Sara Carmel

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...

Use of the Functional Bowel Disorder Severity Index (FBDSI) in a study of patients with the irritable bowel syndrome and fibromyalgia

OBJECTIVE:The purpose of this study was to evaluate the utility of the Functional Bowel Disorder Severity Index (FBDSI) as a measure of severity of disease among patients with the irritable bowel syndrome (IBS) and matched controls.METHODS:A total of 75 IBS patients and 69 matched controls completed questionnaires on bowel symptoms, health status, quality of life, psychological distress, concerns, anxiety, and sense of coherence. All participants also were tested for fibromyalgia (FS), a functional disorder of the musculoskeletal system. All participants were administered a questionnaire that included the FBDSI. On the basis of their responses to the questionnaire, the controls were subdivided as healthy controls (n = 48) or IBS nonpatients (n = 21). On the basis of the FS classification, 75 IBS patients were subdivided as IBS only (n = 50) or IBS and FS combined (n = 25).RESULTS:The mean FBDSI score was higher for the IBS patients than the controls (100.5 ± 12.7 and 23.5 ± 3.9, respectively; p < 0.001). IBS nonpatients had an intermediate score of 42.3 ± 18.0. Patients with both IBS and fibromyalgia had the highest mean FBDSI score: 138.8 ± 31.5. There was no association between FBDSI and age or gender, but FBDSI was significantly associated with other measures of health status.CONCLUSIONS:An association was found between the FBDSI and IBS patient status: IBS nonpatients, patients with IBS only, and patients with both IBS and fibromyalgia had increasingly severe scores. The results provide support for the validity of FBDSI as a measure of illness severity in functional gastrointestinal disorders.

Life events, sense of coherence and health: Gender differences on the kibbutz

The effects of recently experienced life events (RLE) and of a personal coping resource--the sense of coherence (SOC)--on the health of men and women were investigated among members of two small and cohesive communities--two kibbutzim in Israel (n = 230). Results of analyses lend support to previous findings about the negative effects of life events on health, and to Antonovskys theory about the positive influence of SOC on health. Separate analyses for men and women, however, show that while RLEs negatively affect womens health, SOC has no significant counterbalancing effect on their health. Among men, an opposite pattern is found; their health is not affected by RLE, but is significantly affected by their SOC. Our findings lead to the conclusion that men and women are differentially affected by stressors and make different use of their coping resources. These findings should be taken into consideration in further research on stress, coping and health.

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.

Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study

PurposeThis study explored differences in end-of-life (EOL) decisions and respect for patient autonomy of religious members versus those only affiliated to that particular religion (affiliated is a member without strong religious feelings).MethodsIn 2005 structured questionnaires regarding EOL decisions were distributed in six European countries to ICUs in 142 hospital ICUs. This sub-study of the original data analyzed answers from Protestants, Catholics and Jews.ResultsA total of 304 physicians, 386 nurses, 248 patients and 330 family members were included in the study. Professionals wanted less treatment (ICU admission, CPR, ventilator treatment) than patients and family members. Religious respondents wanted more treatment and were more in favor of life prolongation, and they were less likely to want active euthanasia than those affiliated. Southern nurses and doctors favored euthanasia more than their Northern colleagues. Three quarters of doctors and nurses would respect a competent patient’s refusal of a potentially life-saving treatment. No differences were found between religious and affiliated professionals regarding patient’s autonomy. Inter-religious differences were detected, with Protestants most likely to follow competent patients’ wishes and the Jewish respondents least likely to do so, and Jewish professionals more frequently accepting patients’ wishes for futile treatment. However, these findings on autonomy were due to regional differences, not religious ones.ConclusionsHealth-care professionals, families and patients who are religious will frequently want more extensive treatment than affiliated individuals. Views on active euthanasia are influenced by both religion and region, whereas views on patient autonomy are apparently more influenced by region.

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.

Coping with Recent Life Events: The Interplay of Personal and Collective Resources

The importance of personal and collective resources in coping with recent life events was studied among 230 kibbutz members. The sense of coherence, a global life orientation that detects the ability to avoid stressors and to choose appropriate coping strategies and resources, represented personal resources. Collective resources, embedded in the social system to which one belongs, were measured by membership in a religious kibbutz, the kibbutz being viewed as a powerful, collective-coping resource by itself. Physical well-being, psychological distress, and functional limitations were used as outcome measures. Both types of resources have a salutogenic effect, but sense of coherence appears to be a better resource for avoiding the effect of recent life events and for moderating psychological distress and functional limitation after experiencing such events. The two types of resources have no additive effect, nor do they compensate for each other. Only one significant interaction was found, suggesting that the combination of the two resources is useful in avoiding functional limitation. It is also suggested that collective resources have a slight positive effect on personal resources, which, in turn, take over and become most valuable in coping with recent life events. When stress affects social functioning, these same personal resources facilitate the mobilization of whatever collective resources are available.

Recent Life Events, Religiosity, and Health: An Individual or Collective Effect

While recent life events (RLE) cause ill health and psychological distress, religiosity is positively associated with health. The adverse effect of RLE on health is usually explained in terms of stress theory; the positive religiosity-health association is explained by the nature of the religious network, or by the effect of religiosity on the internal environment of the individual. Using data collected from a sample (n = 230) of two Israeli kibbutzim, one religious and one non-religious, with similar ecology, demography, and social structure, the stress-deterrent effect of religiosity is studied. Self-administered questionnaires, including a list of RLE, five health measures, and five religiosity measures, were randomly distributed. Our findings show that whereas RLE adversely relate to health, belonging to a religious community counterbalances the negative health consequences of RLE. Individual religiosity (private praying, theodicity, and religious commitment) do not have the same stress-deterrent effect.

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?

Subjective evaluation of health in old age: the role of immigration status and social environment.

The study investigated the role of immigration status on self-rated health, general health, and well-being among elderly persons by comparing two groups of elderly persons who immigrated from Eastern European countries to Israel—veterans and new immigrants. It also examined the factors that explain self-rated health in both groups. Data for this study (n = 784) were taken from a study based on structured home interviews of a random sample of Israeli Jewish elderly (70+) conducted in 1994. The results show that the new immigrants are younger and have higher education than the veterans, but their economic status is lower and they have a lower percentage of men and married persons. The new immigrants also rank themselves lower than the veterans on a variety of measures of health and psycho-social well-being. It is suggested that the stress caused by immigration and factors related to the standard of living and health services in the countries of origin outweigh the relative advantage that the new immigrants have, in terms of age and education, in influencing their health and well-being. Self-rated health among the new immigrants is explained mainly by objective measures of health, economic status and a feeling of control over life, while among the veterans it is explained by these variables as well as by other psycho-social variables such as self-esteem and social support. These findings suggest careful analyses of subjective evaluations of health in different socio-cultural subgroups in society for theoretical reasons and for purposes of planning interventions directed to promote health and psycho-social well-being of elderly persons on the community level.