaccination uptake among HCP, infection control, and encouraging sick HCP to stay home are important strategies to reduce ARI incidence and decrease the risk of in-hospital transmission.

War-Related Stress among Israeli College Students Following 7 October 2023 Terror Attack in Israel.

BACKGROUND: Warfare represents a significant source of stress in contemporary times, with enduring implications beyond the immediate casualties, fostering a pervasive atmosphere of danger and anxiety within affected populations. The Israel-Hamas war, marked by ongoing armed incursions and missile attacks, stands as a recent example of such turmoil, inflicting widespread trauma and disruption. METHODS: This study, conducted among students at the Ashkelon Academic College in southern Israel, aimed to investigate the stress levels and associated factors amidst the ongoing conflict. Utilizing a cross-sectional survey design, data were collected from 625 participants between January and February 2024, approximately four months after the commencement of the initial attack. The survey encompassed demographic information, perceived stress levels, sleep quality, and social media usage. RESULTS: The findings revealed moderate to high stress levels among participants, with significant differences observed based on gender, parental status, and residency in conflict zones. Moreover, poorer sleep quality was reported among students residing in conflict-affected areas. Regression analysis identified several predictors of elevated stress, including gender, parental status, sleep quality, residency in conflict zones, and social media usage. CONCLUSIONS: These findings underscore the profound impact of ongoing conflict on college students' mental well-being, highlighting the need for tailored interventions and support services within higher education institutions. The limitations include the study's focus on a specific college population and the timing of the data collection relative to the onset of the war. Nonetheless, this research contributes valuable insights concerning the stress dynamics within the unique context faced by Israeli students amidst ongoing warfare.

Food insecurity amongst asylum seekers and people without status in Israel.

BACKGROUND: The COVID-19 pandemic caused massive disruptions globally, with food insecurity a primary concern amongst vulnerable communities. As one of the most marginalized and vulnerable groups in Israeli society asylum seekers and undocumented populations were amongst the first to be affected by the pandemic and the economic crisis that followed. The objective of the study was to evaluate the severity and causes of food insecurity among asylum seekers and other undocumented communities because of COVID-19. METHODS: A multi method approach was used. The quantitative component included an online questionnaire regarding access to food, aid and choices, and the 6 item Household Food Security Survey Module (HFSSM) The qualitative component included 4 focus groups and thematic analysis. The study was conducted in November 2020, by the Ministry of Health's Nutrition Division and the Tel Aviv Municipality's foreign community assistance and information center (Mesila). The convenience sample was drawn from the low-income neighborhood population of South Tel Aviv. Logistic regression, multivariate analysis and content analysis, were performed. RESULTS: Four hundred eighty-five people completed the quantitative survey, with average age 33.2 ± 5.4 years and 349 (72.0%) experienced food insecurity. In the multivariate analysis, being older (p = 0.04, Odds Ratio OR 1.1, Confidence Interval CI 1.05-1.15) and being single (unmarried) (p = 0.03, OR 2.1, CI 1.2, 3.5) predicted food insecurity. Qualitative findings identified three main themes: children preferring Israeli/ Western foods to traditional foods; financial stresses were compounded; a preference for receiving assistance with purchasing food (vouchers), rather than food handouts. CONCLUSION: In conclusion, vulnerable populations (asylum seekers and other undocumented communities) were severely affected and are in danger of food insecurity. Culturally relevant and contextualized solutions are needed to address the acute hunger within the community. These include establishment of a cross-ministerial forum, a social grocery store, increased liaison with food rescue bodies, complete nutritional support for children in educational settings and increased guidance regarding food choices and budgeting.

Tick-Borne Relapsing Fever Infection from a Bunker, a Case Report on a "One Health" Approach.

Background: Tick-borne relapsing fever (TBRF) caused by Borrelia persica is an endemic disease in Israel and highly prevalent in military personnel. Prevention among the Israel Defense Force soldiers is based on increased awareness mainly in hyperendemic areas and selective postexposure prophylaxis with doxycycline. In this study, we report the presence of a suspected outbreak of TBRF in four soldiers who spent 30 h inside a deserted bunker. Materials and Methods: Clinical data on TBRF suspected cases were retrieved from clinical records, soft ticks were collected using carbon dioxide (CO2) traps and their DNA was extracted and analysed by PCR and nucleotide sequencing. Environmental conditions such as relative humidity, air temperature, wind speed, and type of soil, as well as presence or absence of animal traces inside the bunkers were documented. Results: TBRF-like clinical symptoms in the patients included: tick bite scars, fever (37.5-39.2°C), rash, tachycardia, hypotension, myalgia, cough, headache, cervical lymphadenopathy and nausea. Microscopic search for B. persica in blood smears was performed in three patients and was negative. Out of the 255 Ornithodoros tholozani ticks collected from the bunker, 198 were analyzed and 2 (1%) were infected with B. persica. To determine if tick infestation in military bunkers is a common phenomenon, we surveyed nine additional military bunkers located in four different geographical areas for the presence of soft ticks. Only one additional bunker was infested with two O. tholozani ticks, both negative for B. persica. Presence of earth that probably helped sustain a relatively big tick population was observed on the floor in the highly infested bunker. Environmental treatment with lambda-cyhalothrin at 9.7% was performed and showed efficacy with no ticks recovered in the infested bunker 124 days after intervention. Conclusion: This study shows that military bunkers may harbor soft ticks infected with B. persica and entrance into bunkers should be considered as a risk for acquiring this infection like entrance into natural caves and archeological ruins.

Problematic series watching and alcohol consumption among global audiences of Korean Drama in Israel and Indonesia.

Korean dramas (K-dramas), with their unique characteristics, often encourage binge-watching. Moreover, the cultural norms and rituals surrounding alcohol, prevalent in South Korea, are mirrored in K-dramas that have gained global audiences in recent years. The present study aimed to examine problematic K-drama series watching, and the potential associations with alcohol consumption among global adult audiences from Israel and Indonesia. An online questionnaire was distributed to a non-probability convenience sample of 638 adult viewers of K-drama, of whom 383 (60%) were Indonesian and 255 (40%) were Israeli. Fifteen percent of the audiences were identified as displaying problematic K-drama series watching, 36% reported ever drinking Soju (the traditional unique Korean drink), 41% reported drinking alcohol in the past 3 months, and 24% reported binge drinking in the past 12 months. Participants who were higher in problematic K-drama series watching were more likely to be involved with drinking Soju, drinking alcohol in the past 3 months, and binge drinking in the last year. Indonesians and Israelis have significantly different viewing patterns and alcohol consumption. 21.2% of Israelis identified as problematic K-drama series watching compared to 10.7% of Indonesians. Greater percentage of the Israelis have reported consumption of alcohol than Indonesians. Multiple linear regression for problematic K-drama series watching revealed that Israeli audiences, younger age, being defined as a fan, being a member of a K-drama social network, higher number of weekly hours spent watching, and greater number of dramas being watched per month were associated with more problematic K-drama series watching. Series binge-watching may entail potentially negative health and social consequences and professionals should pay more attention to this type of problematic behavior. The identification of problematic K-drama series watching and its association with increased alcohol consumption, suggests the need for health policymakers to consider cultural influences on media alcohol messages consumption.

Religious Differences in Physical and Mental Health among Israeli Jews: Findings from the Global Flourishing Study.

Numerous studies have identified religious correlates of health indicators, but relatively few have been conducted among Jewish populations in Israel or the diaspora. This study investigates the possibility of a religious gradient in physical and mental health and well-being across the familiar categories of Jewish religious identity and observance in Israel: hiloni (secular), masorti lo dati (traditional, non-religious), masorti (traditional), dati (religious or Orthodox), and charedi (ultra-Orthodox). Data are from Jewish respondents aged 18 and over (N = 2916) from the Israeli sample of the new, 22-nation Global Flourishing Study, which used stratified, probability-based sampling and assessed demographic, socioeconomic, political, religious, health-related, and other variables. This analysis investigated religious differences in nine indicators of physical and mental health and well-being among Israeli Jews. Using a strategy of one-way ANOVA and ANCOVA, adjusting for complex sampling design components, a statistically significant "dose-response"-like gradient was found for eight of the outcome measures, validated by additional multiple comparison tests. For four "positively" worded indicators (physical and mental health, happiness, and life satisfaction), scores increased consistently from the hiloni to the charedi categories. For four of five "negatively" worded indicators (bodily pain, depression, anxiety, and suffering), scores decreased across the same categories. Results withstood adjusting for effects of age, sex, education, marital status, urbanicity, income, and nativity (whether born in Israel). Among Israeli Jews, greater religiousness was associated with higher levels of health and well-being and lower levels of somatic and psychological distress.

Faith and Health in Israel, Türkiye and the USA.

This issue of JORH focuses upon faith and health within three nations that have contributed a great deal in terms of religion and health research during this century-namely Israel, Türkiye and the USA.

Needs, Experiences, and Hopes for Aging Futures among Older Adults in the LGBTQ Communities: A Qualitative Study in Israel.

Older lesbian, gay, bisexual, trans, and queer (LGBTQ) individuals tend to live alone, mostly without children and with scarce support from nuclear family members or biological kin. Moreover, traditional resources may not suit their specific end-of-life care needs. While studies have examined these topics in general, they lack focus on end-of-life needs, care, and planning in Israel. Moreover, research on this topic among members of LGBTQ communities is specifically lacking. This study, therefore, aimed at identifying and understanding the attitudes, perceptions, and meanings of older LGBTQ individuals in Israel regarding their needs and challenges, as they age and near end of life. The phenomenological qualitative research methodology was applied, following the interpretive approach. Twenty-one middle-aged and older LGBTQ individuals in Israel, aged ≥ 55, participated in the study. In-depth semi-structured interviews, conducted from November 2020 to April 2021, were audio-recorded, transcribed, and de-identified. Five themes emerged from the interviews: (1) Experiences of loneliness, marginalization, and trauma, and coping through liberation; (2) ageism and exclusion of older adults; (3) elastic and challenging relationships; (4) end of life as reverting into the closet and heteronormativity; and (5) death as a source of generativity and creativity. The study demonstrates that loneliness is an existential experience, exacerbated by the intersectionality of LGBTQ communities. In turn, chosen family members play a minimal role in the end-of-life care of their loved ones. While conveying ambivalence toward social services and housing for the aging, participants in this study expressed fear of being discriminated against and having to re-enter the closet as they age. Ageism and end of life do not represent finality and extinction, yet instead, signify hope and revival. Following Sandberg and Marshall's (2017) concept of queering aging futures, this study refines our understanding of life courses, demonstrating that living and thriving in old age could be positive and desirable. As such, ageism and end of life do not necessarily represent finality and extinction, and may instead signify hope and revival. The unique challenges associated with family and social support of older adults who are LGBTQ members, and their implications on care, deserve further research and are important for practice.

PTSD symptoms and subjective traumatic outlook in the Israel-Hamas war: Capturing a broader picture of posttraumatic reactions.

This study examined the unique associations of both probable posttraumatic stress disorder (PTSD) and subjective traumatic outlook (STO) with psychiatric and psychological concomitants among Israelis during the Israel-Hamas War. While PTSD reflects phenomenological psychiatric reactions to traumatic events, STO reflects subjective evaluations that one is traumatized. A convenience sample of 375 Israelis aged 20-87 from around Israel completed an online survey in the first two months of the war. A series of univariate logistic and linear regressions showed that while both probable PTSD and STO were associated with significant depression and anxiety symptoms, STO showed unique associations with hope and revenge, psychological variables that may be more sensitive following exposure to human-made and war trauma. Theoretical and practical considerations regarding these results suggest that a broader picture of post-trauma reactions can be captured by accounting for both the observed symptoms (PTSD) and one's introspective perception of being traumatized (STO).

ST913-IVa-t991 Methicillin-Resistant Staphylococcus aureus among Pediatric Patients, Israel.

In Israel, prevalence of sequence type 913, staphylococcal cassette chromosome mecIVa, spa type t991 methicillin-resistant Staphylococcus aureus lineage has surged among pediatric populations, predominantly in Arab and Orthodox Jewish communities. Antimicrobial resistance patterns vary by demographics. This lineage's spread and microevolution in the Middle East underscore the need for ongoing surveillance.

Stability of lower dimensional counter-rotating thin-shell wormholes with scalar hair.

The motivation for constructing a thin-shell wormhole from a (2+1)-dimensional rotating black hole arises from the desire to study the effects of a nonminimally coupled scalar field in this particular spacetime. By investigating the behavior of such a field in the presence of rotation, we can gain insights into the interplay between gravity and scalar fields in lower-dimensional systems. Additionally, this construction allows us to explore potential connections between black hole physics and exotic phenomena like traversable wormholes. The radial perturbation around the equilibrium throat radius is considered to explore the stable configuration for specific values of physical parameters. Then, the equations of state, specifically the phantom-like and generalized Chaplygin gas model for exotic matter is used to conduct an extensive investigation into the stability of the counter-rotating thin-shell wormholes. Our results show that the presence of a scalar field enhances the stability of the counter-rotating thin-shell wormholes.

Barriers to mental health service utilization among Arab society in Israel: Perspectives from service providers.

This study attempted to identify the barriers to the utilization of mental health services among the Arab society in Israel, as perceived by professionals working with this population. Twenty-seven therapists from community mental health services participated in structured in-depth interviews with at least 5 years of experience. Five main types of barriers to the utilization of mental health services were discovered: barriers related to attitudes and perceptions regarding mental disorders and their treatment, low literacy in the field of mental health, exposure and stigma, family characteristics and cultural values, and instrumental barriers. Flexibility and sensitivity to the socio-cultural context of the target population while allocating resources to create equality in access to mental health care may increase the utilization of mental health services in a traditional society such as the Arab society in Israel.

Intercultural therapy with Ultra-Orthodox Jews in Israel: the complexity of the encounter between secular therapists and Haredi clients.

This paper explores the exceptional intercultural encounter between secular therapists and Ultra-Orthodox Jews in Israel, focusing on two key aspects. Firstly, it explores the distinctive attributes and conflicts inherent in treating Ultra-Orthodox individuals. On the one hand is the secular Israeli therapist, whose base is in Western philosophy that prioritizes individuality, cultural diversity, and tolerance of differences. On the other hand is the Haredi client, entrenched in values from Jewish tradition and religious principles that amplify solidarity and collectivism while rejecting prevalent secular culture. The existing socio-political climate in Israel often positions these two as potentially conflicting cultures. Secondly, the paper seeks to illuminate the uncommon dynamics of the minority-majority power balance within the therapeutic relationship. In contrast to prevalent literature in intercultural therapy, which typically frames the client as a representative of a disadvantaged minority and the therapist as a representative of a dominant majority, this article aims to unravel a nuanced power balance, where those in the minority perceive the dominant culture both as a threat to its way of life and as a despised entity, but paradoxically rely entirely on its financial support. This reveals a complex and intricate interplay of dominance and dependence, shaping a therapeutic relationship that defies conventional expectations.

"Being My Own Pillar of Support": How Palestinian-Arab Women Citizens of Israel Cope With IPV.

Studies on the ways in which women implement coping strategies to recover from intimate partner violence have primarily focused on Western, non-collectivistic societies. To contribute to the scant literature on coping strategies among women in traditional-collectivistic societies, the current study applied the principles of Clinical Ethnographic Narrative Interview to analyze the experiences of 15 Palestinian-Arab citizens of Israel as these women confronted violence within marriage. This exploration is situated within the backdrop of entrenched collectivistic traditional norms and the broader context of the enduring Israeli-Arab conflict. An Interpretative Phenomenological Analysis revealed three themes that translated into a transformative three-phase coping model. The first theme covers navigating violent relationships through avoidance, emotional encapsulation, and cognitive reframing. The second theme describes strategies to mitigate violence and its consequences, including escapist and immediate departure, sustained fulfillment of duties, and maintaining hope amid adversity. The third theme characterizes strategies aimed at achieving self-care and self-empowerment. The findings highlight the importance of acknowledging women's definition of coping and recovery within their cultural constraints as they chart their coping trajectories.