Judith Bernstein

Social class and infant mortality.

Abstract This paper examines the relationship between the components of infant mortality and social class by analysing the data available from infant mortality studies undertaken in Western Europe and the United States. A full set of data are given in the Appendix. It was found that although infant mortality has declined dramatically in the past century, the inverse relationship between social class and perinatal, neonatal and postneonatal mortality has not narrowed, in spite of the advances in medicine and surgery, sanitation and housing conditions, and the overall rise in living standards which were presumed to be of special benefit to the lower classes. The large influence of perinatal mortality, and especially stillbirths, on the infant loss rate is discussed. Several hypotheses to explain the persistence of the social class gap are presented: the “capital assets” thesis; the “time-lag” argument; and the differential social mobility pattern. Finally, data on variables linking social class to infant mortality are briefly reviewed. Two conclusions are reached. First, that there is a continuing, but unheeded, need for data on class and infant mortality. Second, that the important focus of action, as well as of further research, if the social class gap is to be closed, is less the traditional medical techniques and more the broader issues of social change in education, welfare as well as health services.

Trait-anxiety and sense of coherence: a longitudinal study.

A study of trait-anxiety and sense of coherence on a group of medical students over 18 mo. shows that, although both characteristics are rather stable over time, the measure of sense of coherence is more sensitive to stressors than A-trait and is better predicted by A-trait than the opposite.

Gender Differences in Physical Health and Psychosocial Well Being among Four Age-Groups of Elderly People in Israel

The purpose of this study was to investigate the extent to which the well-established gender differences in physical and psychosocial well being in adulthood persist throughout different age groups of elderly persons, in order to support one of two opposing hypotheses: the convergence and divergence hypotheses. Data were collected by structured interviews from a random sample of 987 Israeli elderly (70+) in 1994. They were divided into four age groups for analysis: 70–74, 75–79, 80–84, and 85 and over. Findings indicate that in nearly every gender comparison by age, women score lower than men on indicators of physical and psychosocial well being, and in both genders increasing limitations on activities of daily living (ADL) were noticed. However, on all measures of physical health, except for ADL, the male advantage declines in the older age groups. This pattern is even stronger for the psychosocial indicators of well being, where no significant gender differences are found between the oldest groups. The trend of convergence among men and women thus occurs mainly in the age group of 85+. The results of multivariate analyses indicate that the sense of control of ones life is an important explanatory variable of satisfaction with life for men but not for women. The significant decline in the sense of control of men, aged 85 and over, is one of the main reasons for the more significant decline found in mens psychosocial well being in comparison to women. Our findings indicate that decline in health status, and other losses experienced with aging, affect more significantly mens sense of control over life, and therefore have a more deleterious effect on the psychosocial well being of men than on that of women. This conclusion, however, has to be supported by longitudinal studies.

TRAIT ANXIETY AND THE SENSE OF COHERENCE

Two different theoretical approaches to the explanation of individual differences in appraisal of environmental demands are expressed by the trait-anxiety (A-trait) scale of the State-Trait Anxiety Inventory (4) and by Antonovskys (2) measure of the sense of coherence. Spielberger, whose orientation is a pathogenic one, is concerned primarily with people who feel threatened by environmental demands. Antonovsky, with a salutogenic approach, is interested in those individuals whose world view leads them to perceive demands as challenging. The hypothesis tested in this study and derived from these two orientations, as distinguished by Antonovsky (I), is that people who score high on sense of coherence will score low on A-trait. Hebrew versions of both measures: along with questions on basic demographic data, were self-administered by students in the first year class (N = 46) at the medical school of the Ben-Gurion University of the Negev, Israel, during the Summer Preparatory Course. Their ages ranged from 17 to 28 yr., with an average of 21.6 yr. There were 29 men and 17 women. The correlation found between sense of coherence and A-trait (Pearson T = -.77, p = ,001) provides suong support for the hypothesis. No significant differences in scores were found by age (Pearson T = -.02 on A-trait and .12 on sense of coherence). No significant differences by sex were noted (t test). The mean score for men on A-trait was 32.96 (SD = 7.32) and for women 34.76 (SD = 8.14); on sense of coherence, rhe mean score for men was 152.52 (SD = 15.24) and for women 149.94 (SD = 17.74). In an earlier study of A-trait among 131 students in four classes of this medical school, age and sex differences were significant, with women and younger students reporting higher anxietg than men and older students (3). The strong negative relationship found between sense of coherence and A-trait scores raises a basic theoretical question: are these two measures, derived from different conceptual approaches, actually measuring the same hen omen on?

Gender Differences Over Time in Medical School Stressors, Anxiety, and the Sense of Coherence

Gender differences in the perception of medical school stressors, trait anxiety, and the sense of coherence were investigated in a longitudinal study in an Israeli medical school. The overall stressor score increased for both sexes from orientation to the second year of studies. The increase in the stressor score among women was due primarily to their increasing concern about professional status issues; for men, the academic demands factor contributed most to their increased overall stressor score. Trait anxiety increased and the sense of coherence decreased over time for both sexes. The gender difference in anxiety was significant in the first two stages, but disappeared in the third stage, indicating that although men had lower scores at all stages, their scores increased relatively more than womens over time. The findings suggest that the stressors of medical education have a negative effect on two personality resources needed to deal with lifes demands.

The occupational integration of former Soviet physicians in Israel.

This paper reports the findings of a five-year, three-stage study of the occupational status persistence of 333 physicians who immigrated to Israel from the former Soviet Union in 1990. The first data collection, by way of a structured questionnaire in Russian, was undertaken in 1991, during their participation in preparatory courses for the medical licensure examination. The second and third stages of data collection were undertaken by mail in 1993 and 1995. Data are presented regarding the influence of gender and age on employment status and on the relationship between employment status and psycho-social well-being, including work and general satisfaction, self-esteem, mood, health and overall adaptation, at both stages. The dynamics of occupational integration are investigated by looking at the effects of occupational stability vs occupational change between stage 2 and stage 3 on the psycho social outcome variables. After three years in Israel, men were more likely to be working as physicians than women, and women were more likely to be unemployed. However, after five years, women were equally likely to have found work in their profession, albeit in lower status positions. Younger respondents were more successful than older respondents in passing the licensure examination, finding work in their profession, and entering residency programs. The gap between them did not close between stage 2 and stage 3. At both stage 2 and stage 3, those working as physicians had significantly more positive well-being scores than those not working as physicians. All occupational groups had more positive scores at stage 3 than at stage 2, except for those who were working in non-medically related jobs. The greatest improvement in psycho-social well-being was among those who became physicians between stage 2 and stage 3, compared to those who were not physicians at either stage and those who were physicians at both stages.

A comparison of attitudes and practices of episiotomy among obstetrical practitioners in New Mexico

The routine use of episiotomy is a subject of considerable controversy. To delineate attitudes and practices, we surveyed various groups of obstetrical practitioners in New Mexico. Routine use was favored most by obstetricians, less by family practitioners, less yet by nurse midwives and least by lay midwives. Many of the reasons given both for and against routine use were the same, underscoring the lack of scientific data and prospective studies of episiotomy and its effects.

Interviewing and the Selection of Medical Students: the Experience of Five Years at Beersheba

Abstract The authors review and evaluate the literature on the interview and other tools for the selection of medical students. They explain the goals of the selection process, which relies on the interview as the critical element of selection in the medical school of the Ben Gurion University of the Negev in Beersheba, Israel. The focus is on three issues: Who are the interviewers? What is the precise nature of the interview? What is the role of the interview evaluation in the final selection of students?

Trait-Anxiety Differences among Medical Students

This study investigated the degree to which age, year of study, sex, and marital status predict trait anxiety, as measured by the State-Trait Anxiety Inventory, among 131 medical students in four classes of a six-year medical school. Univariate analysis showed men had lower trait-anxiety scores than women, and married students had lower scores than single students. Trait-anxiety declined with age and year of study. Multivariate analysis showed that sex was the best predictor of trait-anxiety among these students and that age was a significant predictor even when year of study was held constant. It is suggested that trait-anxiety declines with age among young adults as they successfully cope with the developmental challenges, including professional socialization, of this stage of life.

Identifying with the patient: an intensive programme for medical students

An intensive programme called ‘Hospitalization Week’ was developed at the medical school of the Ben‐Gurion University of the Negev in Israel. The main goal of the programme is to give first‐year medical students an opportunity to understand the complexity of the needs and problems of hospitalized patients. To achieve this goal each student accompanies two patients from their arrival at the emergency room throughout their stay in the hospital. The goals and methods of the programme are described and evaluated.