'SI VIS VITAM, PARA MORTEM' terror management theory and psychosocial healthcare practice.

Terror management theory (TMT) contends that the need to manage the anxiety evoked by the awareness of one's own mortality, through proximal and distal defenses, lies at the heart of any human motivation. Proximal defenses aim at dismissing death awareness. Distal defenses aim at keeping them out of frame. The terror management health model (TMHM) applies TMT to issues of health and illness. TMT and TMHM are both explored mainly through empirical positivist research and theoretical discussions. Very few publications relate to the implementation of TMT. This article suggests further applications of the TMHM in social work practice.

Body-image, quality of life and psychological distress: a comparison between kidney transplant patients and a matching healthy sample.

The purpose of the current study was to assess the uniqueness of the condition of kidney transplant recipients in comparison to a sample of matching healthy peers in relation to body-image dissatisfaction and identification, quality of life and psychological distress. Participants were 45 kidney transplant recipients who were under follow-up care at a Transplant Unit of a major Medical Center, and a sample of 45 matching healthy peers. Measures were taken using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Body Identification Questionnaire (BIQ), Brief Symptoms Inventory (BSI), and the SF-12]. The major findings were the following: (i) kidney transplant recipients reported lower levels of quality of life and higher levels of PsD when compared to their healthy peers; (ii) no difference in body-image dissatisfaction was found between the two studied groups; (iii) significant correlations between body-image dissatisfaction quality of life and PsD were found only in the kidney transplant recipients. The kidney transplantation condition has a moderating effect in the association between body-image dissatisfaction PsD but not in the association between body-image dissatisfaction and quality of life; (iv) kidney transplant recipients experienced higher levels of body identification than did their healthy peers. Taken together, these findings highlight the unique condition of kidney transplant recipients, as well as the function that body-image plays within the self.

The implications of body-image dissatisfaction among kidney-transplant recipients.

The role that body image plays in the psychological adjustment of kidney-transplant recipients is an understudied issue. In the current study, the association between three variables - (a) body-image dissatisfaction, (b) quality of life (QOL), and (c) psychological distress - was investigated. The research participants were 45 kidney-transplant recipients who were under follow-up care at the Transplant Unit of the Tel-Aviv Medical Center (Israel). Body image, psychological distress, and QOL were measured using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Brief Symptoms Inventory (BSI), and SF-12]. Medical and background data were collected from medical and administrative records. The findings indicated an association between higher level of body-image dissatisfaction and a decrease in several quality-of-life dimensions (role emotional, physical pain, general health, and social functioning), and with an increase in psychological distress. These findings highlight the importance of body-image dissatisfaction as a factor that is associated with QOL and psychological distress among kidney-transplant recipients. Body image warrants further attention and should be screened and treated among those who demonstrate high levels of dissatisfaction.

Association between terror attacks and suicide attempts.

Based on Durkheim's 'Control theory,' we explored the association between frequency of terror attacks in Israel and the frequency of suicide attempts admitted to the Emergency Room of a major general hospital in Tel-Aviv (1999-2004). Analysis of the six-year study period as a whole revealed no significant correlation between the variables, with the exception of one 11-month segment within it (December 2000-October 2001) that did show a statistically significant positive correlation, and in opposition to Durkeim's hypothesis. It is suggested that suicide attempts as a phenomena should be seen as a product of a multivariate model, in which the social context plays a role as well.

Etiologies of hearing impairment among infants and toddlers: 1986-1987 versus 2001.

OBJECTIVE: This study compares etiological factors for hearing loss, relevant neuro-sensory impairments and demographics between two groups of children referred for early hearing habilitation in Israel. Group I was referred in the years 1986-1987 (n=73) and group II was referred during 2001 (n=73). METHODS: Family history, pregnancy, risk factors, developmental milestones, medical history, auditory brainstem response, tympanometry, otoacoustic emissions and behavioral audiometric results were retrospectively retrieved in 2003 from medical records at the MICHA Society for Deaf Children in Israel. RESULTS: New referrals per year have doubled themselves over the 15 years that elapsed between 1986-1987 and 2001. No changes in gender and age at time of admission were found. The prevalence of mild-to-moderate hearing loss was higher in Group II while severe and profound hearing loss was more prevalent in Group I. Assisted reproductive technologies were involved only in Group II. There were more twin births and post-natal hypoxia in Group II. Rh incompatibility was reported only in Group I. Severe hearing loss was associated with younger age at admission. No significant associations were found between age at admission and etiology with the exception of the fact that children with genetic background were admitted at an earlier age. Since no significant association between genetic background and severity of hearing loss was found, it is conclude that the association between severity of hearing loss and age at admission did not account for changes in etiology in our sample. CONCLUSIONS: Classic risk factors for hearing loss among infants and toddlers have not changed much over time, and the few changes that have been noticed are probably due to expanded medical knowledge and improved technologies.

Psychological distress symptoms in women undergoing medical vs. surgical termination of pregnancy.

OBJECTIVES: The purpose of this study is to compare the baseline psychological distress and symptom profile of women undergoing either medical (with mifepristone) or surgical pregnancy termination and the psychological outcome 2 weeks after the procedure. METHODS: Women (n = 200) given free choice of pregnancy termination method, either medical or surgical, were assessed before pregnancy termination by a demographic questionnaire including questions regarding the choice of the method of pregnancy termination, the Brief Symptom Inventory (BSI), the Spielberger State Anxiety questionnaire and the Rotter Locus of Control Scale. Two weeks after the procedure, the BSI and Spielberger questionnaires were repeated. RESULTS: Women with a smaller number of past pregnancies tended to choose the medical procedure. Reasons for choosing the medical procedure were fear of surgery, anesthesia and of future fertility difficulties. Prior to the procedure, the "medical group" had significantly higher levels of obsessive-compulsive symptoms, guilt and BSI general symptom index score, and a trend for higher interpersonal sensitivity and paranoid ideation. Postprocedure, both groups showed significant decline in anxiety levels and did not differ on most symptom parameters. CONCLUSIONS: Women who chose to have a medical termination are marginally more symptomatic before the procedure than women choosing surgical termination. However, both methods of pregnancy termination resulted in significant reduction in preabortion psychological distress level.

[The use of alternative medicine by multiple sclerosis patients].

This paper aims to present the results of a study that explores the use of uncontrolled and unexamined alternative treatment methods with 37 MS patients, and to compare these results with previous studies. The studied variables were: (a) reasons and circumstances of referral, (b) self reported outcome effectiveness of alternative treatment, and (c) satisfaction with the conventional physician and alternative healer. From a group of 37 patients, 17 were referred to alternative healers. In comparison with those who were not referred to alternative medicine, the sub-group referred for alternative treatment reported more familial support and lower levels of satisfaction from their rapport with their conventional physicians.

Trauma-Focused Early Intensive Cognitive Behavioral Intervention (TF-EICBI) in children and adolescent survivors of suicide bombing attacks (SBAs). A preliminary study.

OBJECTIVES: To describe and evaluate the impact of an early intervention (Trauma-Focused Early Intensive Cognitive Behavioral Intervention, TF-EICBI) in children and adolescents who were victims of suicide bombing attacks (SBAs) in Israel. DESIGN: Description of an intervention and preliminary experience in its use. SETTING: An acute trauma center of a Child and Adolescent Psychiatric Unit in a Department of Psychiatry of a university-affiliated medical center. PARTICIPANTS: Ten children and adolescents who were victims of SBAs and underwent early interventions (EIG) were compared to 11 adolescent victims who received no intervention (NEIG). The EIG included all the children and adolescent survivors of various SBAs that had occurred during 1 year who presented to our hospital after the TF-EICBI was implemented (June 2001). The NEIG comprised all adolescents girls <18 years of age at follow-up who survived one SBA (at the "Dolphinarium" Discotheque) before the TF-EICBI was available. MAIN OUTCOME MEASURES: At the time of the 1-year post-SBA follow-up, all 21 subjects were assessed by the Structured Clinical Interview for Axis 1 DSMIII R Disorders (SCID), and the Child Behavior Checklist (CBCL). RESULTS: One (10 percent) EI subject and four (36.4 percent) NEI subjects had post-traumatic stress disorder. The mean CBCL total score and most of the mean CBCL behavior problem scores were significantly higher (p < 0.021) among the NEI group members. CONCLUSIONS: Intervention was effective in preventing and lowering mental morbidity of children and adolescents after SBAs.

Communication skills, working environment and burnout among oncology nurses.

PURPOSE: To examine the association between communication self-efficacy, working environment perceptions and burnout in an Israeli sample of oncology nurses. METHODS: A non-randomized convenience sample of nurses (n=39) was recruited from six oncology units in a major tertiary medical center in Israel. Measurements included a socio-demographic survey, the Maslach Burnout Inventory, a communication skills self-efficacy inventory and the Working Environment Scale. FINDINGS: Frequent experiences of emotional exhaustion were reported by >60% of participants, cynicism by 28%, and self-actualization by >80%. Several statistically significant associations were demonstrated between communication skills self-efficacy and burnout, as well as between cynicism and reported positive characteristics of the working environment. CONCLUSIONS: In our study, emotional exhaustion and self-actualization were found to be separate and distinct experiences that can occur simultaneously. Communication self-efficacy and a positive perception of the working environment appear to buffer the occurrence of emotional exhaustion and promote self-actualization.

GnRH-agonist induced depressive and anxiety symptoms during in vitro fertilization-embryo transfer cycles.

To determine whether the use of a GnRH agonist inducing a hypogonadic state during IVF-ET cycles induces negative mood symptoms, we conducted a prospective randomized study in 108 women comparing two different controlled ovarian stimulation protocols. A significant phase effect was observed for depression and anxiety symptoms during IVF-ET cycles reflecting an increase in symptoms between the hypogonadal phase and the peak in gonadotropin stimulation; however, the hypogonadal phase induced by the GnRH agonist was not associated with a significant increase in any of the studied mood parameters.

An investigation of the practice of unsafe sex yet repeated HIV testing.

RATIONALE: A purportedly heterogeneous group of people, who come to take tests at the Human Immunodeficiency Virus (HIV) Test-ing Clinic, includes young males and females who lead a normative lifestyle with no unique characteristics. Within this population, we have observed one distinct subgroup of predominantly male individuals, who return from time to time to take the HIV tests. They tend to partake in many occasional sexual encounters with numerous partners, and despite their obvious knowledge of the risks involved, they attest to not using condoms during sexual intercourse. The aim of this preliminary study was to investigate the patterns of their risky behavior in conjunction with their test taking conduct. METHODS: Ten self-referred volunteering subjects were recruited. EXCLUSION CRITERIA: HIV-positive, drug and/or alcohol abusers, mentally ill, men who have sex with men (MSM) and minors. The study was carried-out using semi-structured interviews (40-90 min each). The interviews were recorded, transcribed and content analyzed. FINDINGS: Data analysis showed several possible explanations for risky sexual behavior, such as applying of a variety of risk management mechanisms, refraining from impulse control behaviors, and self-destruction motives. The reasons for undergoing HIV testing were most frequently related to specific events, high-risk in nature, and not part of a routine behavioral practice. CONCLUSIONS: Our findings might suggest that within this population group, the prevailing primary preventive interventions would not satisfy the purpose of decreasing levels and frequency of risk-taking behaviors. In the opinion of the authors, there are two strategies that could be employed, simultaneously or separately. An indirect approach entails the increase and enhancement in utilizing widely spread media, e.g., feature films and television programs, to convey issues related to curbing risk-behavior. Direct emphasis should be put on secondary preventive measures, by encouraging frequent test-taking conduct, preferably accompanied by counseling, in order to decrease the risk of further transmitting the virus.

Quality of life in patients older than 75 years following major head and neck surgery.

BACKGROUND: This study was designed to evaluate the quality of life (QOL) of patients older than 75 years undergoing major head and neck surgery. METHODS: Three groups of patients were included: elderly patients (>75, n = 35) and younger patients (65 to 75 years, n = 30) undergoing major head and neck surgery and healthy controls (>75, n = 40). Measurements were made using the SF-12 health survey, the University of Washington QOL questionnaire, and measurements of the "sense of burden" on the caregiver. RESULTS: With the SF-12, the role physical, role emotional, and bodily pain were decreased by the surgical intervention, while physical function was affected by age alone. With the UW-QOL Questionnaire, overall QOL was preserved. "Appearance" and "Leisure" subscales were affected by the surgical intervention and old age. "Chewing" and "Activity" were decreased by the surgical intervention in the older patients, and "Speech" was affected by the surgical intervention alone. The "sense of burden" was alleviated by surgery in the elderly patients. CONCLUSIONS: Several QOL domains are decreased in elderly patients undergoing major head and neck surgery.