Are coping resources related to humoral reaction induced by academic stress? An analysis of specific salivary antibodies to Epstein-Barr virus and cytomegalovirus.

The aim of the present study was to investigate whether coping resources mediated the changes in Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) specific salivary antibodies caused by academic stress. Fifty-four first-year female students of nursing and physiotherapy completed pencil and paper written questionnaires and concurrently donated saliva samples. The instrument included the short version of the Sense of Coherence (SOC) scale, measures of social support, current health, health practices, the scale of psychological distress, and state anxiety questionnaire. Data and saliva samples were collected one month after the beginning of the first semester, during term examinations period and a month into the second semester. Statistically significant changes in the level of specific salivary EBV and HCMV antibodies were observed between the four study points. State anxiety and psychological distress were significantly associated with HCMV-specific salivary antibody level increase during examinations and its decrease after the stress was over. Coping resources, however, were not associated with changes in any of the antibodies studied.

Human cytomegalovirus salivary antibodies as related to stress.

Human cytomegalovirus (HCMV) is prevalent in 50-80% of the population worldwide. After primary infection it remains in a latent state until reactivation. Stressful events induce the release of corticosteroids which activate HCMV. The effect of examination stress on HCMV reactivation among first year female students was studied by detecting the values of HCMV specific salivary IgG and IgA antibodies before, during and after two important examinations. Hepatitis A virus (HAV) salivary antibodies served as a non-latent virus control. A statistically significant increase in the level of HCMV specific IgG and IgA antibodies was detected in saliva samples collected during the two examinations, as compared with the samples collected one month before them and two weeks after the grades were posted (p<0.05), whereas HAV antibody levels did not change significantly.

Epstein-Barr virus specific salivary antibodies as related to stress caused by examinations.

Epstein-Barr virus (EBV) is prevalent in 90% of the population. After primary infection it remains in a latent state and the majority of the virus carriers are asymptomatic during their life. Among the immunocompromized patients such as organ and bone marrow transplant recipients, individuals lacking T cell immunity, and patients treated with corticosteroid, cancer, and AIDS patients EBV primary infection and reactivation can cause life threatening diseases. Immunosupression may occur also during stressful events, which induce corticosteroid release and thus activate EBV. The effect of examination stress on EBV reactivation among female students was studied by detecting the values of EBV specific IgG and IgA salivary antibodies. Sequential saliva samples were obtained from first year female students before, during, and after two important examinations. EBV specific IgG and IgA salivary antibodies were tested by enzyme-linked immunosorbent assay (ELISA). Hepatitis A virus (HAV) salivary antibodies served as a non-latent virus control. A statistically significant increase in the values of EBV specific IgG and IgA antibodies was detected in samples collected during the examinations, as compared to the samples collected two months before and one month after the exams (P < 0.05). HAV antibody levels did not change significantly between the four time points. The menstrual cycle had no significant effect on the results. No significant symptoms were reported during the whole study. These results indicate that among female students who endure stress during academic examinations, a significant increase in EBV specific IgG and IgA salivary antibody values could be detected. EBV reactivation should be confirmed by measuring salivary EBV DNA or infectious virus.

Death rests a while: holy day and Sabbath effects on Jewish mortality in Israel.

The purpose of this study was to replicate and expand previous research examining the association between holy days and the timing of death. We analysed daily numbers of deaths of Jewish men and women aged 35 and above in Israel from 1983 to 1992, controlling for long term and seasonal trends. For all men, and for younger women (ages 35-74) there was a clear and significant dip-peak pattern in the number of deaths around the Sabbath (Saturday), but no consistent dip-peak pattern around other holy days. This pattern was found for all causes of death (particularly cerebro-vascular causes), was stronger for men than for women, and was not found among young Jewish children, or among the non-Jewish population.

Exploring the bio-psycho--social approach to premenstrual experiences.

A bio-psycho-social approach to the premenstrual syndrome suggests that cyclical hormonal changes are acknowledged and interpreted in light of the expectations and the attitudes acquired in the process of socialization. In this study, attitudes toward menstruation and premenstrual experiences of 229 Israeli students of different ethnic groups and gender role orientations were explored. The findings were consistent with previous reports: attitudes toward menstruation and premenstrual experiences were associated with exposure to premenstrual symptoms in women family members and negative messages during adolescence; respondents of a more traditional background perceived menstruation as relatively debilitating and bothersome but also a natural event and reported more severe experiences. However, models aimed at estimating the causal relationship indicated that attitudes toward menstruation depend on premenstrual experiences rather than predict them. The difficulties of investigating such reciprocal relationships of menstrual attitudes and premenstrual experiences cross-culturally and longitudinally are discussed.

"Remnants of feudalism"? Women's health and their utilization of health services in rural China.

Almost five decades ago, the Chinese Communist Party wished to abolish all "remnants of feudalism," including the patriarchal social order. Just one year after the revolution, the Marriage Law endorsed women's rights within the family, but no operative measures were taken to enforce it. Some of the economic reforms since independence even strengthened patrilocality and, possibly, patriarchal values. The purpose of this study was to explore the degree to which patrilocality served to maintain the traditional patriarchal stratification among women in the household by exploring women's health patterns and utilization of health services. Data were collected from 3859 women residing in rural Hebei, and variation in health and help seeking of six categories of relation to household head--mothers, wives, daughters, daughters-in-law, family heads, and other relatives--were explored. Utilization of health services is not dependent on women's position in the household, but primarily on per-capita income. Health patterns seem to indicate that mothers of the head of the household still have a considerable power to define their roles and share of household work. Women head of family, most of whom are married, appear to be under strain, which could be a result of their culturally "deviant" position. We conclude that old patriarchal values are intertwined with values of equality in current rural China.

The Israeli Patient's Rights Law: evidence for deprofessionalization?

In this paper, the Israeli Patient's Rights Law of 1996 is discussed within the framework of Haug's predicted process of deprofessionalization. It is argued that the law reflects global processes such as the diffusion of knowledge, consumerism, and values that emphasize human rights and democracy. By guaranteeing patients' access to medical information, by submitting medical decisions to extra-professional regulation, the law erodes professional power.

Surviving the holidays: gender differences in mortality in the context of three Moslem holidays.

"It was hypothesized that holy days may affect mortality patterns differentially by gender. The present study focused on Moslems in Israel.... After removing the long-term growth and the seasonal effects, women's mortality was found to be significantly greater in the month of Ramadan than in the month before, and in the two weeks before the feast of 'Id el-Adhha than in the two weeks after it. For men, mortality was higher in the two weeks after the feast of 'Id el-Fitr than in the two weeks before it."

The effects of replacing beta-blockers with an angiotensin converting enzyme inhibitor on the quality of life of hypertensive patients.

The aim was to evaluate the effects of a change of treatment from beta-blocker to captopril on the quality of life of hypertensive patients. One hundred forty-nine mild to moderate hypertensive patients who were being treated with beta-blockers were randomly assigned to receive captopril (12.5 to 50 mg twice daily), or to continue on beta-blocker treatment (atenolol: 25 to 100 mg once daily [n = 121], or propranolol, 10 to 80 mg twice daily [n = 12]). When required, 25 mg hydrochlorothiazide was added in each group. The patients were followed over periods ranging from 6 to 12 months. Blood pressure, treatment side effects, and quality of life were monitored. Blood pressure was equally well managed in both groups, though a lower level of treatment was required in the captopril group. The captopril treated patients exhibited favorable changes in several aspects of quality of life: sleep-related, gastrointestinal, and physical activity-related symptoms improved from baseline to end of follow-up. Drowsiness and the ability to concentrate significantly improved in the captopril group only (P <.01). Change in treatment from beta-blocker to captopril resulted in equally well controlled blood pressure on a lower drug dose. Moreover, the change to captopril had a positive impact on the quality of life.

Physical and psychological well-being among immigrant referrals to colonoscopy.

The association between immigration and well-being was studied in 2 groups of referrals to colonoscopy in the Negev region of Israel: Eastern Europe born (n = 278) and Israeli born (n = 70). The findings of this study suggest that the first 3 years after migration are associated with inferior physical and psychological well-being, and, to a lesser degree, with poorer family functioning and limited social interactions. The differences between immigrants and Israeli born tended to fade away as years went by, and the most veteran immigrants, those who immigrated more than 40 years prior to the study, scored best on most physical and psychological well-being indicators. Findings are discussed in terms of a life events approach and in terms of Israeli immigration regulations and absorption policy.

The effects of diuretics on quality of life of hypertensive patients.

OBJECTIVES: To study the effect of diuretics and diuretics discontinuation on the quality of life (QOL) of hypertensive patients. METHODS: 149 beta blocker treated mild to moderate hypertensive patients were included in the study. Seventy-three were treated by beta blockers (BB's) only and 60 by BB's and diuretics, for 40 patients diuretics was discontinued. Physical symptoms and QOL were assessed before and 9-15 months after the change in treatment. RESULTS: At baseline, subjects on diuretics experienced more gastrointestinal symptoms, weakness, and sex related problems; and their QOL was poorer. At the end of the follow-up, patients on diuretics scored poorest on physical strength items and on health perceptions; those who were never treated by diuretics scored best; and those who stopped were in between. CONCLUSIONS: Diuretics treatment adversely affect patients' QOL. Cessation of diuretics treatment for at least 9 months improved some aspects of patients' QOL, though those who never received diuretics were better of than others.

Responsibility taking and role definition in family practice: effect of training and practice setting.

There is evidence that family physicians (FPs) reduce health care costs by reducing patient referral to more expensive secondary and tertiary care facilities. Presumably, the effectiveness of FPs in meeting patients' needs is related to their role definition and willingness to assume responsibility. The purpose of this study was to determine the influence of training and practice setting on responsibility taking and role definition of FPs. A previously developed and validated self-administered questionnaire was completed by 153 certified FPs and FP residents from five departments of family practice in Israel. The main independent variables were previous training and practice setting. The main outcome measures were self-reported data on responsibility taking, role boundaries, and reported role performance. The results showed that certified FPs were more willing to assume responsibility, to define broader role boundaries, and to perform more specialized interventions than residents. Differences in practice setting affected only reported performance, with physicians who practice in rural clinics performing more specialized activities than those in urban clinics. Multiple regression analysis shows that professional development is associated with an increased willingness to assume responsibility; this willingness affects role boundaries definitions, which affects reported performance. Practice setting alters the tendency to perform a wider range of interventions, but does not affect physicians' attitudes.

Marital violence: comparing women in violent and nonviolent unions.

PIP: This study examined marital violence among Israeli Jews. Data were obtained from a sample of 161 women who gave birth at Soroka Medical Center in the Negev region of Israel in 1992. The literature reveals that Jewish families tolerate domestic violence if an "evil" woman refuses housework or shows no respect for her husband. It is believed that Jews do not beat their wives. This study explored the degree to which women accept as legitimate the gender division of authority and use of power. It is posited that women in violent marriages (VMs) tend to accept the traditional division of labor and authority and hold more tolerant attitudes toward VMs. It is posited that VMs may be less egalitarian and democratic. VMs may be maintained if women are emotionally dependent on husbands, have a lower self-image, and perceive their husbands more positively. The questionnaire asked about social background and resources, attitudes toward marital power and violence, power relations, self-image, conflict solving, and women's emotional dependency. 18% had 1 domestic violent episode. 8 factors explained 56% of the difference between VMs and non-VMs and 90% of the cases. Husbands tried to avoid conflict. Wives fought for their interests and used external resources when conflict occurred. Husbands were reluctant to share power. There were 2 distinct patterns: the battered women syndrome and the struggle for power. Marital conflict was associated, as in the American literature, with economic hardship, lack of collectiveness in the dyad, and the form of conflict solving tactics used by both spouses. Women in VMs had different attitudes toward husband control and were emotionally dependent on their husbands.^ieng

Referrals for alternative therapies.

BACKGROUND: The purpose of this study was to examine how allopathic physicians participate in the decision to refer patients for alternative therapies. METHODS: A pretested, self-administered, structured questionnaire was distributed simultaneously to all area physicians at community locations in Washington State, New Mexico, and southern Israel. The primary outcome measures were monthly and yearly rates of referral to alternative therapies. RESULTS: More than 60% of all physicians made referrals to alternative providers at least once in the preceding year and 38% in the preceding month. Referrals were generally based on patient requests, synergy between the alternative therapy and the patients' cultural beliefs, failure of conventional treatment, and the belief that patients have "nonorganic" or "psychological" disease. There was no relationship between the rate of referral and the referring physician's level of knowledge about, beliefs about the effectiveness of, or familiarity with alternative therapies. CONCLUSIONS: Primary care physicians are more likely than other medical specialists to be knowledgeable about, personally subscribe to, and refer patients for alternative therapies. Physicians who use alternative techniques for themselves and their families or who adopt complementary therapies into their practices have higher rates of referrals. Referral rates and patterns were similar between sites despite considerable cross-cultural and health system differences. Given the high rate of referral and the absence of an apparent internal logic for such recommendations, guidelines and physician education may be advisable.

Gender differences in health perceptions and their predictors.

This study explored the degree to which risks embedded in the social construction of gender roles and personality traits explained gender differences in health perceptions and reporting among mild hypertensive patients (134 women and 104 men) under the same treatment regime. Compared with men, women were less educated, less likely to be employed, less happy, more distressed, less satisfied with family functioning, and had a weaker sense of coherence. Twice as many women as men evaluated their health as 'poor', and on average reported 2.6 more symptoms than men. These gender differences largely disappeared when unhappiness, distress, and sense of coherence were controlled. While education attainment, employment, and satisfaction with family functioning decreased gender differences in some half of the symptoms, multivariate analysis suggested that unhappiness, distress, and the sense of coherence are far better predictors of gender differential health perceptions. It is suggested that beyond biological predispositions, women's health is in double jeopardy by gender role related risks, which affect morbidity both directly through immunology system and indirectly through health perceptions.

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.

The health of women married to men in regular army service: women who cannot afford to be ill.

The health, distress, and health services utilization of 44 women married to army men was compared to those of 53 women living in the same community. Army wives were found to have less access to health promoting and maintaining resources such as social support, employment, and the "sense of coherence." Although army wives' health is not significantly different from that of the controls, they visit the family physician with their children more often. It is suggested that women who are married to army men learn to cope with instability and with limited access to salutary factors, but the lay referral system is irreplaceable.

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 Antonovsky's theory about the positive influence of SOC on health. Separate analyses for men and women, however, show that while RLEs negatively affect women's 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.

Gender differences in the utilization of emergency department services.

Some of the suggested explanations of the well documented gender morbidity differences imply that these are not 'real' but the result of women's tendency to perceive and report more symptoms, to magnify symptom severity, and to seek help. To contribute to this debate, gender differences in utilization of a general hospital emergency department (ED), often used as a primary care service and for mild conditions, were studied. Data were collected from the general ED admissions registry for 6815 patients. In our data strikingly more men than women visited the ED during the period studied; generally, the same proportion of men and women were self-referred patients; and similar rates of both sexes were hospitalized regardless of type of referral. Thus, these findings suggest that, at least among ED patients, there is no gender differential in symptoms perception, evaluation, or presentation. Indications for these were somewhat found among young patients (aged 17-24) only. Alternatively, the findings with regard to this age group could reflect professional gender stereotyping at the primary care level.

Emergency department utilization: a comparative analysis of older-adults, old and old-old patients.

A comparative analysis of Emergency Department (ED) utilization by 2936 older-adults, old, and old-old patients was conducted in the only hospital available for residents of a vast geographical region. All patients (45+) who arrived at the ED during the first week of every even month from September 1986 to August 1987 were selected for the study. No significant differences were found among the three groups with regard to sociodemographic characteristics other than age. Data showed that the old-old use the ED approximately twice as much as the old and the older-adults; they also use the ED more often than the two other groups during the winter season. These two findings indicate the utility of viewing the old-old not only as a part of the elderly population, but also as a unique risk group. Hospitalization rates present a different pattern: they double in each age group moving from the youngest to the oldest. Complaints of an internal medicine nature are more often presented by the two groups of the elderly in comparison to the older-adults, and are followed by more frequent hospitalizations in internal medicine wards. Such findings have practical implications, and should be taken into consideration by policymakers.