Saralee Glasser

Postpartum depression in an Israeli cohort: demographic, psychosocial and medical risk factors.

Demographic, psychosocial and medical risk factors for postpartum depression (PPD) were studied prospectively in a community cohort of 288 Israeli women. An Edinburgh Postnatal Depression Scale score of > 10 at 6 weeks postpartum was the criterion for PPD. Psychosocial risk factors were found to be the most potent Lack of social support, marital disharmony, depressive symptoms during pregnancy, history of emotional problems and prolonged infant health problems were most predictive of PPD. The major role of psychosocial factors in PPD was similar to that found in other countries. The results were somewhat different for new Russian immigrants. These findings indicate that early identification of women at risk for PPD is feasible, and that consideration should be taken of subgroups that may be at heightened risk, or for whom risk factors play different roles.

Epidemiology of suicide in Israel: a nationwide population study.

Abstract  Background: In Israel, some population characteristics and lifestyle patterns make epidemiological research on suicide of particular interest. The Israeli population is characterized by ethnic diversity, with a multi-religious, multi-national mosaic of Jews and Arabs. These subgroups also vary in their suicidal behavior. The aims of the present study were to examine the trends in suicide incidence rates in Israel from 1984 to 1994, to identify sub-populations at high risk for suicide and to identify suicide methods associated with increased risk. Methods: Suicide rate trends in Israel over the period from 1984 to 1994 were examined for four subgroups: Jewish men and women, and Arab men and women. Cases of undetermined external cause (UEC) of death were also considered. Mortality data were obtained from the computerized data files of the Israeli Central Bureau of Statistics, which includes cause of death and sociodemographic variables. Suicide was classified according to the ICD-9 codes. Results: Suicide rates were higher for Jews than for Arabs, and higher for men than for women. The rates among both population and sex groups increased directly with age. A significant increase over the years studied was found for Jewish men, particularly in the 18- to 21-year-old age group. An increase in the use of firearms was noted, mainly in the groups in which total suicide rates increased. Conclusions: The findings of this study highlight the need for further studies to identify both sub-populations at high risk for suicide, and societal trends such as lifestyles, immigration, military service, and media exposure to violence, as first steps toward planning of intervention programs to reduce suicide rates.

Prenatal stress and risk of spontaneous abortion.

Objective The aim of this study was to evaluate the association between exposure to life-threatening rocket attacks and spontaneous abortions (SAs). Study Design This is a historical cohort study comparing 1345 pregnancies of female residents of a town exposed to rocket attacks with 2143 pregnancies of female residents of an unexposed town. Demographic and medical data were obtained from hospital records and exposure information from official local databases. Intensity of exposure was calculated for preconception and pregnancy periods. Results Compared with unexposed group, women in the exposed group had higher rates of SA (6.9% versus 4.7%, adjusted odds ratio = 1.59, 95% confidence interval = 1.17–2.2, p = .003). Intensity of preconception and pregnancy exposure were nonlinearly associated with SA risk; both the highest and the lowest quintiles of exposure were associated with increased risk of SA. Conclusions Stress during preconception and pregnancy was associated with increased risk of SA.

The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer

This experimental prospective quasi-randomized study examining the impact of a medical clowning encounter after embryo transfer (ET) after in vitro fertilization (IVF) found that the pregnancy rate in the intervention group was 36.4%, compared with 20.2% in the control group (adjusted odds ratio, 2.67; 95% confidence interval, 1.36-5.24). Medical clowning as an adjunct to IVF-ET may have a beneficial effect on pregnancy rates and deserves further investigation.

Fetal sex modifies effects of prenatal stress exposure and adverse birth outcomes

Abstract Prenatal maternal stress is associated with pregnancy complications, poor fetal development and poor birth outcomes. Fetal sex has also been shown to affect the course of pregnancy and its outcomes. The aim of this study was to evaluate whether fetal sex modifies the association between continuous exposure to life-threatening rocket attack alarms and adverse pregnancy outcomes. A retrospective cohort study was conducted in which the exposed group was comprised of 1846 women exposed to rocket-attack alarms before and during pregnancy. The unexposed group, with similar sociodemographic characteristics, delivered during the same period of time at the same medical center, but resided out of rocket-attack range. Multivariable models for each gender separately, controlling for possible confounders, evaluated the risk associated with exposure for preterm births (PTB), low birthweight (LBW), small for gestational age and small head circumference (HC). In both univariable and multivariable analyses exposure status was a significant risk factor in female fetuses only: PTB (adj. OR = 1.43; 1.04–1.96), LBW (adj. OR = 1.41; 1.02–1.95) and HC < 31 cm (adj. OR = 1.78; 1.11–2.88). In addition, regarding all adverse outcomes, the male-to-female ratio was higher in the exposed group than in the unexposed group. The findings support the hypothesis that male and female fetuses respond differentially to chronic maternal stress.

Primiparity at Very Advanced Maternal Age (≥45 years)

This study describes maternal and birth outcomes of primiparae aged ≥ 45. High rates of pregnancy complications and poor birth outcomes were found, stressing that the personal risks and ramifications to the health system should be taken into account in establishing obstetric health policy regarding primiparity at advanced maternal age.

Postpartum depression among Israeli Bedouin women

Postpartum depression (PPD) is a common complication of childbirth with prevalence estimated at 10–20% reported in many countries, including Israel. However, no data has been reported for Israeli Bedouin women, whose lifestyle is significantly different from that of the general population. This study aimed to determine the prevalence of PPD among Bedouin women in the southern Negev. The study included 104 women attending public health clinics for pregnancy and postpartum care. PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). The rate of PPD symptoms was 43% at the EPDS cut-off score of 10, and 26% at the more stringent cut-off score of 13. This rate is considerably higher than reported rates among Israeli Jewish women. No significant difference was found between a score of ≥10 and maternal age, number of children, or level of education; however, at the EPDS score of ≥13, there was an inverse relationship between educational level and PPD symptoms. Lower rates were found among women whose pregnancies were planned and those who worked out of the home. The high rate of PPD among these Israeli Bedouin women challenges health authorities to find ways minimize the negative consequences for themselves, their children, and families.

Psychometric properties of the hebrew translation of the patient activation measure (PAM-13).

Objective “Patient activation” reflects involvement in managing ones health. This cross-sectional study assessed the psychometric properties of the Hebrew translation (PAM-H) of the PAM-13. Methods A nationally representative sample of 203 Hebrew-speaking Israeli adults answered the PAM-H, PHQ-9 depression scale, SF-12, and Self-efficacy Scale via telephone. Results Mean PAM-H scores were 70.7±15.4. Rasch analysis indicated that the PAM-H is a good measure of activation. There were no differences in PAM-H scores based on gender, age or education. Subjects with chronic disease scored lower than those without. Scores correlated with the Self-efficacy Scale (0.47), Total SF-12 (0.39) and PHQ-9 (−0.35, P<0.0001), indicating concurrent validity. Discriminant validity was reflected by a significant difference in the mean PAM-H score of those who scored below 10 (72.1±14.8) on the PHQ-9 (not depressed) compared to those scoring ≥10 (i.e. probable depression) (59.2±15.8; t 3.75; P = 0.001). Conclusion The PAM-H psychometric properties indicate its usefulness with the Hebrew-speaking Israeli population. Practice Implications PAM-H can be useful for assessing programs aimed at effecting changes in patient compliance, health behaviors, etc. Researchers in Israel should use a single translation of the PAM-13 so that findings can be compared, increasing understanding of patient activation.

The association between prenatal maternal objective stress, perceived stress, preterm birth and low birthweight

Abstract Objective: To evaluate the association between prenatal maternal stress, preterm birth (PTB) and low birthweight (LBW). Methods: Forty-seven women exposed to life-threatening rocket attacks during pregnancy were compared to 78 unexposed women. Women were interviewed within 9 months of delivery regarding socio-demographic background, smoking and perceived level of stress prenatally. Clinical data was obtained from hospital records and information regarding rocket attacks was obtained from official local authorities. Results: Women exposed to rocket attacks during the second trimester of pregnancy were more likely to deliver LBW infants than were unexposed women (14.9% versus 3.3%, p = 0.03). No association was found between stress exposure and PTB. A multivariate logistic regression revealed that every 100 alarm increment increased the risk of LBW by 1.97 (adj.OR = 1.97, 95%CI 1.05–3.7). Perceived stress was not associated with LBW. Conclusions: Exposure to rocket attacks during the second trimester of pregnancy was associated with LBW. Objective stress can be used as an indicator of stress. Further studies are required to understand the underlying mechanism.

Exposure to life‐threatening stressful situations and the risk of preterm birth and low birth weight

To evaluate the association between exposure to life‐threatening rocket attacks and the risks of preterm birth (PTB) and low birth weight (LBW).