The impact of a health education course on maternal knowledge: a comparative study in a low socioeconomic rural region.

A comprehensive health education course was designed for mothers in West Bank villages, a relatively low socioeconomic population. The course focused on nutrition, hygiene, child development, and first aid. It was taught by specially trained local instructors in small classes characterized by an individualized teaching method. To evaluate the contribution of the course, the level of knowledge in topics taught in the course was tested. The test was personally administered by trained interviewers to 241 course participants and to a comparison group of 284 mothers who had not participated. As expected, participants demonstrated higher level of knowledge than nonparticipants, regardless of the time since having taken the course. The course seems to have contributed to all participants, but mostly to women of lower education. In a multiple linear regression the two most significant predictors of knowledge were course participation and level of maternal formal education.

PIP: A comprehensive health education course was designed for mothers in West Bank villages, a group of relatively low socioeconomic status. The course focused on nutrition, hygiene, child development, and first aid. It was taught by specially trained local instructors in small classes characterized by an individualized teaching method. To evaluate the contribution of the course, the level of knowledge in topics taught in the course was tested. The examination was administered by trained interviewers to 241 course participants and to a comparison group of 284 mothers who had not participated. As expected, participants demonstrated a higher level of knowledge than nonparticipants, regardless of the time since having taken the course. The course appears to have been useful for all participants,but mostly to those women with less education. In a multiple linear regression, the 2 most significant predictors of knowledge were course participation and level of maternal formal education.

[Routine breast examination and early detection of hypertension and diabetes mellitus by primary care physicians ].

Breast cancer is the leading cause of cancer mortality among women is Israel. On average, 1 in every 12 women develops the disease. While breast self-examination has not proved effective, and routine mass mammography is at present unavailable to the population at large, regular routine breast examination by primary care physicians can effectively screen a large fraction of this country's population. In order to do so, full acceptance of the procedure by women and their physicians is required. This study examines the attitudes and practice of primary care physicians with regard to routine breast examination, and compares them with routine detection of hypertension and diabetes mellitus. A structured questionnaire was distributed to all 97 Kupat Holim (workers' federation sick fund) primary care physicians in the Negev. They included 40 family physicians (FP), board-certified or completing specialization, and 57 general practitioners (GP), not board-certified. There was no difference in response rate between the 2 groups (47%). Nearly all physicians perform routine examinations for detection of hypertension (100% of the FP and 96% of the GP) and diabetes mellitus (91% and 74%, respectively). Of the FP, 96% consider routine breast examination as the task of the primary care physician, versus only 68% of the GP. Accordingly, 92% of the FP stated that they routinely perform the procedure, but only 52% of the GP. Being an FP was positively related with the performance of breast examination, while seeing a large number of patients per clinic session and low job satisfaction were negatively associated with it.

Infant feeding practices: an evaluation of the impact of a health education course.

We assessed the impact of a health education course on infant feeding practices in the West Bank territories by comparing mothers who had attended the course (n = 102) with mothers not exposed to the course (n = 133). After adjustment for child's age, maternal age and education, parity, and birth site, course participants were more likely than non-participants to breastfeed, as well as to start supplementation by semi-solid foods at the recommended time.

Autonomy, job satisfaction and professional self-image among nurses in the context of a physicians' strike.

This paper tests the hypothesis that structural changes in nurses' work settings, which allow nurses to autonomously exercise their knowledge and skills will lead not only to an enhanced feeling of professional autonomy, but also to an improvement in their professional self-image and to an increase in job satisfaction. An opportunity to test this hypothesis arose when physicians in Israel went on a strike which lasted 116 days. Primary care (PC) clinics were completely abandoned by physicians, leaving nurses to operate them on their own, while in hospitals, nurses continued to work as usual under physicians' supervision. The study compares the effect of the strike on head nurses in the two sectors. Data were collected by means of self administered questionnaires. The findings indicate that during the strike, PC head nurses expanded their activities and responsibilities and consequently felt more professional autonomy and job satisfaction, as well as an improvement in professional self-image. Hospital head nurses experienced significantly less changes in their work situation and, as expected, less change in all work related attitudes. It is suggested that, when given the opportunity to define for themselves roles where they can use their experience, knowledge and skills, senior nurses stand up to the challenge and consequently are more satisfied and their professional self-image improves.

Type A behavior pattern and health status after 22 years of follow-up in the Western Collaborative Group Study.

Type A/B behavior has been studied extensively as a risk factor for coronary heart disease. This study tests the hypothesis that Type A/B behavior is associated with ill health in general. All-cause mortality was examined in the original cohort of 3,154 men aged 39-59 years at baseline in the Western Collaborative Group Study in 1960-1961. Morbidity was examined in a group of 2,365 men aged 61-81 years who were surviving members of the cohort in 1982-1983 and who agreed to fill out a self-administered health status questionnaire. On the basis of these data, a three-level general morbidity index was constructed that included coronary heart disease and a number of other chronic conditions. Type A/B behavior was not significantly associated with all-cause mortality over the 22-year follow-up. However, among men 61-71 years of age, behavior type assessed at the baseline examination 22 years earlier (1960-1961) was positively associated with the morbidity index (p less than 0.001). Furthermore, behavior type and the morbidity index showed a dose-response association; extreme Type A personalities had the highest level of morbidity, while those with the fewest Type A characteristics had the lowest level of morbidity. This general pattern of association was not due to the presence of coronary heart disease or to any other particular disease condition in the morbidity index and did not change when an ordinal logistic regression model was used to control for other baseline risk variables. For the older men (aged 72-81 years), the pattern of association was similar but did not reach statistical significance. Thus, in a group of men over 60, a positive association was found between general morbidity status and Type A/B behavior measured over two decades earlier.

Maternal education as a modifier of the association between low birthweight and infant mortality.

Both low birthweight (LBW) and infant mortality rate (IMR) have been consistently shown to be associated with maternal level of educational attainment. This paper examines the mortality risk attributable to LBW in different levels of maternal education. Comprising the study population were 18,715 singleton live births to Jewish mothers ages 20-39, during the years 1977-1980 in the Negev (the southern part of Israel). Data were obtained from a linked record of birth and death certificates. As expected, proportions of LBW (less than 2500 grams) were inversely related to level of maternal education (12.2% in the lowest educational level, 7.9% and 8.0% in the two intermediate levels, and 7.2% in the highest educational level). The mortality risk attributed to LBW was found to be modified by maternal level of education. Mortality ratios standardized for maternal age and parity were computed, using educational level 3, where the lowest mortality rates were observed, as the standard population. Among LBW infants no significant differences were found across educational levels, except for the lowest educational level where only 69% of the expected number of deaths were observed. The survival advantage of LBW infants in the lowest educational level was observed both in the neonatal and the postneonatal periods. Among normal birthweight (NBW) infants, a statistically significant excess mortality was detected both in the highest and the lowest educational levels. The excess mortality of NBW infants in the highest level of maternal education was due to neonatal mortality (SMR = 2.2), while the excess mortality in this birthweight category in the lowest educational level occur mainly in the postneonatal period (SMR = 2.4).(ABSTRACT TRUNCATED AT 250 WORDS)