Julie Cwikel

CHANGES IN KNOWLEDGE, ATTITUDES, AND WORK PREFERENCES FOLLOWING COURSES IN GERONTOLOGY AMONG MEDICAL, NURSING, AND SOCIAL WORK STUDENTS

This study evaluated shortand long‐term effects of courses in gerontology and geriatrics on changes in knowledge, attitudes, and work preferences among medical, nursing, and social work students in...

Contentious issues in research on trafficked women working in the sex industry: Study design, ethics, and methodology

The trafficking of women and children for work in the globalized sex industry is a global social problem. Quality data is needed to provide a basis for legislation, policy, and programs, but first, numerous research design, ethical, and methodological problems must be addressed. Research design issues in studying women trafficked for sex work (WTSW) include how to (a) develop coalitions to fund and support research, (b) maintain a critical stance on prostitution, and therefore WTSW, (c) use multiple paradigms and methods to accurately reflect WTSWs reality, (d) present the purpose of the study, and (e) protect respondents’ identities. Ethical issues include (a) complications with informed consent procedures, (b) problematic access to WTSW, (c) loss of WTSW to follow‐up, (d) inability to intervene in illegal acts or human rights violations, and (e) the need to maintain trustworthiness as researchers. Methodological issues include (a) constructing representative samples, (b) managing media interest, and (c) handling incriminating materials about law enforcement and immigration.

Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations

BACKGROUND Women who work commercially in sex work (female sex workers [FSW]) are considered a high-risk group for sexually transmissible infections (STI), yet the level of reported pathogens varies in studies around the world. This study reviewed STI rates reported in 42 studies of FSW around the world published between 1995 and 2006 and analysed the trends and types of populations surveyed, emphasising difficult to access FSW populations. METHODS Studies were retrieved by PUBMED and other search engines and were included if two or more pathogens were studied and valid laboratory methods were reported. RESULTS The five most commonly assessed pathogens were Neisseria gonorrhea (prevalence 0.5-41.3), Chlamydia trachomatis (0.61-46.2), Treponema pallidum (syphilis; 1.5-60.5), HIV (0-76.6), and Trichomonas vaginalis (trichomoniasis; 0.11-51.0). Neisseria gonorrhea and C. trachomatis were the most commonly tested pathogens and high prevalence levels were found in diverse areas of the world. HIV was highly prevalent mostly in African countries. Although human papillomavirus infection was surveyed in few studies, prevalence rates were very high and its aetiological role in cervical cancer warrant its inclusion in future FSW monitoring. Hard-to-access FSW groups tended to have higher rates of STI. CONCLUSIONS The five most commonly detected pathogens correspond to those that are highly prevalent in the general population, however there is an urgent need to develop rapid testing diagnostics for all five pathogens to increase prevention and treatment, especially in outreach programs to the most vulnerable groups among FSW.

Women brothel workers and occupational health risks

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

Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care

ObjectivePrevalence rates of mental health problems in primary care vary according to population and the type of measure used. This study examined the prevalence of a full range of mental health problems, including sub-threshold diagnoses, and the socio-demographic risk factors for psychiatric disorders among a population with low out-of-pocket expenditures for medical care.MethodFour validated mental health assessment instruments, including the CIDI-SF, were administered to a sample of 976 users of primary care in Israel between the ages of 25–75 in eight clinics throughout the country. Prevalence estimates were obtained for seven psychiatric diagnoses, two “other mental health disorders” (somatization and disordered eating) and five sub-threshold conditions.ResultsThe most common types of morbidity were depression and disordered eating (20.6% and 15.0%, respectively), followed by somatization (11.8%) and general anxiety (11.2%). Among respondents, 31.1% had at least one psychiatric diagnosis, 24.3% had ‘other mental disorders’ and 15.5% had sub-threshold conditions. Panic attack, disordered eating and somatization, as well as a global measure of any psychiatric diagnosis were significantly more prevalent among women than men. Psychiatric diagnoses were also more common among those in the age group 45–64, with less education and insufficient income, the never married and separated/divorced and those not working. No significant differences were found between recent immigrants, veteran immigrants and Israeli-born, between Arab and Jewish Israelis or between secular or religious sectors of the population.ConclusionsThis study establishes the prevalence of the most common disorders in primary care including PTSD, somatization and disordered eating behaviors. The additional of other mental disorders suggests that a more accurate picture of mental disorders in primary care requires an expanded assessment procedure.

Spiraling Between Qualitative and Quantitative Data on Women's Health Behaviors: A Double Helix Model for Mixed Methods

A double helix spiral model is presented which demonstrates how to combine qualitative and quantitative methods of inquiry in an interactive fashion over time. Using findings on womens health behaviors (e.g., menstruation, breast-feeding, coping strategies), we show how qualitative and quantitative methods highlight the theory of knowledge acquisition in womens health decisions. A rich data set of 48 semistructured, in-depth ethnographic interviews with mother—daughter dyads from six ethnic groups (Israeli, European, North African, Former Soviet Union [FSU], American/Canadian, and Ethiopian), plus seven focus groups, provided the qualitative sources for analysis. This data set formed the basis of research questions used in a quantitative telephone survey of 302 Israeli women from the ages of 25 to 42 from four ethnic groups. We employed multiple cycles of data analysis from both data sets to produce a more detailed and multidimensional picture of womens health behavior decisions through a spiraling process.

The Physical and Psychosocial Health of Bedouin Arab Women of the Negev Area of Israel

This study examined the self-reported health status of Bedouin Arab women in relation to two salient features of current Bedouin Arab social mores: the emphasis on maintaining a high rate of fertility and the social acceptance of domestic violence. A quota sample of 202 Bedouin Arab women ranging in age from 22 to 75 were personally interviewed. Fortyeight percent of the women reported a lifetime exposure to physical violence, and 30% reported domestic violence that was associated with symptoms of poor mental health status and gynecological problems. Domestic violence was associated with a large number of children, and there is some indication that the level of domestic violence decreases during pregnancy.

Gait and activity in the elderly: implications for community falls-prevention and treatment programmes.

Falls are the major cause of accidents in the elderly. Falls result from the interaction of medical, psychosocial and age-related changes with environmental conditions. Since many of these factors are amenable to change, theoretically many falls are preventable. As part of a multi-method community fall prevention programme we developed a gait assessment method (ELGAM). We report here on the association between ELGAM parameters and measures of social and physical activity, tested among 36 elderly community-dwelling persons. Social and physical activity were associated with only some of the gait parameters (turning head while walking and walking speed). However, the findings about gait are consistent with other research based on larger samples, and some of the findings from intervention research. Together they suggest the importance of social and physical activity in fall prevention programmes.

Mechanisms of Psychosocial Effects on Health: The Role of Social Integration, Coping Style and Health Behavior

To analyze the mechanisms by which psychosocial factors affect health, this re search investigated social integration and indicators of coping style and their relation to health behaviors and health status. The analysis was conducted using the results of a 1977 survey of 854 household interviews from a multi-stage probability sample of adult residents of Washtenaw County, Michigan. Physical-health status was evaluated by two indices: Self-rated global health and self reports of chronic disability. Mental health was assessed with the Center for Epidemiologic Studies Depression Scale. Over all, the effects of the psychosocial factors were stronger for mental health than physi cal health. Social integration was shown to have direct effects on both physical and mental-health status. Internal locus of control was associated with lower levels of de pressive symptoms. Chronic conditions were primarily affected by age, sex, and health behavior. Evidence from the path analyses suggested that part of the health benefit that women accrue from social integration and an active coping style is related to better health behavior. This mediation effect was not found for men.

The effectiveness of a training method using self-modeling webcam photos for reducing musculoskeletal risk among office workers using computers

An intervention study was conducted to examine the effectiveness of an innovative self-modeling photo-training method for reducing musculoskeletal risk among office workers using computers. Sixty workers were randomly assigned to either: 1) a control group; 2) an office training group that received personal, ergonomic training and workstation adjustments or 3) a photo-training group that received both office training and an automatic frequent-feedback system that displayed on the computer screen a photo of the workers current sitting posture together with the correct posture photo taken earlier during office training. Musculoskeletal risk was evaluated using the Rapid Upper Limb Assessment (RULA) method before, during and after the six weeks intervention. Both training methods provided effective short-term posture improvement; however, sustained improvement was only attained with the photo-training method. Both interventions had a greater effect on older workers and on workers suffering more musculoskeletal pain. The photo-training method had a greater positive effect on women than on men.